Glioma

There are various types of gliomas.

Some are aggressive and hard to treat. Others are slow-growing and respond well to treatment.

Astrocytoma

This cancer occurs in a type of glial cells called astrocytes.

Astrocytomas include:

• Low-grade cancers that grow very slowly. These tumors are more common in children and younger adults but sometimes occur in older adults as well.
• Moderate-grade anaplastic tumors that often progress to glioblastomas without treatment. Early and aggressive treatment is key for this type of brain tumor.
• High-grade cancers that spread quickly. Glioblastomas are the most common and highest grade type of astrocytoma. They require aggressive treatment and are usually fatal within a few years.

More important than the grade of the tumor is its molecular status.

For instance, the presence of:

• IDH gene changes have a better prognosis.
• TERT gene changes only have a poor prognosis.
• The MGMT gene — a DNA repair enzyme — among glioblastomas causes the tumor to resist standard chemotherapies and have a poor prognosis.

At UPMC Hillman Cancer Center, we always test for these genes as part of your first workup.

Oligodendroglioma

This cancer occurs in a type of glial cells called oligodendrocytes.

These cancers have a genetic change called 1p/19 q co-deletion. They occur most often in adults in their late 30s and early 40s.

They can either be slow-growing low-grade or fast-growing high-grade tumors.

These tumors have the most positive prognosis among gliomas.

Ependymoma

This tumor grows from the ependymal cells. These are glial cells that line fluid-filled parts of the brain and spinal cord.

Doctors most often diagnose this cancer in children, who have a good prognosis after surgery.

Changes in the glial cells stop them from growing as they should.

While having risk factors can increase the chance of glioma, doctors don't know what causes these cell changes to occur.

The risk factors of glioma include:

• Age, with older people more likely to get it.
• Radiation treatments.
• Rare genetic syndromes such as neurofibromatosis, Lynch syndrome, and tuberous sclerosis.
• A family history of glioma.

There are currently no known ways to prevent glioma.

Symptoms of glioma may vary based on where the tumor is.

For instance, if the glioma is in the part of the brain involved in:

• Movement, symptoms may include clumsiness.
• Speech, you may slur your words.

Other symptoms of most gliomas include:

• Headaches. It's very rare for this to be the only symptom of a glioma.
• Vision problems.
• Confusion.
• Nausea and vomiting.
• Weakness.
• Balance issues.
• Changes in personality or mood.
• Seizures.
• Lack of bladder control.

Your doctor will talk to you about your symptoms and then do simple tests to measure balance and eye control.

If a doctor suspects a brain tumor, they will order more advanced tests to confirm the diagnosis.

Brain scan/imaging

MRI is the most common scan to diagnose brain cancer. Doctors may use other imaging tests if an MRI isn't safe due to a metal implant, for example.

Doctors can often diagnose the type of glioma based on how the tumor looks on the MRI.

Biopsy to diagnose glioma

In a biopsy, doctors:

• Make a small hole in the skull.
• Use a thin needle to remove a tiny piece of the tumor.
• Analyze the sample using a microscope, genetic testing, or both, to plan the best treatment.

Sometimes, we can tell from an imaging test or biopsy that a glioma is low-grade and unlikely to grow or spread.

For these tumors, we don't need to treat them right away. Instead, we will keep an eye on your tumor with MRIs or other tests to make sure it isn't changing.

This is often the first treatment for glioma.

Your surgeon will remove as much of the tumor as they can, as the extent of the resection impacts prognosis.

Our neurosurgeons at UPMC use advanced imaging techniques to achieve the best possible results:

• Fiber tractography
• Functional MRI
• Brain mapping

Radiation treatment uses high-energy x-ray beams to kill cancer cells.

Doctors often use radiation:

• After surgery to kill remaining glioma cells.
• As the first line of treatment if surgery is too dangerous because of the location of the tumor, for instance.

People with brain tumors often need daily treatments over many weeks.

For some smaller gliomas, we may use radiosurgery, a local one-time boost of high-dose radiation.

Doctors often prescribe oral chemo drugs are often during or after radiation.

The most common oral chemo drug treatment involves temozolomide and a three-drug regimen called PCV of:

• Procarbazine
• CCNU (Lomustine)
• Vincristine

For aggressive gliomas, doctors use low-intensity electric fields that disrupt fast-dividing cancer cells without harming normal cells.

Your doctor places transducers on your scalp with bandages, and then attaches them to a battery with wires.

You can wear the safe and effective TTF transducers throughout the day.

The survival rate for glioma depends on:

• A person's age.
• The type of tumor.
• Genetic features of the glioma.

Some people die within a year of diagnosis, while others may live many decades.