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Gliomas

What is a Glioma?

Gliomas are primary brain tumours. They arise from the supporting cells of the brain. The two main types of gliomas are Astrocytomas and Oligodendrogliomas. Rarer types are Ependymomas and Choroid plexus tumours.

What causes gliomas?

Medical technology at present cannot answer this question.

Radiation exposure can give rise to these tumours. However the vast majority of patients who have gliomas have never had significant radiation exposure. There is some debate at present about the effect of mobile phones. We do not have firm evidence for this and the current thinking is that there is no link.

Some people with certain genetic conditions also develop gliomas.

Where do Glioma’s occur?

Gliomas can occur in any part of the brain. Common locations are the temporal lobes and the frontal lobes.

How do Gliomas affect your health? What symptoms do they cause?

Gliomas can cause many different symptoms including (but not exclusively):

  • Seizures (fits)
  • Headaches
  • Loss of use of your arm or leg
  • Inability to speak
  • Decreased vision, double vision
  • Confusion

Sometimes Gliomas can be found incidentally on scans performed for unrelated symptoms.

What happens after I am diagnosed with a Brain Tumour?

Generally with the onset of symptoms, you may have had a CT scan. The next step will be to have a MRI. This will give a more accurate picture of the tumour and other information about whether it is benign or malignant. Please see the section on the patient journey for more information.

How do we classify Gliomas?

There are different types of gliomas. The different types do behave differently. We also grade gliomas to give us and indication of its behavior.

What is the current recommended treatment for gliomas?

Pilocytic Astrocytomas (grade I) can often be cured by surgery alone.

On the other hand, at the present time there is no known cure for Grade II-IV astrocytomas and oligodendrogliomas.

Treatment is therefore aimed at controlling the tumour for as long as possible. There are three established methods as present.

  • Surgery
  • Radiotherapy
  • Chemotherapy

Each of these treatments is administered by a different specialist. Ideally, these specialists should work together at the same hospital as a team so as to provide integrated care for the patient.

How is surgery done for Gliomas?

Surgery

Surgery for these brain tumours should ideally be performed by someone who subspecializes in the field of Neuro oncology and is part of a multidisciplinary team as described above.
Surgery is required in some form for all of these tumours.

Biopsy

Surgery may just be to obtain some tissue to make a firm diagnosis. This is called a biopsy.  It still requires a general anaesthetic and is usually performed through a small drill hole in the skull called a “burr Hole”.  In order to locate the tumour, a technique known as stereotaxy is utilized. A needle is then passed through brain into the tumour to obtain some tissue. This tissue sample will then be analysed by a Pathologist to determine the exact diagnosis. Occasionally, the tissue obtained may not be of adequate quality to be analysed correctly. In this instance, further surgery may be required to obtain more tissue of better quality.

Surgery for radical resection

Surgery may also be performed to remove as much of the tumour as possible. There is a good amount of medical evidence that states that radical surgery has the effect of lengthening survival. The aim of radical surgery is to remove greater than 95% of the tumour seen on the MRI scan.

Radical surgery may not always be possible. It really depends on where exactly the tumour is located as to whether it can be achieved.

Radical surgery has become safer because of technological developments. The three most important technological adjuncts to surgery are the operating microscope, stereotactic navigation and the intraoperative MRI. The former two are found in all hospitals that offer Neurosurgery and are considered standard of care. The intraoperative MRI is unique to Royal Prince Alfred Hospital. Known as the “Brain Suite”, it is the only one of its kind in Australia and one of 25 worldwide units.

http://www.sswahs.nsw.gov.au/rpa/iMRI/default.htm

Surgery can be done through a keyhole approach or a traditional large incision.

What if I don’t have surgery?

For some tumours, you might be advised not have any surgery and take a “watch and wait” course. This may be for a number of reasons including the location, the size and the symptoms it is causing. This involves close monitoring by your Neurosurgeon with regular MRIs. This may be the appropriate decision for low grade (grade I and II) tumours.

However there is a large body of medical evidence to state that radical surgery to remove as much of the tumour as possible is better for length of survival.

However, the only definitive way of diagnosing the type of tumour, is by obtaining tissue to analyse under a microscope. Without a tissue diagnosis, no other treatment can be prescribed. Therefore for high grade tumours (grade III and IV) this is very important. Generally with no treatment, these tumours will continue to grow and cause more symptoms and problems and eventually become life threatening.

How quickly do these tumours grow?

The growth rate of gliomas depends on the grade of the tumour.

Grade I tumours are slow growing and may only grow by 1-2mm per year.

Grade II tumours again are fairly slow growing and may grow by a few millimeters per year. However grade II tumours can very suddenly change and start to grow more rapidly.

Grade III tumours are malignant and grow significantly over months.

Grade IV tumours are very rapidly growing and tend to grow quickly over a matter of days or weeks.

What other treatments are available?

Radiotherapy

Radiotherapy is administered by a specialist known as a Radiation Oncologist.

Radiotherapy is the crucial next step after surgery for Grade III and Grade IV astrocytomas. The need for radiotherapy for grade II astrocytomas is more controversial. It appears to delay recurrence and transformation into a grade III but does not seem to lengthen overall survival.

Chemotherapy

Chemotherapy is used inconjunction with radiotherapy. The drug most often used is Temozolomide. Chemotherapy is prescribed and supervised by a Specialist Medical Oncologist. For more information contact your Medical Oncologist

Targeted therapies

We are now moving into the era of targeted therapies. These are specially designed molecules that target specific genetic mutations or specific cellular functions within tumour cells. There are many of these drugs in current use for a lot of other cancers. However, at present there are no targeted therapies for gliomas. Some can be accessed through clinical trials. Please discuss this further with your surgeon or oncologist.

Vaccines

Vaccines are treatments that use the patient’s own immune system to fight the tumour. These can be targeted molecules that enhance certain cells in the immune system. Alternatively, tumour tissue obtained at surgery may be used to stimulate the patient’s own immune system to fight the tumour. Vaccines are also only available currently on a trial basis.

We are also now able to detect certain genetic mutations within these tumours that give us more information about their behavior.

Other Brain Tumours

  • Royal Australasian College of Surgeons: RACS
  • Neurosurgical Society of Australasia
  • Australian Medical Association
  • Cancer Institute NSW
  • Cooperative Trials Group for Neuro-Oncology (COGNO)
  • Australia and New Zealand Melanoma Trials Group (ANZMTG)
  • Society for Neuro-Oncology
  • Sydney Catalyst
  • National Biobanking Consortium for Brain Cancer (NBCBC)
  • Melanoma Institute Australia
  • The University of Sydney
  • University of Notre Dame
  • Royal Prince Alfred Hospital
  • Chris O'Brien Lifehouse
  • Mater Hospital - Sydney