Overview of Gliomas
Glioma is the impaired growth of glial cells. It accounts for 58.01% of all CNS tumours.
Glioma is the most common type of primary brain tumor which causes cancerous growth of the glial cells. The glial cells form in the brain or spinal cord to control the neurons. Other cells also included with it are astrocytes, oligodendrocytes, and ependymal cells.
Gliomas are also referred to as intra-axial brain tumours. They are produced within the substance of the brain and sometimes involve healthy brain tissue. Glioma contributes to almost 33% of all brain tumors.
Glioma has many types that determine the treatment and prognosis. Generally, the preferable treatment options are surgery, radiation therapy, chemotherapy, targeted therapy, and experimental clinical trials.
Prevalence of Glioma in Pakistan
Glial tumours constitute the largest category with 538 cases or 54.0 1% reported of all primary CNS tumors. Among the glial tumours, the most common type is astrocytomas. Below are the occurrence rates of all types of glioma in Pakistan.
Doctors Treating Gliomas57 Doctors Available
Signs and Symptoms of Gliomas
Some common signs and symptoms of glioma include:
- Weakness in the arms, face, or legs
- Personality disorder
- Difficulty in speech
Other symptoms include:
- Vision loss
Types of Gliomas
The name of glioma is based on the specific type of brain cells that are affected. Depending on its cells type, it is categorized into three different types of glioma:
- Ependymomas is a tumor of ependymal cells. The main part of this type is that it hardly spreads outside the brain. Therefore, it can be treated through surgery. In rare cases, the affected ependymal cells may spread which is considered malignant. It constitutes less than 2% of all brain tumors and less than 10% of all brain tumors in children.
- Astrocytomas begin in brain cells called astrocytes. Mostly these types of brain tumors spread to all the normal brain tissues. It is difficult to cure, but sometimes, it cannot be cured.
- Oligodendrogliomas are tumors similar to astrocytomas. In some cases, these tumors are slow-growing but still spread to nearby tissues. They can be cured. Another sub-type of it is anaplastic oligodendroglioma which grows and expands more quickly than oligodendrogliomas. It cannot be cured.
- Brain Stem Gliomas also is known as diffuse infiltrating brainstem gliomas or DIPGs. This is a rare tumor present in the brain stem. They generally connect with normal brain tissues which cannot be surgically removed. Because it affects the normal and complex functions of the brain.
Globally, the percentage of 5 years survival rate of glioma is about 5% in adults.
Causes of Gliomas
Researchers are still investigating the exact cause of glioma. But some triggers can increase the risk of tumours.
Following are the risk factors include:
- Age- Generally, glioma can occur at any age. But the risk of a glioma increases with age. That's why it is most commonly present in adults between the age of 45 to 65 years old. Some types of gliomas, such as ependymomas and pilocytic astrocytomas, are more common in children and young adults.
- Radiation Exposure- People exposed to powerful ionizing radiation increase the risk of brain tumors. For example, using frequent headphones may cause glioma.
- Family History- If people have glioma in the family, then the risk of cancer can be twofold increased.
Firstly oncologists begin glioma diagnosis with a medical history. After collecting up the medical history, they will ask about the symptoms, past illnesses, and treatments.
Moreover, doctors conduct a neurological examination to check the following condition of the brain:
- Brain Reflexes
- Coordination and balance
- Pain response
- Muscle strength
Doctors also examine the eyes for the evaluation of increased pressure or swelling. Besides this neurological examination of the brain, doctors may suggest one of the following imaging tests. These tests are helpful to identify any abnormalities or growth of cells in brain tissues.
- Magnetic Resonance Imaging (MRI)- To create a detailed scan of the brain and spinal cord.
- Computed Tomography (CT) Scan- It also gives a detailed scan of the brain by using the rotating X-ray camera. The camera revolves around the body.
- Positron Emission Tomography (PET) Scans- This scan is obtained with the help of radioactive substances. To check the organs and tissues whether are working properly.
- Magnetic Resonance Spectroscopy (MRS)- MRS is a brain scan that is used to identify the biochemical processes of the brain.
- Biopsy- A sample of brain tissues is collected and examined under a microscope.
Treatment of Gliomas | When to Consult a Doctor
Glioma treatment depends on the following factors:
- Location of the tumor
- Person’s health condition
The first-line treatment of glioma is natural herbal remedies that reduce the severity and incidence of cancer.
There are many herbs used for reducing the symptoms associated with a brain tumour, increasing immunity, and giving energy to the brain to improve memory and other skills. The top five effective herbs are as follows
- Indian white cedar
Along with it, people use medications to reduce the signs and symptoms of the tumor. The most preferable drugs are steroids and anti-epileptics to control seizures.
If People do not respond to medications and herbal treatments, a doctor may recommend one of the following therapies.
The first step is the removal of glioma from the affected area of the brain. Sometimes it is very easy to remove or in some cases, it becomes risky to eliminate because of the surrounding sensitive areas of the brain. If doctors even remove the small portion of the tumour, it may help to reduce the signs and symptoms.
Several surgical technologies and techniques have been used for removing the tumour without damaging the other areas of tissues. In this includes:
- Computer-assisted brain surgery
- Intraoperative MRI
- Awake brain surgery
During surgery, there is a risk of infection and bleeding. The area where glioma is present also connects with eye nerves that may also damage and cause complete vision loss.
Radiation therapy uses high-energy beam glioma such as X-rays or protons to kill the tumour cells. There are several types of techniques involved in it such as a Gamma Knife or linear accelerator (LINAC).
These therapies are primarily helpful for the treatment of high-grade tumours.
Following are radiation therapy options:
The high-energy beams are directly transferred to the exact location of brain tumour with the help of a computer for pinpoint delivery of radiation treatment. The main techniques include intensity-modulated radiation therapy and 3D conformal radiation therapy.
- The source of radiation is the positive parts of atoms other than X-rays. This technique is also called conformal proton beam therapy. It causes less damage than X-rays.
- In this radiation therapy, multiple beams pass through the brain tumour and kill them quicker than other techniques. This technique is called stereotactic radiation therapy (radiosurgery).
Side effects of radiation therapy based on the type and dose of radiation. Common side effects of radiation include fatigue, headaches and scalp irritation.
This technique is used with other therapies or alone to treat the glioma. The drugs are used in a form of a pill (orally) or injected into a vein (IV) such as temozolomide (Temodar), available in pill form
Common side effects of chemotherapy are nausea and vomiting, headache, hair loss, fever, and weakness.
Targeted drug therapy
The main focus of targeted drug treatments on the specific abnormalities present within cancer cells. By inhibiting these abnormalities, targeted drug treatments can kill the cancerous cells.
The commonly used drug for the treatment of glioma is bevacizumab (Avastin). This drug, administered through a vein (intravenously), which kills the tumour cells without damaging the blood vessels.
Rehabilitation after treatment
Brain tumours develop in the most complicated and delicate areas of the brain. These areas control motor skills, speech, vision, and thinking. Therefore, doctors may suggest attending rehabilitation sessions after treatment for quick recovery. Following are the options of rehabilitation programs.
- Physical therapy can help to improve motor skills or muscle strength
- Occupational therapy requires to get back the normal daily activities such as work, after a brain tumor or other illness
- Speech therapy is good for enhancing the speaking skills of patients.
- Tutoring for school-age children is applicable for children to increase their memory and thinking after a brain tumor
After the treatment, people should attend follow-up sessions on time for quick and fast recovery. Also helps to monitor properly.
New Treatment Innovations
Brain cancer research is a vast field of study. Researchers are investigating new approaches to administer drugs for the treatment of brain tumours, including pumps that release a continuous, slow flow of chemotherapy or targeted drug therapies to a tumour. This type of treatment is called convection-enhanced delivery (CED).
Another new way that researchers are finding is the use of more modified technology called tumour treating fields (Optune). This procedure passes the electric fields to the brain, which can help inhibit the proliferation of cancer cells. Optune is a wearable, portable device and is used in combination with temozolomide. It is applicable for newly diagnosed adults with glioblastoma.
Implanted, biodegradable wafer therapy (Gliadel) uses the implanted disc that releases chemotherapy to tumor tissue. After surgery, this disc remains in the brain to transfer the chemotherapy across the blood-brain barrier directly to a tumour.
All these techniques are not available in Pakistan.
Doctors to treat Gliomas in Pakistan
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