Glioma 645839 222483146 2008-06-29T16:09:57Z 68.40.210.251 /* Classification */ {{DiseaseDisorder infobox | Name = Glioma | ICD10 = {{ICD10|C|71||c|69}} | ICD9 = {{ICD9|191}} | ICDO = 9380/0-9460/3 | Image = | Caption = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | DiseasesDB = 31468 | MeshID = D005910 | }} A '''glioma''' is a type of [[cancer]] that starts in the brain or spine. It is called a glioma because it arises from [[glial cell]]s. The most common site of gliomas is the [[brain tumor|brain]].<ref>Mamelak A.N., and Jacoby, D.B. ''[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&list_uids=17335414&cmd=Retrieve&indexed=google Targeted delivery of antitumoral therapy to glioma and other malignancies with synthetic chlorotoxin (TM-601)]'' Expert Opin. Drug Drliv. (2007) '''4'''(2):175-186.</ref> ==Classification== Gliomas are classified by cell type, by grade, and by location. ===By type of cell=== Gliomas are named according to the specific type of cell they most closely resemble. The main types of gliomas are: * [[Ependymoma]]s — [[ependymal cell]]s * [[Astrocytoma]]s — [[astrocyte]]s * [[Oligodendroglioma]]s — [[oligodendrocyte]]s * Mixed gliomas, such as [[oligoastrocytomas]], contain cells from different types of glia. ===By grade=== Gliomas are further categorized according to their [[grade]], which is determined by [[pathology|pathologic]] evaluation of the tumor. [[Image:MRI glioma 28 yr old male.JPG|thumb|right|Low-grade brain glioma in a 28 year-old male. (Taken on [[2007-07-10]])]] * '''Low-grade''' gliomas are well-differentiated (not anaplastic); these are [[cancer|benign]] and portend a better prognosis for the patient. * '''High-grade''' gliomas are undifferentiated or [[anaplastic]]; these are [[cancer|malignant]] and carry a worse prognosis. Of numerous grading systems in use, the most common is the [[World Health Organization]] (WHO) grading system for astrocytoma. The WHO system assigns a grade from 1 to 4, with 1 being the least aggressive and 4 being the most aggressive. Various types of astrocytomas are given corresponding WHO grades. :'''WHO grading system for astrocytomas''' :*WHO Grade 1 &mdash; e.g., [[pilocytic astrocytoma]] :*WHO Grade 2 &mdash; e.g., diffuse or low-grade astrocytoma :*WHO Grade 3 &mdash; e.g., [[anaplastic]] ([[cancer|malignant]]) astrocytoma :*WHO Grade 4 &mdash; [[glioblastoma multiforme]] (most common glioma in adults) The prognosis is the worst for grade 4 gliomas, with an average survival time of 12 months. Overall, few patients survive beyond 3 years. [http://www.emedicine.com/NEURO/topic147.htm] [http://www.cjns.org/25augtoc/long.html] ===By location=== Gliomas can be classified according to whether they are above or below a membrane in the brain called the [[tentorium cerebelli|tentorium]]. The tentorium separates the [[cerebrum]], above, from the [[cerebellum]], below. * [[supratentorial]]: Above the tentorium, in the cerebrum, mostly in adults (70%). Senator [[Edward M. Kennedy]]’s brain tumor, for example was supratentoral, in the parietal area in the upper part of the left side of his brain, above the ear.<ref>Prognosis Usually Bleak for Condition, a Glioma, By LAWRENCE K. ALTMAN and ANAHAD O’CONNOR, New York Times, May 21, 2008</ref> * [[infratentorial]]: Below the tentorium, in the cerebellum, mostly in children (70%) ==Symptoms== Symptoms of gliomas depend on which part of the central nervous system is affected. A [[brain tumor|brain glioma]] can cause [[headaches]], [[nausea]] and [[vomiting]], [[seizures]], and [[cranial nerve]] disorders as a result of increased intracranial pressure. A glioma of the [[optic nerve]] can cause visual loss. Spinal cord gliomas can cause [[pain]], [[weakness]], or [[numbness]] in the extremities. Gliomas do not [[metastasis|metastasize]] by the bloodstream, but they can spread via the [[cerebrospinal fluid]] and cause "drop metastases" to the spinal cord. ==Pathology== High-grade gliomas are highly-[[vascular tumor]]s and have a tendency to infiltrate. They have extensive areas of [[necrosis]] and [[hypoxia (medical)|hypoxia]]. Often tumor growth causes a breakdown of the [[blood-brain barrier]] in the vicinity of the tumor. As a rule, high-grade gliomas almost always grow back even after complete surgical excision. On the other hand, low-grade gliomas grow slowly, often over many years, and can be followed without treatment unless they grow and cause symptoms. ==Prognosis== Gliomas cannot be cured. The prognosis for patients with high-grade gliomas is generally poor, and is especially so for older patients. Of 10,000 Americans diagnosed each year with malignant gliomas, about half are alive 1 year after diagnosis, and 25% after two years. Those with anaplastic astrocytoma survive about three years. Glioblastoma multiforme has a worse prognosis.<ref>[http://www.washingtonpost.com/wp-dyn/content/article/2008/05/20/AR2008052001376.html Malignant Gliomas Affect About 10,000 Americans Annually,] By Rob Stein, Washington Post, May 20, 2008</ref> ==Treatment== ===Standard therapy=== Treatment for [[brain tumor|brain gliomas]] depends on the location, the cell type and the grade of malignancy. Often, treatment is a combined approach, using surgery, [[radiation therapy]], and [[chemotherapy]]. The radiation therapy is in the form of external beam radiation or the [[stereotactic surgery|stereotactic]] approach using [[radiosurgery]]. Spinal cord tumors can be treated by surgery and radiation. [[Temozolomide]] is a chemotherapeutic drug that is able to cross the [[blood-brain barrier]] effectively and is being used in therapy. ===Refractory disease=== For recurrent high-grade glioblastoma, recent studies have taken advantage of [[angiogenic]] blockers such as [[bevacizumab]] in combination with conventional chemotherapy, with encouraging results.<ref name="pmid17947716">{{cite journal |author=Wong ET, Brem S |title=Taming glioblastoma: targeting angiogenesis |journal=J. Clin. Oncol. |volume=25 |issue=30 |pages=4705–6 |year=2007 |pmid=17947716 |doi=10.1200/JCO.2007.13.1037}}</ref> ===Experimental therapies=== The use of [[oncolytic virus]]es or [[gene therapy]] using [[prodrug converting retroviruses]] and [[adenoviruses]] is being studied for the treatment of gliomas.<ref>{{cite journal |author=Gromeier M, Wimmer E |title=Viruses for the treatment of malignant glioma |journal=Curr. Opin. Mol. Ther. |volume=3 |issue=5 |pages=503–8 |year=2001 |pmid=11699896}}</ref><ref>{{cite journal |author=Rainov N, Ren H |title=Gene therapy for human malignant brain tumors |journal=Cancer journal (Sudbury, Mass.) |volume=9 |issue=3 |pages=180–8 |year=2003 |pmid=12952303}}</ref> The experimental cancer medicine "Ukrain" has been used for solid cancers. There are case reports of efficacy on gliomas.<ref> {{cite journal | last = Aschhoff | first = B. | title = Retrospective study of Ukrain treatment in 203 patients with advanced-stage tumors | journal = Drugs Exp Clin Res | date = 2000 | volume = 26 | issue = 5-6 | pages = 249–252 }}</ref> [[Boron neutron capture therapy]]. ==Notable cases== *[[Fred Conlon]] *[[Daniel W. Hardy]] *[[Charles Whitman]] *[[Ted Kennedy]] *[[Chuck Schuldiner]] *[[Kim Walker]] ==References== {{reflist}} ==External links== * [http://www.astrofund.org.uk SDBTT Astro Fund: funding research and offering support to those affected by low-grade gliomas * [http://www.abta.org/index.cfm?contentid=59 American Brain Tumor Association: Malignant Gliomas] * [http://www.ninds.nih.gov/disorders/brainandspinaltumors/detail_brainandspinaltumors.htm Brain and Spinal Tumors: Hope Through Research (National Institute of Neurological Disorders and Stroke)] * {{GPnotebook|-2147090429}} * [http://virtualtrials.com/pdf/williams2007.pdf Treatment Options for Glioblastoma and other Gliomas (.pdf format)] * [http://www.hirntumorhilfe.de German Brain Tumor Association] * [http://rad.usuhs.mil/rad/who/who-index.html WHO Classification of Glioma] * [http://rad.usuhs.mil/medpix/medpix.html?mode=image_finder&action=search&srchstr=malignant%20glioma&srch_type=all#top Glioma Images]MedPix Database * [http://www.sciencedaily.com/releases/2007/08/070830155859.htm Experimental Anti-cancer Drug Kills Brain Tumor Stem Cells (Science Daily)] * [http://www.medicalnewstoday.com/articles/61156.php Statin Plus Cancer Drug Deliver Combo Punch to Brain Cancer Cells (Medical News Today, Jan 2007)] * [http://www.drugresearcher.com/news/ng.asp?n=77126-merck-kgaa-merck-serono-cilengitide-brain-tumour-glioblastoma KGaA drug blasts aggressive brain tumours] {{Nervous tissue tumors}} [[Category:Neurology]] [[Category:Types of cancer]] [[Category:Neurosurgery]] [[de:Gliom]] [[fr:Gliome]] [[it:Glioma]] [[ja:神経膠腫]] [[pl:Glejak]] [[pt:Glioma]] [[fi:Gliooma]] [[zh:神經膠質瘤]]