Glioblastoma and utilisation of 5-ALA technology by Dr Mazarakis.

Glioblastoma is a malignant brain tumour that grows particularly rapidly and aggressively, requiring immediate medical intervention. Below, we explain in simple terms what it is, what symptoms it causes, and how it is treated.

What exactly is glioblastoma?

It is a primary tumour, meaning it originates from the brain's own cells and is not a metastasis from another organ. It arises from cells called astrocytes and belongs to high-grade gliomas (grade 4 according to WHO), which means is highly aggressive and grows quickly.​

What symptoms might it cause?

Common symptoms include persistent headaches, nausea, vomiting, and drowsiness, due to increased pressure inside the skull. It may also cause epileptic seizures, weakness in an arm or leg, difficulty speaking or understanding, memory disturbances, and changes in behaviour or personality, depending on the tumour's location.​

How is it diagnosed?

Diagnosis begins with a neurological examination and magnetic resonance imaging (MRI) of the brain with contrast, which shows the tumour's position and extent. The definitive diagnosis is made via biopsy or analysis of the tissue removed during surgery, where the pathologist examines the cells under a microscope.​

Treatment options

The key step is surgery, aiming to remove as much of the tumour as possible without causing serious neurological damage. After the operation, a combination of radiotherapy and chemotherapy usually follows, while in selected cases, newer, more targeted therapies or participation in clinical trials may be discussed.​

What does a glioblastoma diagnosis mean for the patient and their family?

Glioblastoma remains a very serious and challenging disease, but proper and organised management by a specialised multidisciplinary team can improve quality of life and survival duration. Psychological support, proper information, and close collaboration with the treating neurosurgeon and oncologist help the patient and family make calmer and better-informed decisions about the course of treatment.​

Dr Mazarakis is certified in the use of 5-ALA (5-aminolevulinic acid), which is used in glioblastoma resection surgery to help neurosurgeons identify and remove more tumour tissue accurately.

Photo resource: Maharita AR and Izzuna MMG. 5-Aminolevulinic Acid (5 ALA) for Brain Tumour Surgical Procedure. Technology Review. Ministry of Health Malaysia: Malaysian Health Technology Assessment Section (MaHTAS); 2021. 83 p. Report No.: 002/2021

How does 5-ALA work?​

A few hours before surgery, the patient takes an oral solution of 5-ALA, which is absorbed by the malignant glioblastoma cells. The cancer cells then produce a fluorescent substance (PpIX), which glows pink-red under a special blue light of the surgical microscope, whereas healthy cells do not fluoresce. In this way, more accurate identification of abnormal tissue and a more complete surgical removal of the tumour become possible.​

What are the advantages of surgery using 5-ALA?​

• It improves prognosis, as a greater extent of tumour resection is associated with longer progression-free survival.

• It is particularly useful in glioblastomas with irregular borders or superficial components that are not clearly visible on imaging.

• It is compatible with neuronavigation systems and intraoperative imaging, thereby increasing safety.​

For any information, clarification, or request for case evaluation, please contact Dr Mazarakis directly on 6975400064.​