Brain Tumors: Gliomas and Glioblastoma (How Modern Treatment Decisions Are Made)

Brain tumors can be especially intimidating because the brain is delicate, symptoms are scary, and treatment plans often involve multiple specialists. This guide explains the big categories, why molecular testing matters, and what treatment typically includes.

Important: This is educational information, not medical advice. Brain tumor care is highly individualized based on tumor type, molecular features, location, symptoms, and overall health.

60-second orientation

“Brain tumor” is not one disease. A major group is gliomas (tumors arising from glial cells).
Molecular testing (tumor genetics) strongly influences how gliomas are classified and treated.
Treatment often includes:
- surgery (maximal safe removal),
- radiation therapy,
- and systemic therapy (often chemotherapy; targeted therapy may apply for certain subtypes).
Glioblastoma is the most aggressive common primary brain tumor and usually requires urgent, multi-step care.

Key terms (defined once)

Glioma: a broad category of brain tumors.
Glioblastoma (GBM): an aggressive high-grade glioma.
Grade: how abnormal/aggressive tumor cells look under a microscope; higher grade usually means faster-growing.
Molecular testing: lab testing of tumor DNA/RNA to classify the tumor and identify targets.
Maximal safe resection: removing as much tumor as possible without causing unacceptable neurologic harm.

Step 1: the diagnosis is “type + grade + molecular features”

Two people may both be told “glioma,” but treatment can differ a lot based on:

grade (lower vs higher)
molecular features (which define major subtypes)

Ask your team:

“What type and grade is this?”
“What molecular features were tested, and what subtype does that make it?”

Step 2: treatment usually starts with surgery (when possible)

Surgery

Goals of surgery can include:

confirming diagnosis (getting tissue)
reducing tumor burden (which can help symptoms and improve outcomes)
making subsequent therapy more effective

Not all tumors are safely operable, depending on location.

Step 3: radiation and systemic therapy (common patterns)

Many glioma plans include:

radiation therapy to control tumor locally
chemotherapy (often a key systemic tool)
additional therapies depending on tumor subtype, grade, and response

For aggressive tumors like glioblastoma, treatment tends to move quickly and involves planned steps.

What’s changing now (the themes)

More precise classification of gliomas using molecular features (this changes prognosis discussions and treatment planning).
Targeted therapy in selected subtypes is becoming more meaningful.
Continued research on immunotherapy, vaccines, and novel delivery methods—some promising, but many approaches are still in trials.

A useful framing:

Some advances are already standard for certain molecular subtypes.
Other advances are “on the horizon” and may be accessed through clinical trials.

Questions to ask your care team (high value)

What is the exact tumor type and grade?
What molecular features were tested, and what subtype does that make it?
Is surgery recommended, and what does “maximal safe resection” mean for my tumor location?
What is the goal right now (cure attempt vs control), and what outcomes are realistic for my subtype?
What therapies are planned after surgery (radiation, chemotherapy, others)?
How will symptoms be managed during treatment (seizures, swelling, headaches, fatigue)?
Should I consider a second opinion at a specialized brain tumor center?
Are there clinical trials appropriate for my subtype?