Learning you have glioma or any other brain tumor can be pretty scary. However, the best course of action is to equip yourself with as much information as possible to make the best decision regarding your treatment. We wrote this article to help you find some of the answers to the questions that patients commonly have. Please consider booking an appointment with us to discuss surgical options.
Gliomas are brain tumors originating from glial cells in the central nervous system. Glial cells, also called neuroglia, are supportive cells that surround and protect the nerve cells or neurons.
These neoplasms are the most common group of primary brain tumors and are majorly classified based on the histological type of cell present within the tumor. Gliomas can grow alongside and mix with normal brain tissue, which is why they are called intra axial tumors.
Some gliomas are classified according to the prominent cells and tissues within them, whereas others are named based on their location.
Determining the exact cause of gliomas is quite tricky. However, there are quite a few risk factors that can increase the probability of an individual developing glioma.
The different types of gliomas show various symptoms according to their size, grade, location, and growth rate. Most of the symptoms occur because these space-occupying lesions press on and invade the normal tissue of the brain and spinal cord.
Patients commonly complain of headaches, nausea, and vomiting due to raised intracranial pressure caused by the mass effect of the tumors. Seizures are also quite frequent, and they exhibit features based on their location within the brain.
Other symptoms include changes in behavior and personality, increased agitation and irritability, confusion, difficulty in retaining new information, memory loss, and problems with vision such as blurring of vision, double vision, and difficulty in peripheral vision.
Numbness and weakness in different areas of the body, an inability to hold in urine, difficulties in talking and understanding, and impaired balance are also some symptoms commonly experienced by patients suffering from gliomas.
If you or anyone around you is experiencing any of the symptoms mentioned above, now would be the right time to visit your doctor. The doctor will take a detailed history of the presenting complaint along with the risk factors, symptoms, and family history of the patient. They will then perform relevant examinations to reach a preliminary diagnosis.
The next step would be performing computed tomography (CT Scan) or magnetic resonance imaging (MRI) to visualize different areas of the brain and determine the location of the glioma. These imaging techniques also aid the detection of tumors elsewhere in the body.
If a mass is detected within the brain, the doctor will then perform a biopsy where a tissue sample is removed from the mass and observed under the microscope. This technique can help understand the histological type, grade, and malignancy of the tumor and allow the healthcare provider to develop a complete plan of action.
There are a variety of treatment options available for patients suffering from gliomas. However, everyone requires a customized treatment plan based on their tumor's location, grade, and symptoms.
For most cases of gliomas, surgery is the first-line treatment used worldwide. Grade 1 or low-grade tumors can easily be cured through surgery alone, whereas grade 2 tumors require total resection along with radiotherapy to follow up. Grade 3 and 4 tumors are considered high grade, and these require complete resection along with chemotherapy and future radiotherapy to prevent a recurrence.
The most commonly performed surgery is a craniotomy, which is done to open the skull cap after making an incision in the scalp. Microsurgical tools are then used to remove as much of the mass as possible with minimal damage to surrounding tissues. This method is used along with imaging techniques and brain mapping when the tumor is present near essential structures in the brain.
Another type of surgery is an advanced procedure known as neuroendoscopy. Since it uses a much smaller incision than other surgeries, the process is considered minimally invasive and is only employed for specific tumors based on their location. The surgeon requires specialized surgical instruments, a video camera with high resolution, and a powerful lens to perform this surgery. Neuroendoscopy can be used for both diagnosis and treatment.
Laser ablation therapy is another minimally invasive procedure where neoplastic tissue is destroyed using heat from a laser. Through ablation, layers of tissue can be removed without removing an entire part of the brain.
Radiation therapy can either be used as an adjunct to surgery or on its own when the tumor is widespread or in a dangerous location and cannot be treated through surgical resection. High doses of radiation are used to kill or shrink the neoplastic cells in malignant tumors, thus preventing recurrence or slowing down the progress of benign tumors.
External beam radiation therapy (EBRT) is the most commonly used radiation technique for gliomas and other brain tumors. In this procedure, ionizing radiations are directed at the cancer and nearby brain tissues in short doses so that the surrounding healthy tissue has sufficient time to heal. Radiation can also be given to the whole brain when the tumor has metastasized to different areas. Patients usually undergo EBRT once daily for five days per week for a period of 2-9 weeks. Daily treatment lasts for a duration of 10 to 30 minutes.
Another form of radiation therapy is Stereotactic radiosurgery. This precise technique is used when the tumor is present in tricky locations, and surgical resection is not possible. Precise X-ray beams target and destroy the neoplastic cells while leaving the healthy tissue intact. There is a much lesser risk of infection with this technique, making it exceptionally safe for patients who have recently undergone surgery.
Proton therapy is the third type of radiation therapy used to treat gliomas and other brain tumors. Unlike the other radiation therapies, it uses protons to transmit high-energy beams that target tumor cells more accurately than X-rays, killing neoplastic cells layer by layer. This therapy requires the presence of both a doctor and a physicist.
Chemotherapy involves the use of certain medications that target and kill the neoplastic cells. However, it is rarely used alone. Instead, it is often combined with surgery and radiotherapy to achieve effective outcomes.
These medicines can be consumed orally (through the mouth), through injectables in the veins or the cerebrospinal fluid, and as dissolvable wafers made up of a combination of carmustine and polifeprosan 20. After surgical resection is complete, the empty space is filled using these wafers, which slowly release the medication after dissolving.
Targeted drug therapy is also used as a part of the chemotherapy regimen. These medicines specifically target particular genes within the neoplastic cells so that the tumor proliferates and grows at a much slower speed. Since these therapies do not harm the healthy surrounding tissues, they are associated with milder and less frequent side effects.
The drug used most often in chemotherapy regimens is Temozolomide (Temodar). This is taken orally in pill form, and it dramatically improves the outcome of radiotherapy.
Once the treatment process is complete, the tumor support team in the hospital will help the patient by coming up with a follow-up plan. This ensures that there is no recurrence of the tumor and that the patient can return to their everyday functional life.
The patient will undergo regularly scheduled visits with different healthcare professionals who will perform relevant examinations and brain imagings to check brain health. In addition, counselors, psychologists, and support groups help the patient deal with the emotional aspects of the disease and its treatment.
Rehabilitation is an essential aspect of recovery and helps the patient recover lost functions and skills. Physical therapy helps to regain motor skills and muscle power, such as being able to walk safely and climb stairs. On the other hand, speech therapy can aid in the recovery of speech and correct problems of understanding and comprehension. Occupational therapy allows patients to regain their footing in society and gain jobs.