Gliomas

What Is a Glioma?

A glioma is a type of brain tumor that starts in glial cells. These cells support the nerve cells of the brain and spinal cord.

Glioma (glee-OH-muh) tumors can happen anywhere in the brain or spine and symptoms depend on the location of the tumor. They can be low-grade (slow-growing) or high-grade (fast-growing). High-grade tumors are more likely to spread and are harder to treat than low-grade tumors.

Doctors treat most gliomas with surgery alone or combinations of surgery, chemotherapy, and radiation therapy.

Gliomas are the most common type of brain tumor in children, with low-grade tumors happening more often than high-grade tumors.

What Are the Types of Gliomas?

There are many different types of gliomas. They used to be grouped by the cells involved and where they form in the brain or brainstem. But doctors have learned a lot about the gene changes seen in different kinds of tumors. Now, they use these changes to help group different tumors and decide on the best treatment.

Types of gliomas include:

• pilocytic astrocytomas (ah-streh-sye-TOE-muhz): These are the most common type of gliomas. They form from star-shaped brain cells called astrocytes. These tumors are low-grade, can often be removed with surgery, and are most common in the cerebellum. If they can’t be removed, doctors often treat them with chemotherapy or radiation therapy.
  
  Other types of gliomas that are less common than pilocytic astrocytomas, but still grow slowly, include tectal glioma, oligodendroglioma, ganglioglioma, and pleomorphic xanthroastrocytoma.
• optic nerve gliomas: These form in or around the optic nerve that connects the eye to the brain. These tumors are more common in kids with neurofibromatosis type 1.
• anaplastic astrocytomas, glioblastoma multiforme, and diffuse midline gliomas: These are considered high-grade tumors and can grow and spread rapidly. These are much harder to treat and are more likely to grow back after treatment.

What Are the Signs & Symptoms of a Glioma?

A glioma can cause symptoms by pressing on parts of the brain near it. It also can lead to a buildup of spinal fluid and pressure throughout the brain. This is called hydrocephalus.

Signs or symptoms vary depending on a child's age and the location of the tumor. They may include:

• headaches
• vision problems
• vomiting
• seizures
• weakness of the face, arms, or legs; poor coordination; or trouble standing or walking
• slurred speech, confusion
• changes in behavior
• tilting the head
• in babies and young toddlers, an increased head size

What Causes Gliomas?

Doctors don't know what causes gliomas, but kids with some types of genetic conditions are more likely to develop them.

How Is a Glioma Diagnosed?

If doctors suspect a glioma, they will do an exam and order imaging tests of the brain, like an MRI. These let them see inside the brain and find any areas that look abnormal. 

If there is a glioma, surgery may be the next step. Depending on how the tumor looks on imaging tests, surgeons may try to remove as much of it as they can.

Samples of the tumor are viewed under a microscope to learn what type of tumor it is and whether it is low-grade or high-grade. Then, doctors can develop a treatment plan.

How Are Gliomas Treated?

Treatment depends on the type of glioma. Some low-grade tumors can be treated with surgery alone. But many kids with gliomas need a combination of surgery, radiation therapy, and/or chemotherapy. Diffuse midline tumors usually can’t be removed, so kids will get chemotherapy and radiation instead.

Recent advances in medicine and technology means that more kids are being cured now than ever before. Treatment may include:

Surgery: In many cases, a tumor can be completely removed with one surgery. But some tumors are removed with “staged” surgeries. This means that at first neurosurgeons take out only part of the tumor. The patient then might get chemotherapy and/or radiation therapy to shrink the tumor, followed by a second or even third surgery to remove the rest of the tumor.

After surgery, some kids won’t need more treatment. They’ll just get regular checkups and imaging scans to watch for problems. Others will need radiation therapy, chemotherapy, or both.

Radiation therapy: This uses high-energy X-rays (photon therapy) or proton beam therapy to kill rapidly multiplying cells. It’s very effective in treating brain tumors. But long-term side effects are common in young children whose developing brains are highly sensitive to its effects. New methods of radiation like proton therapy or intensity-modulated radiation therapy (IMRT) are less likely to cause these side effects because they more accurately target the tumor and help avoid injury to other parts of the brain.

Chemotherapy: Chemo is the use of drugs to kill cancer cells. It's routinely used for gliomas in kids with good results.

Targeted therapies: New information about genetic changes in tumors has led to a whole new class of treatments that specifically target these changes. They are being used with increasing success in children with brain tumors.

Doctors are always looking for new ways to treat gliomas. Some patients might be candidates for a clinical trial. Talk to the doctor about whether this might be a good option for your child.

Who Is on the Care Team?

A team of specialists works together to care for a child with a glioma. They may include:

• a pediatric neuro-oncologist (a doctor who treats cancers of the brain or spine)
• a pediatric neurologist (a doctor who treats nervous system problems)
• a pediatric neurosurgeon (a surgeon who operates on the brain or spine)
• a pediatric radiation oncologist (a specialist who gives radiation therapy)
• pediatric rehabilitation medicine specialists, including speech therapists, physical therapists, and occupational therapists
• pediatric psychologists and social workers

What Else Should I Know?

If your child has a glioma, it can feel overwhelming. It’s normal to feel sad, scared, and even angry. It helps to find support from members of your care team, friends and family, and other parents who’ve gone through it.

When talking about it with your child, it’s best to be honest, but give information that fits your child’s age and emotional maturity. Make sure kids know that the tumor isn’t the result of anything they did. If you need help answering questions, or don’t know what to say, a member of your care team can help.

The future for kids with brain tumors is better than ever. You can find more information and support online at:

• National Cancer Institute
• Pediatric Brain Tumor Foundation