Gliomas
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Gliomas are tumors that develop from glial cells, support cells found in the brain and spinal cord. At Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, we specialize in glioma treatment options including surgery, radiotherapy and chemotherapy.
Gliomas make up more than a quarter of all brain tumors. Several types of gliomas exist, each of which can be benign or malignant. Each type is named after the kind of glial cell from which it arises. Glial cells include astrocytes, oligodendrocytes, and ependymocytes; each performs unique functions to support the brain and spinal cord. These are the types of gliomas:
Astrocytomas develop from astrocytes and are the most common type of glioma.
- Oligodendrogliomas arise from oligodendrocytes, oblong glial cells that cover nerve cells in the brain. These tumors make up about 10 to 15 percent of gliomas.
- Ependymomas come from cells called ependymocytes, which line the cavities of the brain and spinal canal. These tumors are rare and develop mostly in children.
- Mixed gliomas contain more than one type of glial cell. They are also sometimes called oligoastrocytomas and are usually a mixture of abnormal oligodendrocytes and astrocytes. Sometimes abnormal ependymocytes are present. Mixed gliomas make up about 5 to 10 percent of gliomas.
- Gangliogliomas develop from both glial cells and nerve cells. These are rare.
Gliomas can grow in a variety of places throughout the brain. Gliomas that grow in certain locations in the brain may have a name other than one listed above. This alternative, or additional, name is used because it describes the location of the tumor. Below are a few examples. All of these examples, derived from astrocytes, are astrocytomas.
- Optic glioma: a tumor that develops from the astrocytes around the optic nerves, which transmit visual information from the retina at the back of each eye to the brain.
- Brain stem glioma: A tumor in the brainstem, the lower region in the brain that coordinates circulation, respiration, and other tasks.
- Cerebellar astrocytoma: a tumor in the cerebellum, the small, lower part of the brain that coordinates balance and motor control.
Symptoms
Symptoms vary from patient to patient and depend on the type of glioma. Some common symptoms may include:
- Headache in the morning upon waking
- Nausea and vomiting
- Lethargy
- Changes in personality or behavior
- Seizures
- Vision problems
- Ataxia
Diagnosis
Diagnosing a glioma usually starts with a physical examination and a neurological examination to assess brain function. If a physician suspects a glioma or another type of brain tumor, a diagnostic imaging test such as magnetic resonance imaging (MRI) or computed tomography (CT) scan is most often the next step.
- MRI uses magnets, radio waves and advanced computer technology to image the brain and soft tissue structures like tumors. MRI is usually prefered to CT scan for glioma diagnosis.
- CT scan uses X-rays and a computer to image the skull bone, blood vessels and other structures in the brain. CT scan is a good option for patients who cannot undergo MRI, such as patients with pacemakers or other metallic implants.
A contrast agent (either swallowed as a pill or injected as a dye) can be used with each imaging test to increase the level of brain and tumor detail in the images.
Depending on several factors, including glioma location, a biopsy may be appropriate. The biopsy procedure is conducted in one of two ways—either open or stereotactic biopsy. Open biopsy is done while a neurosurgeon is performing brain tumor surgery to remove the tumor. Stereotactic biopsy does not require open surgery. Instead, a doctor performing stereotactic biopsy drills a small hole in the skull and then, using computer guidance, passes a needle through to obtain a tumor tissue sample.
Risk Factors
Experts aren’t sure what causes gliomas; investigation into possible causes is ongoing.
A few risk factors exist, including:
- Diagnosis of certain genetic disorders like neurofibromatosis type 1, tuberous sclerosis, Li-Fraumeni syndrome or Turcot syndrome
- Exposure to radiation, such as that from X-rays or gamma rays used to treat tumors
Gliomas occur in men and women and affect individuals of all ages.
Treatments
Each type of glioma requires its own unique treatment approach.
Our neurosurgeons consider the type of glioma, among several other factors like location and patient’s age, to devise an optimal treatment plan. For most patients with a glioma, treatment includes a combination of brain tumor surgery, radiotherapy and chemotherapy.
If the glioma can be removed without risking brain damage, a neurosurgeon will perform brain tumor surgery. During brain tumor surgery, a neurosurgeon removes part of the skull to access the tumor, a procedure called a craniotomy. A neurosurgeon’s goal during surgery is to remove as much of the glioma as possible while protecting the function of healthy brain tissue.
A combination of radiotherapy and chemotherapy is usually used to eliminate any tumor that could not be safely removed with surgery.
Patient Stories
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In the spring of 2013, most people knew Jan Greenfield, soon to be Dr. Sisti’s patient, as an outgoing, popular nurse at Columbia University Irving Medical Center. No one knew that he would soon be a patient there, too.
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