Symptoms and diagnosis of brain glioma

What is a brain glioma?

Brain glioma is a brain cancer that can occur at any age, including childhood.

Brain glioma in children

In childhood and adolescence, gliomas are the most common type of primary tumors of the central nervous system, accounting for up to 25% of all cases of childhood cancer. Low-grade gliomas are most common in this age group; the average age of patients is 5–7 years. Modern approaches to the treatment of brain cancer abroad make it possible to achieve high survival rates for children with this disease.

What is brain glioma in adults

In adults, gliomas are also the most common type of primary brain tumor, but, unlike gliomas in children, high-grade gliomas predominate in adults. Such tumors require timely diagnosis and immediate and active therapy, as they progress rapidly.

Forecasts

The rapid development of neuro-oncology makes it possible to make favorable prognoses for many types of brain cancer, including glioma. Typically, people are most concerned about their potential life expectancy. And that's okay. Fortunately, medicine is moving forward. Previously, the maximum survival rate after diagnosis was 9-12 months. Today, these statistics have improved significantly. Specialists use the most modern treatment methods, thanks to which the patient gets the opportunity to live from 2 to 10 years. It all depends on the degree of malignancy of the oncological process. Such a noticeable improvement in survival statistics clearly demonstrates how far medical researchers have come in the fight against brain oncologies. However, complete victory is still far away, so a lot of effort needs to be directed towards deepening knowledge in the field of neuro-oncology.

Types of brain glioma

Depending on which neuroglial cells started the tumor process, the following types of gliomas are distinguished:

• astrocytomas, or astrocytic gliomas (the most common);
• medulloblastomas (more often diagnosed in children and adolescents);
• oligodendromas;
• ependymomas (typical of childhood).

Tumors are distinguished not only by histological structure, but also by degree of malignancy (high and low degree of malignancy), location and other characteristics.

Astrocytic glioma of the brain

This is the most common type of glioma. In turn, they are divided into three more types, which simultaneously represent stages of astrocytoma development:

• Low-grade astrocytoma (stages I and II).
• Anaplastic astrocytoma (stage III).
• Glioblastoma, including glioblastoma multiforme, is the most malignant of all (stage IV).

Anaplastic astrocytomas are common in young patients.

Glioblastomas are diagnosed more often in middle-aged and elderly patients and are called primary (i.e., this type of astrocytoma is diagnosed for the first time), however, anaplastic astrocytoma can develop into glioblastoma, which in this case is called secondary. Primary glioblastomas differ somewhat from secondary ones in their characteristics.

Sometimes an astrocytoma contains oligodendrocytes - cells that give rise to another type of glioma, oligodendroma. In this case, the tumor has mixed characteristics and is called oligoastrocytoma. Oligoastrocytomas have a better prognosis than other types of astrocytomas.

Brain stem glioma

Gliomas located in the brain stem are high-grade gliomas; they account for about 40% of all high-grade gliomas. These tumors quickly manifest with severe symptoms, since this area is extremely important for the body, connecting the brain with the body, limbs, and cranial nerves. They have a poor prognosis.

Diffuse glioma of the brain

A diffuse tumor is one that has diffuse, i.e., scattered growth, unevenly infiltrating brain tissue. Both high- and low-grade tumors can be diffuse. For example, the high-grade brainstem glioma described above is fully called “diffuse primary brainstem pontine glioma.” Another example is low-grade diffuse astrocytoma. Due to the difficulty of complete removal due to their diffuse nature, such tumors require the use of chemotherapy and/or radiation therapy.

Benign glioma of the brain

Benign is a glioma that has no signs of malignancy or aggressive growth. It should be understood, however, that unlike benign tumors of other anatomical zones that do not pose a threat to life, benign brain tumors pose such a threat because, developing in the confined space of the skull, they gradually compress and destroy nearby structures. The most benign type of gliomas are oligodendromas, with the exception of anaplastic ones, which have a higher malignancy.

Glioma of the frontal lobe of the brain

The oligodendromas described above develop most often in the frontal lobes of the brain. They respond well to chemotherapy and radiation therapy and generally have a favorable prognosis (it is better in those oligodendromas in which deletion of the p-arm of chromosome 1 and/or deletion of the q-arm of chromosome 19 is detected).

Treatment

After carrying out all the necessary procedures and determining the diagnosis, specialists decide what type of treatment will be carried out - aimed at healing the child or alleviating his condition. The latter type is usually chosen in cases where intensive treatment no longer makes sense and will do more harm than good. When healing seems possible, the first step is surgery. The neurosurgeon’s task is to remove the tumor as much as possible, since the child’s chances of recovery depend on this. If there are no severe symptoms after surgery, treatment goes into observation mode. If the tumor resumes growth or the child’s condition worsens, chemotherapy and/or radiation therapy is prescribed. For inoperable tumors, for example near the brain stem, chemotherapy or radiation therapy, or a combination of both, is immediately used.

Symptoms of brain glioma

All the signs of brain tumors fit into the picture of many other neurological diseases, so the diagnosis cannot be made only by the clinical picture, however, the persistent appearance of one, and even more so several of them, is a reason to consult a doctor and undergo an examination.

The main features are as follows:

• Persistent, sometimes constant headache . The pain often occurs in the morning after sleep, or is more intense after sleep. It intensifies with coughing, changes, especially sudden ones, in body position, and physical activity. Intense headaches are often accompanied by nausea and vomiting (in this case, it is important that nausea and vomiting are not associated with the digestive system, but are directly related to the headache).
• Visual impairment . They may manifest themselves as decreased visual acuity, double vision, loss of peripheral visual fields, and the appearance of photopsia.

Other signs and symptoms depend on the specific anatomical zone in which the tumor is located:

• 
  convulsions (generalized or partial);

• hearing impairment;
• disturbances of consciousness (fainting, confusion);
• disorders of coordination, balance, movement;
• violations of speech function, writing;
• changes in behavior;
• various hormonal disorders;
• excessive sleepiness;
• hydrocephalus (in children).

Classification of symptoms

Because malignant gliomas grow much faster, their presence usually becomes apparent within a few weeks or months. Experts divide the main symptoms into two categories: nonspecific general, characteristic of all malignant tumors of the central nervous system, and specific, depending on the location of the tumor.

Nonspecific. Common symptoms of malignant gliomas include head and back pain, dizziness, nausea, vomiting and lack of appetite, mood swings, decreased activity, sudden thinness or weight, and difficulty concentrating. Also, tumors often disrupt the outflow of cerebrospinal fluid (CSF), and its accumulation leads to hydrocephalus. It can be noted that the general symptoms differ little from the symptoms of benign gliomas, and therefore it is difficult to determine the type of tumor from them.

Specific. Such symptoms, also called local, can more accurately indicate the location where the tumor has formed. For example, when localized in the cerebellum, glioma causes problems with coordination of movements. This can be seen in the child’s unsteady, unsteady gait and frequent falls. Seizures may be a sign that a tumor is growing in the cerebrum, and paralysis of any muscles is characteristic of a tumor in the spinal cord. Specific symptoms also include visual and sleep disturbances, and in infants and young children, macrocephaly.

Causes of brain glioma

The reasons for the development of gliomas are unknown. Only a few factors have been identified that presumably increase the risk of tumor development.

These include:

• viral infection;
• embryogenesis disorders;
• gene mutations;
• carcinogenic effects of certain chemicals and ionizing radiation;
• brain injury.

A direct connection between these factors and brain cancer has not yet been discovered.

Features of diagnosing brain glioma

Leading clinics in Israel have the ability to quickly and accurately diagnose gliomas, excluding erroneous diagnoses, thanks to which the optimal treatment tactics are determined and treatment can quickly begin.

The following are used in the diagnosis of gliomas:

• study of anamnesis;
• objective examination;
• instrumental research methods;
• morphological analysis.

During the examination, the neurologist determines sensitivity disorders, muscle tone, conducts coordination tests, checks reflexes, and assesses the patient’s emotional state.

Hardware diagnostics:

• electroneurography – assessment of the state of the nervous system;
• electromyography – assessment of the state of the muscular system;
• electroencephalography - allows you to determine focal brain damage;
• magnetic resonance imaging (brain glioma is well defined on MRI, as is its relationship with the underlying tissues), multislice computed tomography, contrast angiography of cerebral vessels, scintigraphy - determination of tumor localization and staging;
• positron emission tomography – allows you to assess the rate of tumor growth, and is also used to monitor the effectiveness of treatment;
• lumbar puncture, cerebrospinal fluid analysis - search for cancer cells in the cerebrospinal fluid.

During diagnosis, the tumor is differentiated from a post-stroke condition, brain abscess, cerebral hematoma, epilepsy and some other diseases of the central nervous system.

Diagnostics

If, after studying the symptoms and conducting an examination, the pediatrician suspects that the child has glioma, he issues a referral to a children's oncology clinic. There they conduct a full examination with the involvement of specialists from various fields and either confirm or refute the diagnosis. Diagnosis usually includes the following steps:

1. Examination by a neurologist. The doctor checks the quality of reflexes, skin sensitivity, and the child’s ability to control limb movements.
2. Visual diagnostics: MRI (magnetic resonance imaging) and CT (computed tomography) of the brain and spinal cord. These diagnostic methods make it possible to accurately understand whether a child has a tumor, if so, where exactly it is located and what size it has already reached. The images also allow you to determine the boundaries of the glioma, its shape and structure.
3. Electroencephalography (EEG). This procedure is carried out to assess brain activity and identify possible disorders.
4. Electromyography, electroneuromyography (EMG, ENMG). A method for studying the electrical activity of muscles.

Treatment of brain glioma abroad: main approaches

Combination therapy is indicated for brain gliomas. Treatment includes total (if possible) or subtotal surgical removal of the tumor, chemotherapy and/or radiation.

Sometimes (first-grade gliomas) the tumor can be completely removed, but most often we are talking about subtotal resection. In some cases, chemotherapy is given before surgery, which makes the operation more effective. Unfortunately, brain glioma often recurs after surgery; to reduce the risk of relapse in the postoperative period, chemoradiotherapy is also performed.

Innovations in cancer treatment abroad increase the effectiveness of the methods used. Thus, tomotherapy is used - a method with which you can regulate the intensity of radiation exposure, change the angle and dose of radiation, and control the effect on adjacent tissues and organs.

Symptoms

The disease manifests itself after the tumor compresses the brain and spinal tissues. Often, these manifestations are presented:

• headache; • convulsions; • weakness of arms and legs; • feeling of numbness.

Occasionally, other symptoms are present: nausea and accompanying vomiting, periodic or permanent loss of vision. A specialist can perform an eye examination to find out whether the lesion is pressing on the optic nerve. This nerve connects the eyes and the brain, but with glioma lesions it becomes inflamed. Compression of such a nerve requires prompt medical attention.

How is brain glioma treated in Israel?

In Israel, the latest methods of treating all tumor diseases are used. Everything that is new in the treatment of brain tumors abroad can be obtained in Israeli neuro-oncology centers - many innovative diagnostic and treatment methods are developed here.

Some gliomas in Israeli clinics are treated using innovative techniques, for example, using the Gamma Knife technique (as well as CyberKnife, NanoKnife, TruBim). These are non-surgical methods for removing brain tumors that are as effective as surgery, but without the risks associated with it.

Statistical data based on many years of observation of patients treated in Israeli clinics indicate that treatment of brain tumors in Israel has a high level of effectiveness.

Read reviews about treatment of brain glioma abroad

Gornostaeva O. E., Russian Federation

“My child was diagnosed with astrocytic glioma a year and a half ago. We did not immediately realize that it was a case of brain cancer, and when we realized this, we decided to treat the child abroad. We were lucky to get treatment in Israel at the Ichilov hospital. There are very experienced, very competent neurosurgeons and wonderful oncologists here. Thank God, the tumor turned out to be operable. Now the treatment is over, the child has almost recovered, everything turned out fine, but I’m not at all sure that this would have happened if we hadn’t been in the right place at the right time. Thank you!"

Prevention

There are no consistent preventive measures that will provide reliable protection against cancer. There are only general recommendations from oncologists:

1. strengthen your immune system;
2. lead an active lifestyle;
3. avoid stress;
4. treat emerging diseases in a timely manner;
5. provide nutritious, regular meals;
6. give up bad habits;
7. exercise at least a little;
8. get more rest;
9. sleep 6-8 hours;
10. Avoid exposure to radiation.

It is important not to live one day at a time, but to constantly monitor your health. You need to undergo regular medical examinations. Remember that such a simple procedure can save your life!