High-Grade Gliomas
High-grade gliomas are fast-growing cancers that form in the brain or spinal cord. Surgery, radiation, and targeted therapies can help
What Are High-Grade Gliomas?
A high-grade glioma is a type of tumor formed in the brain or spinal cord (central nervous system or CNS) through the abnormal growth of glial cells. Glial cells surround, protect, and help with the functions of neurons—the cells that help send messages from your brain to the rest of your body. Gliomas are classified into different tumor types based on which glial cells the tumor developed from, what part of the brain the tumor grows in, and how aggressive the tumor cells appear under the microscope. There are four different types of glial cells that can turn into a glial tumor: ependymal cells, microglia, astrocytes and oligodendrocytes. Then gliomas are also categorized into four different grades, based on how aggressive the tumor cells are and how fast the tumor grows. High-grade gliomas are graded as a 3 or 4, indicating they are more aggressive and grow more rapidly.
What Causes High-Grade Gliomas?
In most cases, there is no known cause for the development of high-grade gliomas, and they are usually not passed down to offspring / children There is no evidence to suggest that any outside elements (diet, lifestyle, culture, climate, etc.) an cause this type of tumor. Researchers believe that the most common cause absences of things found during normal development that results in the growth of the tumor. Specifically, cells of the brain and spinal cord grow and divide as the body develops. During this cell division process, cells need to replicate their genetic material. Errors can take place during this process, leading to mutations, which may allow cells to grow into tumors. These errors generally occur randomly and could not have been prevented.
What Are the Signs and Symptoms of High-Grade Gliomas?
Your child’s symptoms can vary depending on the location and size of the tumor. One of the most common symptoms is severe headache in the morning that causes your child to wake up, often accompanied by nausea and vomiting.
Some of the other symptoms that your child might experience include:
- vision, hearing, communication and balance problems
- one-sided weakness
- seizures
- unexplained weight loss or gain
- changes in behavior or personality
- increased head size (in infants, due to the fontanels, the space between the bones of the skull, not being completely closed)
How Are High-Grade Gliomas Diagnosed?
Your child's healthcare provider will ask about your child's health history and symptoms. The provider will do a physical exam and a neurological exam. They will test your child’s reflexes, muscle strength, eye and mouth movement and coordination. Your child's healthcare provider may refer your child to a cancer specialist (oncologist). Your child may need tests such as:
- CT Scan - A CT scan uses a series of X-rays and a computer to make detailed pictures of the body. CT scans are very quick imaging, usually no more than a few minutes of scanning (though preparation may take longer).
- MRI - An MRI uses large magnets, radio waves, and a computer to make detailed pictures of the body. Contrast dye may be injected into your child's vein. It helps show the tumor clearly on the final image. MRIs are very detailed imaging (provide much more information about the tumor), so take longer to perform (often 1-2 hours).
- Biopsy - Tumor cells are removed during surgery and sent to a lab for testing. This is done to find out the type of tumor (to finalize the tumor diagnosis) to determine how best to treat it and to understand how aggressive it is.
How Are High-Grade Gliomas Treated?
Treatment for high-grade gliomas will be individualized for your child based on the patient’s age as well as the location, grade, and possible genetic testing. Your child’s treatment can include some or all of the following:
- Surgery - This is done to remove part or all of the tumor. More surgery may be needed over time if the tumor grows back. Surgery may be followed by chemotherapy or radiation therapy.
- Chemotherapy - These are medicines that kill cancer and other fast-growing cells. One or more medicines may be given. Medicines may be oral or given through an IV or central line.
- Targeted Therapy - These are medicines (usually oral) used to target specific genetic alterations in the cancer cells and kill them.
- Radiation Therapy - These are high-energy X-rays or other types of radiation. They're used to kill cancer cells or stop them from growing.
- Clinical Trials - A clinical trial is a way to test new treatments for cancer. Ask your child's healthcare provider if there are any treatments being tested that may be worth trying for your child. Many new treatments are only available in clinical trials.
- Supportive Care - Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, nausea and vomiting. This is an important part of cancer care.
Other treatments may include:
- Steroids - These are medicines to help prevent or reduce swelling in the brain.
- Anticonvulsant Medicines - These help to prevent or control any seizures.
- Shunt Placement - A shunt is a small plastic tube. It’s put into the skull to drain any fluid that has built up in or around the brain. It is internal (all inside the body) and usually connects the ventricles (the parts of the brain containing spinal fluid) with the abdomen.
A child may have short- and long-term problems from the tumor or from treatment. They may include things such as:
- Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech or eyesight
- Problems after surgery, such as infection, bleeding and problems with general anesthesia
- Infection and increased risk of bleeding from chemotherapy
- Delayed growth and development
- Learning problems
- Problems with reproduction (infertility)
- Return of the cancer (recurrence)
- Increased risk for other cancers later in life
Talk with your child’s doctor about what you should watch for and what can be done to help prevent complications.
Why Choose Nationwide Children’s Hospital?
The Neuro-Oncology Program at Nationwide Children’s Hospital offers clinical excellence in treating children, adolescents, and young adults with brain and spine tumors. Patients and their families will be supported by a multi-disciplinary team of providers, all dedicated to ensuring that the patient has the best possible outcomes. Depending on the specific tumor diagnosis and treatment plan, the patient and their family will be cared for by oncologists, neurosurgeons, radiation oncologists, clinical psychologists, rehabilitation medicine doctors, neurologists, endocrinologists, ophthalmologists, therapists (physical, occupational, speech, art, music), social workers, dieticians, and/or pharmacists. These team-members all work closely together with one another and the family to provide the best care for the patient.
Nationwide Children’s Hospital is also a national leader in oncology research and clinical trials. There are many ongoing research studies aimed at improving outcomes for children and young adults with brain/spine tumors—understanding why these tumors develop and how to appropriately target them. We are members of all major pediatric brain tumor consortia including Pediatric Brain Tumor Consortium, Collaborative Network of Neuro-oncology Clinical Trials ( CONNECT), Pacific Neuro-oncology Consortium (PNOC) and the Children’s Oncology Group (COG) and have many open clinical trials testing new drugs in difficult-to-treat tumors.
