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Glioma Treatment

Brain Tumor & Neuro-Oncology Center

A glioma is a broad category of brain or spinal cord tumors with many subtypes, affecting the glial cells of the brain. Gliomas are one of the most common types of primary brain tumors, or a tumor originating in the brain, and graded based on aggressiveness and growth rate.

The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health offers a multi-disciplinary team of board-certified neurologists, neurosurgeons, neuro-oncologists, oncologists, radiation oncologists, and support staff to treat gliomas and all other types of brain and spinal tumors. Many of our patients have come to us from other doctors, seeking a second opinion or higher quality treatment.

If you have been diagnosed with a glioma or suspect you could have a brain tumor, we encourage you to reach out to us today for a consultation.

Types of Gliomas

Gliomas are characterized both by subtype and a numerical grading system indicating the severity and aggressiveness of the tumor. Grade 1 tumors are usually benign (non-cancerous), slow-growing and can often be removed through surgery, and grade 4 gliomas are malignant (cancerous), fast growing, very aggressive, and difficult to treat. Glioma prognosis varies based on the patient’s age and overall health, as well as on the grade, location and size of the tumor itself.

Glioma tumors are produced in the glial cells, which are located between neurons to provide support and insultation. Three types of glial cells in the brain can produce tumors: astrocytes, oligodendrocytes, and ependymomas. Mixed gliomas contain a mixture of different cell types.

Glioma tumors are named based on the cells from which they originate, and include:

  • Astrocyctoma, also called glioblastoma: This is the most common subtype of glioma. They appear in the astrocytes, the star-shaped cells making up the glue-like, supportive tissue of the brain. There are further subtypes of astrocytomas, such as pilocytic/diffuse/anaplastic astrocytomas, and each patient will experience different symptoms based on their tumor subtype and grade.

  • Ependymoma: These tumors grow in the ependymal cells lining the brain’s ventricle and the center of the spinal cord. Ependymomas are divided into different subtypes and graded based on how abnormal the cells appear under a microscope. The most common ependymomas are grade 2, meaning they grow over time and may invade nearby brain tissues. These tumors are rare in adults, occurring about 2-3% in all adult brain tumor patients. They are the 6th most common brain tumor in children, however, and account for one-third of all pediatric ependymomas in patients under the age of 3, according to the American Brain Tumor Association.

  • Oligodendroglioma: These greyish-pink tumors are associated with the oligodendrocyte cells in the brain, which make up the glial tissues. They are either grade 2 or 3 and can be mixed with other cell types. Usually they grow slowly over time and are not diagnosed for years. Symptoms may include seizures, headaches, and noticeable changes in personality. If these tumors are accessible, they are removed through surgery. Grade 3 tumors are usually treated with a combination of chemotherapy and radiation therapy.

  • Mixed glioma, also called oligoastrocytoma: If more than one type of glial cell is present in the tumor, it is “mixed.” The behavior of a mixed glioma varies based on its grade, size, and location.

  • Optic glioma: Unlike other tumors, “optic” gliomas are named for their location, not the type of cells from which it originates. Optic gliomas are located anywhere in the optic pathway and have the potential to spread. They are most common in children under the age of 10.

  • Brain stem glioma: This type of brain tumor originates in the brain stem, hence its name.

Tumor Grades

A pathologist will biopsy brain tumor cells under a microscope to assign a grade based on how abnormal the cells appear. The pathologist is also able to determine the exact type of tumor it is, and the cells from which it originated. The World Health Organization (WHO) defines 4 grades of brain tumors, and grades may change over time for the same patient. Grades 1 and 2 are considered “low grade” while grades 3 and 4 are “high grade.” The higher the grade of tumor, the more aggressive it is and the harder it is to treat.

Tumor grades include:

  • Grade 1: These are benign (non-cancerous) tumors which grow slowly over time. The borders of the tumor are distinct and the cells appear almost normal under a microscope, compared to higher grade tumor cells. Although these tumors are benign, they can still cause significant health problems, as they compress the brain and invade healthy brain tissues. Most patients are able to have grade 1 gliomas fully removed through surgery. Grade 1 gliomas are associated with good, long-term survival rates.

  • Grade 2: These tumor cells appear more abnormal under a microscope than grade 1 tumors, and are more aggressive as well. They may be benign or malignant. These tumors are also slow-growing, and are more likely to invade nearby brain tissues. These tumors may return after successful treatment.

  • Grade 3: These are malignant, or cancerous, tumors which contain abnormal, rapidly-reproducing cells spreading quickly into healthy brain tissues. Grade 3 tumors are likely to recur, coming back as a grade 4 glioma.

  • Grade 4: This is the most aggressive, cancerous type of glioma tumor. The border of the tumor is indistinct, and cells appear highly abnormal under a microscope, and they may have a core of dead cells (necrosis). They are the most difficult to treat and have a poor long-term survival rate.

Causes of Gliomas

Brain tumors which begin in the brain, called “primary” brain tumors, often have no known cause, but there are risk factors for developing gliomas.

Risk factors for gliomas include:

  • Age: Gliomas may occur at any age but are most common in adults between the ages of 45 and 65. Certain types of gliomas are more common in different age groups.

  • Radiation exposure: If you have previously had radiation therapy for cancer or if you’ve been exposed to radiation in some other way, you are at a higher risk for a glioma.

  • Family history: Usually gliomas do not run in families. While some genes have shown an association with glioma, more research is needed in this area.

Symptoms of Gliomas

Glioma symptoms vary based on the area of the brain affected and are caused by the tumor pressing on the brain or spinal cord. Headaches are the most common symptom of a glioma, affecting about half of all glioma patients. Other symptoms may include seizures, physical weakness in the limbs or face, nausea, speech difficulties, vision loss, dizziness, and more.

Glioma Diagnosis

If your doctor suspects you have a brain tumor, you will likely be referred to physician called a neurologist, who is a specialist trained in treating disorders of the brain and spinal cord.

The following tools are used for diagnosing gliomas:

  • Medical history and physical exam: You will be questioned regarding your family medical history and symptoms, such as when you first noticed your symptoms, the severity of your symptoms, and if anything appears to improve or worsen your symptoms.

  • Neurological exam: Your doctor will test your vision, hearing, speech, coordination, balance, reflexes and memory. Problems in one or more of these functions may indicate that a part of your brain is affected by a tumor.

  • Imaging tests: Brain scans prove useful in determining the size and location of the glioma. These include computerized tomography (CT) or magnetic resonance imaging (MRI) scans, or both. If these tests suggest the presence of a brain tumor, a biopsy may be performed to confirm a diagnosis.

  • Biopsy: This is the only way to definitively diagnose a glioma brain tumor and to provide the patient with a prognosis. Biopsies may be performed with a needle before treatment begins, or during brain surgery as the tumor is being removed. Once removed, the tumor will be tested and examined under a microscope by a pathologist to determine if it is cancerous.

Glioma Treatments

Treatment for these brain tumors depends on many factors, including how rapidly it is growing and its location in the brain or spinal cord. The patient’s overall health and personal preferences will also determine which treatments are best for optimal outcome.

  • Craniotomy surgery: This is usually the first step in treating gliomas and involves opening a part of the skull to access the part of the brain where the tumor is located in order to remove it. For grade 1 tumors that have easily distinguishable borders which do not extend to surrounding healthy brain tissue, surgery may be the only treatment necessary to cure the patient. For patients with higher grade tumors, removing even a portion of the abnormal growth can significantly reduce symptoms. Surgery is performed using a variety of techniques to assist the neurosurgeon in navigating the brain, including computer-assistance and intraoperative MRI.

  • Radiation therapy: This treatment utilizes high-energy proton or X-rays via a machine outside your body to kill cancer cells and is usually used for grades 2, 3 and 4 gliomas. Radiation therapy is administered by a radiation neuro-oncologist. Multiple beams of radiation may be used, with a technique called stereotactic radiation therapy, or radiosurgery, called Gamma Knife or linear accelerator (LINAC).

  • Chemotherapy: This drug therapy attempts to stop the growth of cancer cells and may be administered orally or via injections. Usually, chemotherapy is used in conjunction with radiation to treat gliomas.

  • Targeted therapy: Drug treatments focus on blocking abnormalities in cancer cells, usually administered intravenously.

  • Alternative medicine: Although little research has been conducted to determine the efficacy of alternative glioma treatments, and no alternative treatment is proven to treat a glioma, many patients turn to complementary treatments to cope with their treatment. These therapies may include acupuncture, meditation, music therapy, and relaxation exercises. Glioma patients should always inform their neurologist of any alternative medicine they wish to try.

After you have had glioma treatments, you will likely need some form of rehabilitation to return to your everyday activities. Rehabilitation focuses on assistance with regaining lost motor skills and muscle control, occupational therapy, and speech therapy. Follow-up care with your glioma treatment team is also very important.

Request an appointment online now or call 833-656-3876.