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:
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 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 symptoms to decide:
- how your tumour is likely to behave
- what the best treatment is
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
Treatment options for low grade glioma
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.
Your surgeon will remove as much of the tumour as possible. This is called 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 fluorescent dye. It shows up the border of the tumour and allows the surgeon to remove more of the tumour safely.
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
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
Your surgeon will remove as much of the tumour as possible. This is called debulking.
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.
You might have temozolomide (chemotherapy tablets) after surgery if you are fairly fit and well. You have this for several months.
You might have temozolomide alongside 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
Treatment options for brain stem glioma
Glioma in the brain stem is 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.
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.