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Glioma Brain Tumors

 

                

What is a glioma brain tumor?

A glioma is a type of brain tumor that grows from glial cells. Glial cells support neurons with energy and nutrients and help maintain the blood-brain barrier. There are various types of glial cells, each with different function:

  • Astrocyte – transports nutrients and holds neurons in place
  • Oligodendrocyte – provides insulation (myelin) to neurons
  • Microglia – digests dead neurons and pathogens
  • Ependymal cells – line the ventricles and secrete cerebrospinal fluid

Glioma is an umbrella term used to describe the different types of glial tumors: astrocytoma, oligodendroglioma, and glioblastoma. Gliomas vary in their aggressiveness, or malignancy. Some are slow-growing and are likely to be curable. Others are fast-growing, invasive, difficult to treat, and are likely to recur. 

What are symptoms of a glioma brain tumor?

Symptoms of a glioma are related to the location of the brain in which they occur and may include:

  • Headaches
  • Numbness
  • Weakness
  • Personality changes
  • Confusion
  • Seizures

How is a glioma brain tumor diagnosed?

If a patient has symptoms that suggest a glioma, the physician will work with a team of specialists to confirm the diagnosis. Your team may include a neurosurgeon, oncologist, radiation oncologist, radiologist, neurologist, and neuro-ophthalmologist. 

The doctor will conduct a neurological examination and order CT and/or MRI scans. These imaging tests can help determine the size, location, and type of tumor.

If a diagnosis cannot be made clearly from the scans, a biopsy may be performed to determine what type of tumor is present. A biopsy is a procedure to remove a small amount of tumor cells to be examined by a pathologist under a microscope. A biopsy can be taken as part of an open surgical procedure to remove the tumor or as a separate diagnostic procedure, know as a needle biopsy. The burr hole is drilled in the skull so that a hallow needle can be guided into the tumor and a tissue sample removed.

What are treatment options for a glioma brain tumor?

Treatment options vary depending on the cell types, grade, size and location of the tumor. The goal of treatment may be curative or may focus on relieving symptoms (palliative care). Treatments are often used in combination with one another.

Gliomas are graded by the cell activity and aggressiveness on a scale of I to IV.

Grade I – Pilocytic astrocytoma: typically occurs in children in the cerebellum or brainstem, and occasionally in the cerebral hemispheres. It can occur in adults, but less commonly. Grade I gliomas are slow growing and relatively benign. Treatment options include:

  • Observation
  • Surgery
  • Radiation

Grade II – Low-grade glioma: includes astrocytoma, oligodendroglioma, and mixed oligoastrocytoma. Grade II gliomas typically occur in young adults (20s - 50s) and are most often found in the cerebral hemispheres. Dur to the infiltrative nature of these tumors, recurrences may occur. Some grade II gliomas recur and evolve into more aggressive tumors (grade III or IV). Treatment options include:

  • Observation
  • Surgery
  • Radiation
  • Chemotherapy

Grade III – Malignant glioma: include anaplastic astrocytoma, anaplastic oligodendroglioma, and anaplastic mixed oligoastrocytoma. Grade III tumors grow faster and more aggressively than grade II astrocytomas. They invade nearby brain tissue with tentacle-like projections, making complete surgical removal more difficult. Patients often present with seizures, neurological deficits, headaches, or changes in mental status. Treatment options include:

  • Observation
  • Surgery
  • Radiation
  • Chemotherapy
  • Recurrence is common for most patients, and typically occurs at the site of the initial tumor, usually within 2 cm. Treatment of recurrences can include additional surgery, radiation, chemotherapy or combinations.

Grade IV – Glioblastoma multiforme (GBM): is a malignant glioma. GBM is the most aggressive and most common primary brain tumor. Glioblastoma multiforme usually spreads quickly and invades other parts of the brain, with tentacle-like projections, making complete surgical removal more difficult. It is common for GBMs to recur after initial treatment. Treatment options include:

  • Observation
  • Surgery
  • Radiation
  • Chemotherapy
  • Recurrence is common for most patients, and typically occurs at the site of the initial tumor, usually within 2 cm. Treatment of recurrences can include additional surgery, radiation, chemotherapy or combinations.

Are there clinical trials for glioma brain tumors?

Clinical trials are research studies in which new treatments – drugs, diagnostics, procedures, and other therapies – are tested in people to see if they’re safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the web. Studies can be sponsored by the National Institute of Health (see clinicaltrials.gov) as well as private industry and pharmaceutical companies (see www.centerwatch.com).

  • Immunotherapy – Also known as biotherapy, activates the immune system (T-cells and antibodies) to destroy tumor cells. Research is exploring ways to prevent or treat cancer through vaccines.
  • Gene therapy – Uses viruses or other vectors to introduce new genetic materials into tumor cells. This experimental therapy can cause tumor cells to die or increase their susceptibility to other cancer therapies.
  • Hyperbaric oxygen – Using oxygen at higher-than-normal levels to promote wound healing and help fight infection. It may also improve the tumor’s responsiveness to radiation. Currently it is being used to help the body naturally remove dead tumor cells and treat radiation necrosis.

What is recovery like after glioma brain tumor treatment?

Your primary care doctor and oncologist should discuss any home care needs with you and your family. Supportive measures vary according to your symptoms. For example, canes or walkers can help those having trouble walking. A plan of care to address changes in mental status should be adapted to each patient’s needs.

Driving privileges may be suspended while you are taking anti-seizure medication. As each state has different rules about driving and seizures, discuss the issue with your doctor.

It may also be appropriate to discuss advance medical directives (e.g., living will, health care proxy, durable power of attorney) with your family to ensure your medical care and wishes are followed.

What is the prognosis for a glioma brain tumor?

How well a tumor will respond to treatment, remain in remission, or recur after treatment depends on the specific tumor type and location. A current tumor may be a tumor that still persists after treatment, one that grows back some time after treatment destroyed it, or a new tumor that grows in the same place as the original one.

When a brain tumor is in remission, the tumor cells have stopped growing or multiplying. Periods of remission vary. In general, benign tumors recur less often than malignant ones.

Since it is impossible to predict whether or when a particular tumor may recur, lifelong monitoring with MRI or CT scans is essential for people treated for a brain tumor, even a benign lesion. Follow-up scans may be performed every 3 to 6 months or annually, depending on the type of tumor you had.

If you have any questions or would like to schedule an appointment with on of our Spine Center specialists, please call 515.875.9560.

Support groups provide an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments and medications.

National Brain Tumor Society – http://www.braintumor.org/

American Brain Tumor Association – http://www.abta.org