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High-grade gliomas

A high-grade glioma is a malignant tumor in the brain or spinal cord. A high-grade glioma has a higher degree of malignancy (grade 3 or 4) and is more difficult to control than a low-grade glioma (grade 1 or 2). A glioma is a tumor that emanates from the supporting tissue (glia) of the brain. A glioma is caused by a fault in the development in one of the precursor cells of the support cells.

There are different types of gliomas. Each type is named after the support cells from which it originated. There are also subtypes. For example, an anaplastic astrocytoma and a glioblastoma multiforme are both high-grade astrocytoma’s. Every year in the Netherlands a high-grade glioma is discovered in about 35 children. This brain tumor occurs in children of all ages. They can occur in the cerebrum, the cerebellum and the spinal cord. Pontine gliomas lie in the pons, part of the brain stem. Children with high-grade gliomas generally have a moderate chance of recovery. The most important thing is whether the tumor can be removed completely. The grade of the tumor also plays a role. Grade 3 is slightly more favorable than grade 4. If the tumor can be removed completely and there are no metastases, then the chance of a cure is reasonable to good.

 
Symptoms of this disease

The complaints depend on the location of the tumor. Initially, a glioma in the cerebellum or in one of the ventricles of the brain mainly causes ambiguous symptoms. Your child may be a bit nauseous or have a headache. This is due to the increased brain pressure as a result of increased tissue and/or fluid in the brain. If the pressure increases further, your child may vomit more. Balance problems also occur; your child may trip over his or her own legs as well as crawl or walk differently. There are children who suddenly start to look cross-eyed or see double because of the increased pressure in their heads.

If the tumor is in the vicinity of the brain stem, it is possible that your child will have less control of his/her arms or legs, have difficulty swallowing or breathing, experience problems writing or no longer be able to maintain his/her temperature. This is because important nerves are trapped. Later on, the pressure in the brain can also increase.

A glioma in the cerebrum can cause epilepsy. A seizure is sometimes the first symptom. Hormonal disorders such as growth retardation, obesity or premature puberty also occur.


How do we make the diagnosis?

In case there is suspicion of a brain tumor, an MRI scan always needs to be performed. This is important for high-grade gliomas in order to get a good picture of the local expansion and to assess whether the tumor can be reduced or removed by means of neurological surgery or whether a biopsy needs to be performed. The assessment of the tumor tissue obtained during an operation is ultimately decisive for the diagnosis. Additional diagnosis of cerebrospinal fluid is less common with high-grade gliomas.

 
Treatment of high-grade gliomas

The treatment of a high-grade glioma almost always starts with an operation. This is followed by radiotherapy. In young children, because of the expected long-term consequences, radiotherapy is delayed for as long as possible or limited to a small part of the brain. Surgery is not usually an option for pontine gliomas. An attempt is often made to temporarily reduce the symptoms of radiotherapy. Most gliomas are not as sensitive to chemotherapy. However, recently more and more scientific research has been carried out into the effect of new medicines. Your doctor will discuss any options with you.