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Glioma in adults

Read about gliomas in adults and how they are treated. 

What it is

Gliomas are brain tumours starting in the glial cells. 

There are 3 main types of glioma:

  • astrocytoma
  • oligodendroglioma
  • ependymoma

Sometimes the tumour can have a mix of more than one of these types.

Gliomas can be low grade (slow growing) or high grade (fast growing). Doctors use the grade to decide which treatment you need. The position of the tumour is also very important.

What is astrocytoma

Astrocytomas are the most common type of glioma in both adults and children. They develop from the cells called astrocytes. Astrocytes are the cells of the brain that support the nerve cells (neurones).

Astrocytomas can be low grade (slow growing) or high grade (fast growing), or grades 1 to 4. Grade 4 tumours look the most abnormal under the microscope and are more fast growing.

Some astrocytomas are very localised (focal). This means it is easy to see the border between the tumour and normal brain tissue on a scan or during an operation. Focal astrocytomas are often diagnosed in children and are not common in adults. 

Other astrocytomas are called diffuse. These do not have a clear boundary between the tumour and normal brain tissue. 

The most common types of brain tumour in adults are: 

  • grade 3 astrocytoma - also called anaplastic astrocytoma
  • grade 4 astrocytoma - also called glioblastoma multiforme (GBM)

These are malignant (high grade) brain gliomas. They are generally fast growing and can sometimes spread to other parts of the brain. 

Unspecified gliomas

Unspecified glioma means that the cells are glioma cells. But your doctor cannot tell exactly the tumour grade or sometimes the type of cell it started from. Sometimes this can be because it was only safe to take a small biopsy and this may not give the full picture. 

Your doctors will use scans and information about your symptons to decide:

  • how your tumour is likely to behave
  • what the best treatment is

Diagnosing glioma

Your doctor will examine you and you may have blood tests to check your general health. Other tests include:

  • CT or MRI scan 
  • neurological examination by your doctor 
  • biopsy 

Treatment options for low grade glioma

Monitoring 

You might not need treatment straight away for a very slow growing low grade tumour. You have regular MRI scans to monitor your tumour. This is called watchful waiting.

About half (50%) of people with low grade tumours will need surgery within 2 to 3 years of monitoring. 

Surgery 

Your surgeon will remove as much of the tumour as possible. This is callled debulking. Even when some tumour is left behind, slow growing tumours may take years to cause symptoms again.

You may be asked to swallow a capsule called Gliolan before surgery. This contains a florescent dye. It shows up the border of the tumour and allows the surgeon to remove more of the tumour safely. 

Radiotherapy 

You might have radiotherapy after surgery. Your doctor is likely to recommend this if you:

  • are over 40 
  • have a lot tumour left behind 
  • have symptoms such as weakness in one area of your body 

Chemotherapy

Your doctor might recommend chemotherapy (instead of radiotherapy) after surgery if you have a gene change (mutation) called 1p19q.

Treatment options for high grade glioma

Surgery 

Your surgeon will remove as much of the tumour as possible. This is called debulking. 

Radiotherapy 

You might have radiotherapy after surgery. It will not cure your tumour, but aims to control your tumour for as long as possible. You might have one treatment a day, from Monday to Friday for a few weeks. 

A long course of radiotherapy might not be suitable if you are not very fit. So your doctor might offer you a shorter course over 2 weeks and you may have treatment every day, or every other day. 

Chemotherapy 

You might have temozolamide (chemotherapy tablets) after surgery if you are faily fit and well. You have this for several months.

You might have temozolamide alongisde a course of radiotherapy after your operation. 

Your surgeon might use carmustine (chemotherapy) implants if more than 90% of your tumour is removed. Your surgeon places the implants in the area of your tumour during your operation. This treatment is only available in specialist centres and may not be suitable for everyone. 

If your tumour starts to grow again

You might have one, or a combination of the following treatments:  

  • further surgery
  • carmustine wafers
  • radiotherapy 
  • chemotherapy

Treatment options for brain stem glioma

Glioma in the brain stem are very rare. It might sometimes be possible to take a biopsy from the tumour but the tumour cannot be removed. The brain stem is too delicate an area to operate on.  

The most common treatment is radiotherapy. It will not cure your cancer, but it might slow its growth and control your symptoms.

Coping with glioma

Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult if you have a rare cancer. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.

Follow up

You will have regular check ups once you finish your treatment. Your doctor will examine you and ask about your general health.

This is your chance to ask questions and to tell your doctor if anything is worrying you.

How often you have check ups depends on your individual situation.

Research and clinical trials

There may be fewer clinical trials for rare types of cancer than for more common types.

It is hard to organise and run trials for rare cancers. Getting enough patients is critical to the success of a trial. The results won't be strong enough to prove that one type of treatment is better than another if the trial is too small.

The International Rare Cancers Initiative (IRCI) aims to develop more research into new treatments for rare cancers. They are designing trials that involve several countries so that more people will be available to enter trials.

Last reviewed: 
29 Sep 2015
  • Cancer and its management (7th edition)
    Tobias J and Hochhauser D
    Blackwell, 2015

  • High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    R Stupp and others 
    Annals of Oncology. 2014. Volume 25, Issue suppl 3. Pp. iii93-iii101

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