Glioma

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What is Glioma?

Glioma, also known as a Brain Tumor, refers to a tumor that develops in the brain or spinal cord. A Glioma originates from glial cells that are present in the brain and spinal cord. Most of the central nervous system tumors are Gliomas.

Is Glioma a Medical emergency?

Glioma or a Brain Tumor is a medical emergency condition.

Types

Three types of glial cells produce these tumors. Classification of Glioma is made depending upon the type of glial cell present in the tumor and the genetic feature of the tumor. Types of Glioma include:

  • Astrocytoma: Astrocytoma is a type of cancer that occurs in the brain or spinal cord. It begins in star-shaped glial cells called astrocytes that support the nerve cells in the brain. This type of Brain Tumor causes symptoms of nausea, headaches, and seizures.
  • Ependymoma: This type of Glioma or Brain Tumor develops in the tissues of the central nervous system. The brain and spinal cord are the primary components of the central nervous system. In children, it develops intracranial whereas in adults it develops in the spinal cord.
  • OligodendroGlioma: OligodendroGlioma is a type of Glioma, a tumor that occurs in the brain or spinal cord. They originate from the glial cells called oligodendrocytes. They primarily occur in adults. They also occur in children.

Causes

The exact cause of Glioma is not clear. However, genetic disorders such as neurofibromatosis or tuberous sclerosis can cause Gliomas. Radiation exposure can also play a vital role in the development of Glioma. Other environmental factors like food and exposure to toxic chemicals can cause Glioma.

Risk factors

Factors that increase the probability of developing Glioma include:

  • Gliomas are most common in individuals 45 to 65 years of age. Some types of Gliomas such as ependymomas and pilocytic astrocytomas are more common in kids than in adults
  • Having a previous history of radiation exposure during cancer treatment or due to exposure to atomic bombs can increase the risk of developing Glioma
  • Having a family history of Glioma
  • Having excessive consumption of alcohol, tobacco smoking, and illicit drugs
  • Excessive usage of cell phones

Symptoms & signs

Glioma can develop either in the brain or spinal cord. The function of the brain is affected depending upon the type and location of Glioma in the brain. Symptoms also vary depending upon tumor size, location, and how rapidly it grows.

Symptoms include:

  • Headache
  • Nausea and vomiting
  • Confusion
  • Memory loss
  • Difficulty with balance
  • Seizures
  • Vision problems like blurred vision, double vision, or loss of peripheral vision
  • Irritability
  • Speech problems

If Glioma affects the spinal cord symptoms include:

  • Pain in the neck, arm, back, and legs
  • Fatigue
  • Weakness and numbness in extremities
  • Unsteady gait
  • Loss of muscle control
  • Loss of bowel or bladder control

Investigations

Investigation tests to diagnose Glioma include:

  • A neurological examination that includes testing of vision, hearing, balance, and coordination, and reflexes
  • Complete blood tests
  • Imaging tests including MRI, CT scan, and PET scan. These tests help diagnose the size, type, and location of the tumor and help in designing a treatment plan

After diagnosing Glioma, the below tests are performed:

  • A tumor biopsy is performed to determine if the tumor is cancerous or non-cancerous. A needle is used to remove tissue of Glioma that are hard to reach or in sensitive areas of the brain
  • Tests to find the spread of cancer to other parts of the body

All these tests are essential to determine the treatment plan.

Diagnosis

Diagnosis of Glioma is made by reviewing the signs and symptoms and considering the results of the investigation tests.

Course/ Stages

Glioma is classified as low-grade Glioma and high-grade Glioma. Low-grade Glioma grows slowly and in some cases can be removed with surgery whereas high-grade Glioma is fast-growing, aggressive, and can spread easily.

Astrocytoma type of Glioma is classified into the following:

  • Grade I: This is the initial stage of Glioma and they occur mainly in children
  • Grade II: This is a low-grade Glioma
  • Grade III: This stage of Glioma is considered high grade
  • Grade IV: This is the final stage of Glioma where the tumor is fast-growing and aggressive

Ependymoma type of Glioma is classified as:

  • Subependymoma: This is a grade I type of ependymoma and is very rare
  • Ependymoma: This is the middle stage of ependymoma Glioma. In children, ependymoma arises in the brain whereas for adults it arises in the spinal cord
  • Anaplastic ependymoma: This is a high-grade type of Glioma where the cells multiply rapidly. The cells grow very quickly and are of unusual shape

OligodendroGlioma is classified into:

  • Low grade oligodendroGlioma (Grade II)
  • Anaplastic oligodendroGlioma (Grade III)

Treatment options

Treatment depends on the type, size, location, grade of the tumor, and also age and general health condition of an individual.

Medical treatment

Medical treatment includes drugs that are prescribed to reduce signs and symptoms:

  • Medications: Steroids are used to reduce swelling and pressure inside the brain. Anti-epileptic medications are prescribed to control seizures.
  • Chemotherapy: Chemotherapy is a drug treatment that is used to kill and destroy fast-growing cancer cells. Chemotherapy is prescribed in the treatment of Glioma. It is given either orally or through injections. It is given in combination with radiation therapy. The most common chemotherapy drug that is used to treat Glioma is temozolomide.
  • Targeted drug therapy: Targeted drug therapy is a type of therapy that focuses on particular abnormalities present in the cancer cells. By blocking these abnormalities, targeted drug therapy causes the cancer cells to die. One of the targeted drug therapy used to treat Glioma is bevacizumab.

Interventional treatment including surgery and indications for surgery/ Surgical treatment

In the majority of the cases, surgery is performed in the treatment of Glioma. Surgical treatment of the Glioma depends upon the location of the tumor in the brain or spinal cord. The tumor can be removed completely or partially depending on its location. If the tumor is located in a region where complete resection is possible, then it is surgically excised. If the tumor is located near sensitive areas in the brain where resection would be risky and there would be possible damage to surrounding structures, partial resection of the tumor is done. The tumor is removed as much as possible.

Removing a part of the Glioma also decreases the severity of the symptoms. Surgical resection of Glioma is done with the help of intraoperative MRI and lasers. The neurosurgeon tries to protect as much a healthy brain as possible. Awake brain surgery is also performed in the treatment of Glioma. In this type of surgical procedure, the patient is asked to perform certain tasks during operation to ensure the area of the brain controlling that function is not damaged.

Radiation

Radiation therapy is essential in treating Glioma. It is usually followed by surgical treatment. Radiation therapy is a type of cancer treatment in which high-energy beams are focused to kill the cancer cells. Radiation therapy for Glioma is done using external beam radiation. In external beam radiation therapy, radiations are applied only to the tumor or to the entire brain. High energy beams such as x-rays or protons are focused on the tumor to destroy the cancer cells.

Radiosurgery or stereotactic radiation therapy is a type of surgery where a selected area of tissue is destructed using radiation. In radiosurgery, multiple beams of radiations are focused on the Glioma. Each ray may not contain a high dose of radiation but as it reaches the Brain Tumor it releases a high dose of radiation. There are different types of technologies used in the treatment of Glioma including the Gamma Knife technique or linear accelerator (LINAC).

Proton beam therapy or proton therapy is a type of radiation therapy. This is also used in the treatment of Glioma. In this therapy, high targeted doses of radiations are focused on the tumor minimizing exposure to the surrounding healthy tissue. Protons cause less damage to the surrounding structures than x-rays.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

After undergoing the treatment of a Glioma, a rehabilitation program is initiated. Rehabilitation is an important part of recovery after the treatment of Glioma. A Brain Tumor affects many functions like vision, speech, thinking, and motor skills. Treatment of a Brain Tumor also makes the body weak. So rehabilitation is of utmost importance to gain back strength and to resume normal activities of life.

The rehabilitation program for Glioma includes physical therapy, occupational therapy, and speech therapy. The rehabilitation program also improves an individual’s memory and thinking after recovering from a Brain Tumor. Even after the treatment of Glioma, yearly follow-up is required with MRI scans.

Some of the lifestyle modifications include:

  • Discontinue tobacco smoking
  • Avoid or limit alcohol intake
  • Avoid usage of illicit drugs
  • Regular exercises
  • Maintaining a healthy weight
  • Minimizing exposure to chemicals, sun rays or tanning beds, and pollution
  • Minimizing the usage of cell phones

Complications

The following are the possible complications of a Glioma:

  • Problems with coordination, muscle strength, speech, or eyesight
  • Increased risk of developing other types of cancers
  • Chances of recurrence
  • Infection and bleeding from chemotherapy
  • Side effects from exposure to radiation

Prognosis

The overall prognosis of Glioma is poor. In the majority of the cases, the survival rate is 5 years after the treatment. However, it varies depending on several factors like the type of tumor, its location, the extent of its spread, age, and general health condition of the individual.

When to contact the doctor?/ How to identify complications?

Consultation is recommended after noticing the signs and symptoms of Glioma.

Indications for hospitalization

Chemotherapy and radiation treatments of Glioma can be performed in outpatient settings; however, surgical removal of a Glioma requires hospitalization. The length of the hospital stay depends upon the intensity of the surgery as well as the general health condition of an individual.

Suggested clinical specialists/ Departments to consult for this condition

  • Neurology
  • Neurosurgery
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