Understanding Gliomas: Symptoms, Diagnosis, and Treatment Options

Glioma is a general term for brain tumors arising from the glial cells of the brain and spinal cord. Gliomas can range from benign to malignant, and while benign tumors such as meningiomas or acoustic neuromas may have successful long-term outcomes with surgery, gliomas are often more serious.

From a neurosurgical perspective, gliomas are malignant brain tumors arising from the cancerous transformation of glial cells. They account for 50-60% of primary malignant brain tumors. Most cases occur between the ages of 20 and 50, with a peak incidence between 30 to 40 years old. Interestingly, there is also a relatively high incidence in children around 10 years old. The exact causes of gliomas are unknown, but they are thought to be related to genetic factors, brain trauma, ionizing radiation, certain chemicals, and food contaminants like methylcholanthrene and nitrosamines.

Types of Gliomas

Gliomas can be classified based on the morphology and malignancy of tumor cells, as well as the location of the tumor. The most common type of glioma is astrocytoma (75%), followed by oligodendroglioma (8.8%), ependymoma (7.3%), and medulloblastoma (3%). Other types include pineal tumors, mixed gliomas, choroid plexus papillomas, and unclassified gliomas.

Gliomas are also classified by their grade, indicating the level of malignancy:

• Low-grade gliomas (WHO grade 1-2) are well-differentiated and tend to have a better prognosis, often manageable with surgery and radiation.
• High-grade gliomas (WHO grade 3-4) are poorly differentiated and are considered malignant, with a poorer prognosis and shorter survival.

Early Symptoms of Gliomas to Watch Out For

The symptoms of gliomas are related to their pathological characteristics, location, and growth rate. They often depend on the pressure exerted by the tumor and the area of the brain affected. The most common early symptoms of gliomas include:

• Headache: Often worse in the morning or at night.
• Vomiting: Usually associated with increased intracranial pressure.
• Blurred Vision: A common symptom caused by pressure on the optic nerve.
• Neurological Deficits: These may include weakness in the limbs, sensory disturbances, speech difficulties, delayed reactions, or memory loss.

Gliomas are known for their rapid progression in some cases, with some symptoms appearing within days, while in others, symptoms may develop slowly over several years. It is important to recognize these early signs for accurate diagnosis and timely intervention.

How Are Gliomas Diagnosed?

For clinical diagnosis of gliomas, CT scans and MRI are the most common imaging techniques used. MRI is the preferred method as it provides a clearer and more detailed image of brain tissue, pinpointing the tumor's location and size. CT scans can also be useful, especially for certain types of tumors that may show specific patterns.

Other supportive diagnostic tools include PET, PET-CT, PET-MRI, EEG, and MEG (magnetoencephalography). Some tumors may also lead to hormonal abnormalities, especially in the case of pituitary tumors, or may present with specific tumor markers in the case of metastatic tumors.

How Are Gliomas Treated? Is Surgery Necessary?

Treatment of gliomas often involves a combination of surgery, radiation therapy, and chemotherapy. Surgery is typically the first-line treatment, especially for tumors that are accessible for resection. Advances in medical technology have made brain tumor surgeries more minimally invasive, with techniques such as microsurgery, intraoperative navigation, intraoperative MRI, and neurophysiological monitoring improving the accuracy, safety, and effectiveness of operations. These techniques allow surgeons to remove tumors from areas that were once considered difficult to access, including the brainstem, thalamus, corpus callosum, basal ganglia, and spinal cord.

Surgical resection of gliomas is the most direct way to alleviate the physical effects of the tumor. For gliomas located in functional areas of the brain, surgery can also help restore the function of the affected brain regions. Some patients who had symptoms like speech difficulties or paralysis before surgery experience significant improvements after the tumor is removed, providing a better quality of life and making further treatments easier.

Final Thoughts

Gliomas are a significant health challenge due to their malignancy and impact on the brain. Early detection and timely treatment, primarily through surgery, can offer patients a fighting chance for better outcomes. If you or someone you know is experiencing symptoms like unexplained headaches, vision changes, or neurological deficits, it is essential to seek medical advice promptly for accurate diagnosis and early intervention.