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 — e.g., [[pilocytic astrocytoma]]
:*WHO Grade 2 — e.g., diffuse or low-grade astrocytoma
:*WHO Grade 3 — e.g., [[anaplastic]] ([[cancer|malignant]]) astrocytoma
:*WHO Grade 4 — [[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]]
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