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Low-grade gliomas

A low-grade glioma is a tumor in the brain or spinal cord. A low-grade glioma has a lower degree of malignancy (grade 1 or 2) than a high-grade glioma (grade 3 or 4), grows slower and is associated with better life prospects. 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. Some children with low-grade glioma have neurofibromatosis, a disorder of the hereditary material (DNA) of the cells that can eventually cause tumors in the nervous system. There are different types of gliomas. Each type is named after the support cells from which it originated. The low-grade astrocytoma is particularly common in children. Every year in the Netherlands a low-grade glioma is discovered in about 40 children. This type of tumor occurs in children of all ages and can occur in the cerebrum, the cerebellum and the spinal cord. Children with low-grade gliomas generally have a good chance of recovery.

Symptoms of this diseasee

The symptoms depend on the location of the tumor. Initially, a low-grade 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. There are children who suddenly start to look cross-eyed or see double because of the increased pressure in their heads. Balance problems also occur; your child may trip over his or her own legs as well as crawl or walk differently.

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. The pressure in the brain may also increase later. 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. Based on this MRI, it will be possible to identify suspicion to a low-grade glioma. In order to confirm the diagnosis, tumor tissue will almost always have to be obtained. This can be done by means of a biopsy or a resection of part or sometimes of the entire tumor. In some cases, when there is suspicion of a low-grade glioma, a wait-and-see policy may also be adopted, with regular checks being carried out using MRI scans. This is only justified if there is no doubt about the low-grade nature of the tumor.

Treatment of low-grade gliomas

The treatment of a low-grade glioma may consist of surgery, chemotherapy or radiotherapy. Sometimes a wait-and-see policy is initially adopted. This is particularly the case for a tumor by the optic nerve(s). Your child will be closely monitored, regularly receives an MRI and the eyes are also scrutinized.

The choice of therapy depends on the location of the tumor and the age of the child. It often starts with an operation. If the glioma can be completely removed, then your child will not receive any after-treatment but a long period of checks will follow in which your child is continuously carefully examined. If the glioma cannot be removed or can only be partially removed and the doctor expects the tumor to grow again, radiotherapy and/or chemotherapy will sometimes follow. Children older than eight years usually receive radiotherapy; if your child is younger than eight, chemotherapy is the first choice. A combination of both treatments is also possible. Children with neurofibromatosis almost always receive chemotherapy.