Glioma – Diagnosis and Treatment
Diagnosis
When a doctor suspects a brain tumor, such as a glioma, they start by checking the person’s nerves and brain function. This is known as a neurological exam.
The doctor might test reflexes, vision, hearing, muscle strength, balance, and coordination. Trouble with any of these can be a sign that something is affecting the brain.
People with gliomas often report symptoms like headaches, trouble speaking, weakness, seizures, or changes in thinking.
Imaging tests help create detailed pictures of the brain. Doctors most commonly use an MRI scan, sometimes with a special dye to help show the tumor more clearly.
Doctors may also use other imaging tools, like a CT scan or PET scan, to spot tumors in the brain or spinal cord. These scans help doctors find the tumor’s location and see how big it is.
Below is a comparison of imaging tests:
| Imaging Test | What It Shows | Common Use |
|---|---|---|
| MRI | Soft tissue, tumors, nerves | Most commonly used for diagnosing gliomas. |
| CT Scan | Bone, bleeding, some soft tissue | Sometimes used if MRI is not available or suitable. |
| PET Scan | Cancer activity, metabolic changes | Helps show active cancer cells in the brain. |
After imaging, doctors sometimes need a sample of the tumor. This is called a biopsy. If surgery is not planned yet, doctors might use a stereotactic needle biopsy.
The surgeon makes a tiny hole in the skull and guides a thin needle into the tumor to collect a small tissue sample. The lab team then examines the tissue.
Lab staff analyze the tumor to determine the type of glioma, such as astrocytoma, oligodendroglioma, or ependymoma.
Pathologists also check how fast the cancer cells are growing (high grade vs low grade) and look for genetic changes. For example, they may look for changes in the IDH gene or other features that can affect treatment choices.
The main goal is to learn where the tumor is, what type it is, and how aggressive it might be so patients get the right care as soon as possible.
Treatment
People with gliomas often experience symptoms like seizures, headaches, or fatigue. Doctors may prescribe medicines to ease these symptoms and help patients feel more comfortable.
Common medicines include:
- Seizure Control Medications: Prevent or limit seizure activity.
- Steroids: Reduce swelling in the brain, which can lessen headaches or other effects.
- Stimulants: Sometimes fight severe tiredness.
- Medications for Memory and Thinking: Help if there are changes in alertness or cognition.
Doctors may recommend one or a mix of these medications depending on the person’s specific needs.
Surgical Approaches
Surgeons usually operate as the first treatment for most people with glioma. They aim to remove as much of the tumor as possible, without harming healthy brain tissue.
If the tumor is in a sensitive or hard-to-reach area, the surgeon may only be able to remove part of it. This is called a “subtotal resection.” Even partial removal can reduce symptoms.
Brain surgery can cause risks such as infection, bleeding, or loss of certain abilities, depending on where the tumor is in the brain. For example, operating near nerves that control sight may affect vision.
Surgery at a Glance
| Surgery Type | Description | Typical Risks |
|---|---|---|
| Complete Resection | Removal of all visible tumor | Bleeding, infection |
| Subtotal Resection | Removal of part of the tumor | Vision loss, brain effects |
| Biopsy | Sampling a small part for diagnosis | Minimal, but possible risks |
Radiation Treatments
Radiation therapy uses targeted energy beams—like X-rays or protons—to damage or destroy tumor cells. Doctors often give this treatment after surgery to kill any leftover cancer cells. Sometimes, they use it as the main treatment if surgery is too risky.
A typical radiation schedule involves sessions five days a week for a few weeks. The machine directs focused beams at the tumor site while protecting healthy tissue.
Common side effects of radiation include:
- Fatigue
- Scalp tenderness
- Hair loss on the treated area
Doctors may adjust the treatment plan based on the individual’s needs and the type of glioma, such as glioblastoma.
Medicines That Target Tumor Cells
Chemotherapy uses special drugs that travel either through the bloodstream (by IV) or by mouth (pills) to reach and kill cancer cells. Sometimes, doctors place drugs directly at the tumor site.
Doctors often combine chemotherapy with radiation therapy, especially after surgery or when complete tumor removal isn’t possible.
Usual side effects include:
- Nausea or vomiting
- Hair loss
- Feeling very tired
- Fevers
Doctors may give other medicines to help manage side effects.
Electrical Field Therapy
Tumor treating fields therapy sends gentle electrical signals through the scalp using sticky pads. These signals disrupt the growth and division of tumor cells. Doctors mostly use this treatment for aggressive tumors like glioblastoma and sometimes combine it with chemotherapy.
How it works:
- Sticky pads are placed on the scalp, connected by wires to a small portable device.
- Patients often need to shave their heads to allow the pads to stick well.
- The device delivers low-intensity electrical fields that slow tumor growth.
The most common side effect is skin irritation where the pads are placed.
Precision Medicines
Targeted therapy uses drugs that focus on specific features of cancer cells, such as proteins or genes that drive tumor growth. These drugs block the processes that let cancer cells survive.
Doctors usually run tests before starting this treatment to see if the tumor has targets that can be blocked by these medicines. Targeted therapy may be used when surgery cannot remove the tumor completely, or if other treatments have not worked.
Possible side effects depend on the medicine and how it’s given, and may include rash, diarrhea, or changes in blood counts.
Recovery and Support After Treatment
Treating gliomas can affect movement, speech, memory, and other daily abilities. Many people need special support to recover or learn new ways to manage tasks.
Types of Recovery Support
- Physical Therapy: Helps patients regain strength and movement in arms, legs, and other parts of the body.
- Occupational Therapy: Teaches ways to return to routine activities, work, and hobbies.
- Speech Therapy: Supports people who have trouble talking, understanding speech, or swallowing.
- Tutoring for Children: Helps young patients with changes in learning or memory after treatment.
Teams often include different specialists to help patients adjust and recover as much function as possible.
Non-Traditional Therapies
Some people with glioma choose to use alternative approaches alongside standard treatments. These approaches do not cure gliomas but may help manage symptoms and reduce stress.
Examples of complementary methods include:
- Acupuncture
- Hypnosis
- Meditation
- Music therapy
- Relaxation exercises
These techniques are often called integrative treatments. Patients should talk to their medical team before starting any new therapy. Integrative methods can be used with treatments like surgery, radiation, or chemotherapy.
Coping and support
Facing a glioma diagnosis can be difficult, but there are ways to manage the stress and uncertainty that come with it. Taking steps to understand the condition and available treatments can help individuals make informed choices about their care.
Strong support from friends and family is important. Loved ones can help with daily tasks and provide emotional comfort, especially during challenging times. Knowing there is someone to rely on reduces feelings of isolation and helps with mental well-being.
Talking about feelings and worries is useful for many people. Whether it is with a close friend, a relative, or a professional counselor, sharing emotions can lighten the mental burden.
Many also benefit from joining a support group where they can connect with others who are going through similar experiences, either in person or online.
Getting Ready for Your Visit
Steps You Can Take Beforehand
The time before an appointment can feel stressful, but being organized helps. Patients should make sure they clarify any special instructions for the visit, such as whether to fast or avoid certain foods.
This information is best gathered when first scheduling the appointment. Keeping track of symptoms is key. Writing down every symptom, even those that don’t seem connected to a brain tumor, can be helpful.
Note when symptoms began, how often they happen, and whether anything makes them better or worse.
Personal history matters. Bringing notes about recent life changes, stress, or events that might relate to health can help the healthcare team understand the big picture.
Medications, supplements, and vitamins should all be listed in detail, including the dose and how often each is taken. This can prevent harmful interactions and give the doctor a clear overview.
Many people find it hard to remember everything discussed during medical visits. Bringing a family member or friend provides extra support. This person can take notes, remember advice, and ask questions the patient might forget.
Preparing questions ahead of time helps maximize the value of the appointment. Writing them in order of importance is smart since time can be short. Some examples of questions to consider include:
- What type of brain tumor is present?
- Where is the tumor located?
- How large or severe is the glioma?
- Is it cancerous?
- What tests will be needed next?
- What are all the possible treatments?
- Are there pros and cons for each treatment option?
- What impact could treatments have on daily life, such as talking, moving, or working?
- Should a specialist such as a neuro-oncologist be consulted?
- Are there clinical trials available?
- How often will follow-up appointments be needed?
To stay organized, patients can use a table like the one below:
| Item to Prepare | Example |
|---|---|
| List of symptoms | Headaches, forgetfulness, vision changes |
| Current medications | Aspirin 81 mg daily, Vitamin D 1,000 IU daily |
| Major life events | Job loss, move, recent stress |
| Questions for the doctor | See above list |
| Support person | Bring a trusted family member or friend |
Tip: Pick the three most important questions in case time runs short so these can be asked first. If more questions come up during the appointment, it’s okay to ask on the spot.
Types of Questions Your Provider Might Ask
During the appointment, providers often ask very specific questions to understand symptoms and the overall situation. Your responses give important clues about the tumor and its effects.
Some questions a healthcare provider, such as a neurologist or neuro-oncologist, might ask include:
- When did the symptoms start appearing?
- Are symptoms ongoing or do they come and go?
- How intense or severe are the symptoms?
- Has anything made the symptoms better or worse?
Clear answers give providers more time to discuss options and next steps. Patients can prepare by writing out brief timelines and descriptions ahead of time.
A specialist like a neuro-oncologist may ask more about:
- Family history of cancers or neurological disease
- Any prior treatments for brain or nervous system problems
- Lifestyle factors, like diet or sleep habits
Sometimes, patients can complete forms in advance, either online or on paper. Filling these out early allows the first appointment to focus on important decisions, such as treatment planning or getting second opinions.
