Glioma
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Glioma is a type of tumor that occurs in the brain and spinal cord.
The brain tissue is primarily made up of cells responsible for transmitting impulses, known as nerve cells or neurons. Interestingly, the most abundant group of cells in the brain is referred to as ‘glial’ cells, which provide support and nourishment to the nerve cells. Among these glial cells, the most common type is the astrocyte, and tumors originating from astrocytes are termed astrocytomas. Other types of glial cells include Oligodendroglia (tumors arising from these are called oligodendrogliomas) and ependymal cells (tumors arising from these are referred to as ependymomas). Collectively, tumors originating from any of these three cell types are broadly termed gliomas.
Types
Causes
Symptoms
Diagnosis
Complications
Types
Three types of glial cells can produce tumors. Gliomas are classified according to the type of glial cell involved in the tumor, as well as the tumor’s genetic features, which can help predict how the tumor will behave over time and the treatments most likely to work.
Types of glioma include:
- Astrocytomas, including astrocytoma, anaplastic astrocytoma and glioblastoma
- Ependymomas, including anaplastic ependymoma, myxopapillary ependymoma and subependymoma
- Oligodendrogliomas, including oligodendroglioma, anaplastic oligodendroglioma and anaplastic oligoastrocytoma
A glioma can affect your brain function and be life-threatening depending on its location and rate of growth.
Gliomas are one of the most common types of primary brain tumors.
Causes
Like most primary brain tumors, the exact cause of gliomas is not known. But there are some factors that may increase your risk of a brain tumor. Risk factors include:
- Your age. Your risk of a brain tumor increases as you age. Gliomas are most common in adults between ages 45 and 65 years old. However, a brain tumor can occur at any age. Certain types of gliomas, such as ependymomas and pilocytic astrocytomas, are more common in children and young adults.
- Exposure to radiation. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
- Family history of glioma. It’s rare for glioma to run in families. But having a family history of glioma can double the risk of developing it. Some genes have been weakly associated with glioma, but more study is needed to confirm a link between these genetic variations and brain tumors.
Symptoms
The symptoms of glioma vary by tumor type as well as the tumor’s size, location and rate of growth.
Common signs and symptoms of gliomas include:
- Headache
- Nausea or vomiting
- Confusion or a decline in brain function
- Memory loss
- Personality changes or irritability
- Difficulty with balance
- Urinary incontinence
- Vision problems, such as blurred vision, double vision or loss of peripheral vision
- Speech difficulties
- Seizures, especially in someone without a history of seizures
Diagnosis
- A neurological exam. During a neurological exam, your doctor may check your vision, hearing, balance, coordination, strength and reflexes. Problems in one or more of these areas may provide clues about the part of your brain that could be affected by a brain tumor.
Imaging tests. Magnetic resonance imaging (MRI) is often used to help diagnose brain tumors. In some cases, a dye (contrast material) may be injected through a vein in your arm during your MRI study to help show differences in brain tissue.
A number of specialized MRI scan components — including functional MRI, perfusion MRI and magnetic resonance spectroscopy — may help your doctor evaluate the tumor and plan treatment.
Other imaging tests may include computerized tomography (CT) scan and positron emission tomography (PET).
- Tests to find cancer in other parts of your body. To rule out other types of brain tumors that may have spread from other parts of the body, your doctor may recommend tests and procedures to determine where the cancer originated. Gliomas originate within the brain and are not the result of cancer that has spread (metastasized) from elsewhere.
- Collecting and testing a sample of abnormal tissue (biopsy). Depending on the location of the glioma, a biopsy may be performed with a needle before treatment or as part of an operation to remove the brain tumor.
A stereotactic needle biopsy may be done for gliomas in hard-to-reach areas or very sensitive areas within your brain that might be damaged by a more extensive operation. During a stereotactic needle biopsy, your neurosurgeon drills a small hole into your skull. A thin needle is then inserted through the hole. Tissue is removed through the needle, which is frequently guided by CT or MRI scanning. The biopsy sample is then analyzed under a microscope to determine if it’s cancerous or benign. A biopsy is the only way to definitively diagnose a brain tumor and give a prognosis to guide treatment decisions. Based on this information, a doctor who specializes in diagnosing cancer and other tissue abnormalities (pathologist) can determine the grade or stage of a brain tumor.
The pathologist will also examine the physical appearance and growth rate of your biopsy sample (molecular diagnosis). Your doctor will explain the pathologist’s findings to you. This information helps guide decision-making about your treatment plan.
Complications
Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech, or eyesight
Seizures
Problems after surgery, such as infection or bleeding, and problems with general anesthesia
Infection and bleeding from chemotherapy
Delayed growth and development
Learning problems
Problems having children in the future (infertility)
Return of the cancer
Growth of other cancers
Treatment of Glioma
Treatment for glioma depends on the type, size, grade and location of the tumor, as well as your age, overall health and preferences. In addition to actions to remove the tumor itself, treatment for glioma may also require using drugs to reduce the signs and symptoms of your tumor. Your doctor may prescribe steroids to reduce swelling and relieve pressure on affected areas of the brain. Anti-epileptic drugs may be used to control seizures.
Innovative treatments
Brain cancer research is a very active field of study. Researchers are investigating new ways to deliver drugs to brain tumors, including pumps that release a continuous, slow flow of chemotherapy or targeted drug therapies to a tumor. This type of treatment is called convection-enhanced delivery (CED). Another type of therapy uses technology called tumor treating fields (Optune) to deliver electric fields to the brain, which can help stop the proliferation of cancer cells. Optune is a wearable, portable device and is used in combination with temozolomide to treat newly diagnosed glioblastoma in adults.
Implanted, biodegradable wafer therapy (Gliadel) relies on an implanted disc to release chemotherapy to tumor tissue that remains after surgery. And in nanoparticle therapy, particles with an unusually high surface area carry chemotherapy across the blood-brain barrier directly to a tumor
Surgery
Chemotherapy
Radiotherapy
Steroids
Others
Surgery
Surgery is the first step for the treatment of gliomaa, as it provides two important benefits: First, it procures tumor tissue to establish a diagnosis. Secondly, it offers the possibility to remove as much tumor is safely possible to relieve mass effect, reduce swelling and facilitate response to adjuvant therapies, when indicated. The decision whether to perform a simple biopsy or a full resection depends on multiple factors, but particularly on the clinical and medical conditions of the patient, as well as the predicted extent of resectability of the tumor.
Important tools to maximize efficiency and safety of surgery are:
- Neuronavigation: it is, in essence, a GPS system for the brain, and allows the surgeon to visualize in real time on the MRI his/her localization within the patient’s brain. This significantly increases precision and minimizes the risk of injuring normal brain.
- Awake surgery: This technique is particularly useful to resect tumors located in speech areas, and also when close to primary motor cortex bilaterally. The patient is kept sedated but not intubated, so that he/she can speak and execute commands when asked to. In this way, the surgeon can continuously asses the patient’s functions while removing the tumor.
- Motor mapping during general anesthesia: The regions of the brain controlling movement can be also stimulated with an electrode even if the patient is asleep. A stimulator is used to apply currents directly to the brain cortex, and muscle responses are recorded. Positive responses are interpreted as brain structures that should be spared from resection.
- Fluorescent dyes: Tumors, particularly those of higher grade, have the characteristic to avidly absorb certain dyes that are given IV to the patient just before surgery. In this way, the tumor tissue becomes colored by the specific dye, while the normal brain does not. This allows a much more precise definition of what should be resected and what should be left untouched. Among the most reliable dyes are 5-ALA, which colors the tumor violet, and Fluoresceine, which colors the tumor yellow, when visualized with appropriate lenses.
Chemotherapy
Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken in pill form (orally) or injected into a vein (intravenously).
Chemotherapy is usually used in combination with radiation therapy to treat gliomas. The chemotherapy drug used most often to treat gliomas is temozolomide (Temodar), which is taken as a pill.
Side effects of chemotherapy depend on the type and dose of drugs you receive. Common side effects include nausea and vomiting, headache, hair loss, fever, and weakness. Some side effects may be managed with medication.
Radiotherapy
Radiation therapy usually follows surgery in treatment of glioma, especially high-grade gliomas. Radiation uses high-energy beams, such as X-rays or protons, to kill tumor cells. Radiation therapy for glioma comes from a machine outside your body (external beam radiation).
There are several types of external beam radiation currently used and under study for the treatment of glioma. The type of glioma you have, its grade and other prognostic factors are considered in determining the timing and type of radiation therapy you may receive. A doctor who specializes in radiation therapy for cancer (radiation oncologist) will work closely with your other doctors to plan and coordinate the most appropriate radiation treatment for you.
Radiation therapy options include:
- Using computers to pinpoint delivery of radiation treatment to the exact location of the brain tumor. Techniques include intensity-modulated radiation therapy and 3D conformal radiation therapy.
- Using protons — the positive parts of atoms — rather than X-rays as the source of radiation. This technique, called conformal proton beam therapy, delivers radiation only once proton beams reach the tumor, causing less damage than X-rays to surrounding tissue.
- Using multiple beams of radiation to give a highly focused form of radiation treatment. While this technique is called stereotactic radiation therapy (radiosurgery), it doesn’t actually involve surgery in the traditional sense. Each beam of radiation isn’t particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells in a very small area.
There are different types of technology used in radiosurgery to deliver radiation to treat brain tumors, such as a Gamma Knife or linear accelerator (LINAC).
Side effects of radiation therapy depend on the type and dose of radiation you receive. Common side effects during or immediately following radiation include fatigue, headaches and scalp irritation.
Steroids
Steroid Dexamethasone is the preferred medication for alleviating symptoms related to brain swelling associated with the tumor. While highly effective in providing quick relief, it does not have a direct impact on the tumor. Prolonged use, beyond 2-3 weeks, may lead to notable side effects such as weight gain, elevated blood sugars, hypertension, increased infection risk, and irritability.
Others
- Bevacizumab is a drug that hinders the tumor’s ability to recruit blood vessels, impeding their growth. While effective in reducing tumor-related swelling and improving symptoms, it doesn’t significantly prolong survival, setting it apart from radiation and TMZ. It serves as a potent alternative to steroids.
