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Glioma – Causes, Symptoms & Treatment

A glioma is a brain tumor that originates from glial cells of the brain or spinal cord. It is one of the most common primary brain tumors.

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Things worth knowing about "Glioma"

A glioma is a brain tumor that originates from glial cells of the brain or spinal cord. It is one of the most common primary brain tumors.

What Is a Glioma?

A glioma is a tumor of the central nervous system (CNS) that arises from glial cells – the supportive cells of the brain and spinal cord that nourish, protect, and insulate nerve cells. Gliomas are among the most common primary brain tumors in adults and can occur across a wide spectrum of severity.

Types of Gliomas

Gliomas are classified by the cell type from which they arise and by their degree of malignancy:

Astrocytoma: Arises from astrocytes; ranges from benign to high-grade forms.
Glioblastoma (Glioblastoma multiforme): The most aggressive and most common glioma in adults; classified as WHO Grade IV.
Oligodendroglioma: Arises from oligodendrocytes; typically slower-growing.
Ependymoma: Originates from ependymal cells lining the brain ventricles.
Diffuse intrinsic pontine glioma (DIPG): A highly aggressive tumor of the brainstem, predominantly affecting children.

The WHO classification divides gliomas into Grades I through IV, with Grade I being the least aggressive and Grade IV the most malignant.

Causes and Risk Factors

The exact causes of glioma development are not yet fully understood. The following factors are being investigated:

Genetic mutations: Alterations in genes such as IDH1, IDH2, TP53, and EGFR play a significant role.
Ionizing radiation: Prior radiation therapy to the head increases the risk of developing a glioma.
Hereditary syndromes: Conditions such as Neurofibromatosis Type 1 and Li-Fraumeni syndrome are associated with an elevated glioma risk.
Age and sex: High-grade gliomas are more common in men and in middle to older age groups.

Symptoms

Symptoms of a glioma depend on the location and size of the tumor. Common signs include:

Headaches, especially in the morning
Epileptic seizures (often the first symptom)
Personality changes and behavioral disturbances
Cognitive impairment (memory, concentration)
Speech or vision disturbances
Weakness or numbness in limbs
Nausea and vomiting due to increased intracranial pressure

Diagnosis

The diagnosis of a glioma involves a combination of imaging and tissue analysis:

MRI (Magnetic Resonance Imaging): The primary imaging method for assessing the location, size, and extent of the tumor.
CT (Computed Tomography): Used as a supplement, particularly in emergency settings.
Biopsy and histology: A tissue sample is taken for microscopic examination and molecular genetic analysis (e.g., IDH mutation status, MGMT promoter methylation).
Cerebrospinal fluid analysis: Used in select cases to examine the fluid surrounding the brain and spinal cord.

Treatment

Treatment depends on the type, grade, and location of the glioma, as well as the general health of the patient:

Surgery

The goal is maximum safe resection of the tumor without damaging critical brain functions. In high-grade gliomas, complete removal is often not achievable.

Radiation Therapy

Following surgery, radiation is commonly applied to the tumor area to destroy remaining cancer cells.

Chemotherapy

The drug temozolomide is the standard chemotherapy agent for glioblastoma, typically combined with radiation (the Stupp protocol). Other chemotherapy regimens, such as PCV, are used for other glioma types including oligodendroglioma.

Targeted Therapy and Immunotherapy

Newer approaches include bevacizumab (an anti-VEGF antibody) and tumor treating fields (TTFields, e.g., Optune device) as adjuncts to standard therapy for glioblastoma. Immunotherapy options are still under clinical investigation.

Palliative Care

For incurable gliomas, the focus shifts to quality of life: pain management, corticosteroids to reduce brain edema, and psychosocial support for patients and families.

Prognosis

Prognosis depends strongly on the WHO grade, the age of the patient, and the molecular profile of the tumor. Low-grade gliomas (Grades I-II) have a significantly better outlook than high-grade tumors (Grades III-IV). Despite modern therapy, the glioblastoma has a median survival of approximately 14 to 16 months following diagnosis. Tumors with an IDH mutation and MGMT promoter methylation respond better to treatment and carry a more favorable prognosis.

References

Louis DN et al. - The 2021 WHO Classification of Tumors of the Central Nervous System. Neuro-Oncology, 2021.
Stupp R et al. - Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New England Journal of Medicine, 2005.
National Cancer Institute (NCI) - Adult Brain Tumors Treatment (PDQ). Available at: www.cancer.gov

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