Glioblastoma brain new therapy

Brain glioma: life expectancy, symptoms, causes and treatment

Brain glioma is a disease that includes a group of tumor pathologies localized in the meninges. The impetus for the development of gliomas is pathologically overgrown auxiliary cells of the nervous system.

Gliomas account for more than half of all brain tumors; the disease affects not only adults, but also children. The life expectancy of patients depends on the degree of tumor.

Causes of tumor

Scientists have found that neoplasms appear due to the rapid proliferation of immature glial cells. This is how benign and cancerous gliomas appear.

Tumors form in the gray or white matter around the central canal, in the posterior part of the pituitary gland, cells in the cerebellum, or in the retina. Glioma develops slowly from the volume of a small grain to a round body with a diameter of 10 cm. Metastases spread in rare cases. The exact reasons for the growth of cancerous glioma have not been determined, but scientists are inclined to believe that they lie at the genetic level when the structure of the TP53 gene is disrupted.

It is difficult to treat this disease precisely because it is poorly understood. This tumor has clear contours and affects one area of ​​the brain. Metastases almost never develop.

Forecast

Glioma usually has a poor prognosis due to the impossibility of its complete removal. After resection, the tumor is prone to rapid recurrence. With a high degree of malignancy, 50% of patients die within a year, 25% within two years. When stage I (benign) glioma is removed, in 80% of cases patients live longer than 5 years.

You can undergo a high-precision test for predisposition to cancer at any time, as well as tests for the sensitivity of cancer to anticancer drugs.

Classification

Gliomas include a variety of tumors depending on which cells are affected. Thus, they can arise from ependyma, astrocytes and other cells. The most common types are:

1. Ependymoma - occupies about eight percent of all brain tumors, mostly affecting the ventricles;
2. Diffuse astrocytoma - this disease occurs in every second case. This tumor is usually located in the white matter of the brain. The most common glioma is the brainstem;
3. Mixed tumors - include altered cells from the above types, can occur in any part of the brain;
4. Oligodendroglioma is a pathology that occurs on average in every tenth patient out of a hundred. Localized along the ventricles, can grow into the cerebral cortex;
5. Neuromas - a tumor originating from the myelin sheaths, is benign in nature, but can provoke tissue malignancy. This is an optic nerve glioma or chiasmal glioma;
6. Vascular tumors are a rare brain pathology with tumor growth into the vessels;
7. Neuronal-glial tumors are the rarest type of disease; both neurons and glial tissue are involved in the pathological process.

Glioma symptoms

The symptoms of a growing glioma directly depend on which part of the brain the tumor occupies. The neoplasm compresses tissues and membranes, which leads to cerebral symptoms:

1. Severe headaches that cannot be relieved by taking analgesics and antispasmodics.
2. The appearance of heaviness in the eyeballs.
3. Nausea resulting from headaches. Patients also complain of periodic vomiting, which also occurs at the peak of an attack.
4. Cramps.

If a glioma compresses the cerebrospinal fluid pathways and ventricles of the brain, hydrocephalus develops and intracranial pressure increases. In addition to general cerebral symptoms, glioma also affects the occurrence of focal manifestations of the disease, these are:

1. Dizziness.
2. Unsteadiness during normal movement.
3. Visual impairment.
4. Hearing loss or tinnitus.
5. Speech function disorder.
6. Decreased sensitivity.
7. Decreased muscle strength, which causes paresis and paralysis.

In patients with brain glioma, mental changes are also detected, expressed by disorders of all types of memory and thinking, and certain disturbances in behavioral function.

Why do children get high-grade gliomas?

The disease begins due to mutation of nervous tissue cells [glial cells]. No one knows exactly why these cells mutate.

It is known that if a child has a hereditary disease that is associated with certain developmental disorders/anomalies (for example, neurofibromatosis type I, Li-Fraumeni syndrome or Hippel-Lindau syndrome), then they have an increased risk of developing high-grade glioma.

In addition, experts have found that glioma cells have changes in certain genes or chromosomes [chromosomes]. Due to these breakdowns in genes, a mechanism can be triggered when a healthy cell becomes a glioma cell (mutates). In general, changes in genes that experts find in tumor tissue are not hereditary. It is highly likely that these changes occur at a very early stage of development.

It is also known that if a child has previously been treated for acute leukemia or eye cancer (for example, retinoblastoma) and had radiation to the brain, then he has a higher risk of developing brain cancer over time.

Stages of development

According to the international classification of diseases, the stages of tumor development are assessed according to the degree of danger to the patient’s life. It is customary to divide the disease into four groups or stages of development:

1. 1st degree – benign formation with a tendency to slow development. Has the most favorable course of the disease. With timely measures taken, it is possible to extend the patient’s life to 8-10 years. This grade corresponds to congenital benign glioma.
2. Grade 2 – the tumor begins to slowly but steadily increase in size. The first signs of degeneration into a malignant formation appear. Signs of deterioration are manifested in a constant increase in neurological and other symptoms.
3. Grade 3 – anaplastic glioma. At the third stage, the disease has symptoms characteristic of a malignant neoplasm. Life prognosis does not exceed 2-5 years. There is no metastasis to other areas of the body, but sometimes the spread of cancer to different parts of the hemispheres is observed.
4. The prognosis for diffuse brainstem glioma is extremely unfavorable. The patient rarely lives more than 2 years.
5. Grade 4 – a large tumor of a malignant nature with a tendency to rapid tumor growth. The prognosis is unfavorable. The patient's life expectancy is up to 1 year. At this stage, inoperable malignant glioma is diagnosed.

Diffuse glioma in young patients is treated radiologically. After a short-term improvement, the disease returns in a more severe form.

Diffuse gliomastem

( Diffuse brainstem glioma ) – a tumor of the brain stem, consisting of immature glial cells, can have both low and high degrees of malignancy (Grade I-IV), accounting for 15% of all brain tumors in children.
The peak incidence occurs between 3 and 9 years of age; boys and girls are affected with equal frequency. It is distinguished by diffuse infiltration of the anterior sections of the bridge with distribution along the spinal tract. As a rule, it occurs due to genetic mutations. Clinically manifested as nausea, vomiting, headache, dysfunction of cranial nerves with bulbar symptoms, ataxia, dysarthria, nystagmus, sleep apnea, pyramidal symptoms. It has a poor prognosis, with an average life expectancy of less than 1 year. Clinical case

Patient, 8 years old. Complaints of drowsiness, vomiting, weakness in the left upper and lower extremities. The patient has a trunk syndrome of uneven, predominantly left-sided hemiparesis, paresis of facial muscles on the left, ophthalmoparesis, and dry eye syndrome. According to MRI of the brain, the brainstem is sharply enlarged in size due to the presence of a diffuse formation of the bridge, spreading to the middle cerebellar peduncles (more on the right), the midbrain, more pronounced to the right peduncle, anteriorly to the prepontine, interpeduncular and suprasellar cisterns. In the posterior-right parts of the formation, hemorrhage is determined; tortuous vessels of various diameters are visualized upward and along the contour of the hemorrhage.

Diagnostics

Low-grade gliomas are very rarely diagnosed in the initial stages because they may not have clinical symptoms. In most cases, they are discovered during computed tomography or magnetic resonance imaging after traumatic brain injury or to evaluate vascular disease. In such situations, brain examinations are prescribed by neurologists. When losing vision or hearing, patients turn to specialists in a narrow field, who must be aware of insidious pathologies in the brain.

To adequately assess brain glioma, the patient is referred for magnetic resonance imaging. It is this type of diagnosis that allows you to accurately determine the location of the tumor, its volume and the affected area in a three-dimensional image.

Depending on the symptoms, the patient may be referred for echoencephalography, multivoxel or magnetic resonance spectroscopy, or positron emission tomography. For the most accurate diagnosis, a biopsy is prescribed - a microscopic examination of part of the biological material.

Methods for diagnosing glioblastoma

Computed tomography (CT) scan reveals the tumor and associated changes. However, CT scanning may miss small tumors. A small low-grade glioma missed on screening may eventually develop into glioblastoma multiforme. In addition, multifocal tumor variants may not be visible on CT scans. Spread of glioblastoma via cerebrospinal fluid flow, especially early spread, can also be difficult to diagnose using CT.

Magnetic resonance imaging (MRI) is a much more sensitive method for detecting tumors as well as associated changes, including peritumoral edema. Therefore, MRI is the method of choice for patients with suspected or confirmed glioblastoma multiforme. Because this tumor exhibits aggressive infiltrative growth, tumor cells are often located outside the zone of altered signal intensity on MRI. Metastases to the central nervous system are common, but extracerebral metastases (located outside the brain) are quite rare.

Get an MRI of the brain in St. Petersburg

After surgery, distinguishing between recurrent tumor and scar tissue based on MRI alone can be difficult. In this case, a more suitable research method would be positron emission tomography (PET).

Due to the wide variety of tumor manifestations, in some cases it can mimic other conditions such as infarction, abscess or even tumor-like plaque in multiple sclerosis, and thus delay the correct diagnosis. In addition, other pathological processes of the brain are also sometimes mistaken for glioblastoma. In such cases, it is necessary to consult an experienced neuroradiologist in order to clarify the true nature of the formation. Repeated interpretation of MRI in a specialized medical center increases the accuracy of the diagnosis. If we talk about the signs that magnetic resonance imaging characterizes tumors ranging from low-grade astrocytoma to glioblastoma multiforme, we can make the following generalization (although exceptions are possible):

• The incidence of areas of calcification in the tumor decreases on a spectrum from low-grade astrocytoma to glioblastoma multiforme
• The incidence of tumor enhancement increases along a spectrum from low-grade astrocytoma (contained by the blood-brain barrier, has a low incidence of contrast enhancement) to glioblastoma multiforme (penetrates the blood-brain barrier)
• The incidence of hemorrhage, necrosis, mass effect and edema also increases from low-grade astrocytoma to glioblastoma multiforme
• In the absence of hemorrhagic changes, most tumors are hypointense on T1-weighted images and hyperintense on T2-weighted images
• Signal enhancement on CT images is similar to that on MRI images

There are different types of glioblastoma multiforme. Giant cell (monstrocellular) glioblastoma is a type of glioblastoma multiforme, but has the same features on MRI.

Treatment of brain glioma

The only method that helps achieve significant improvements in the patient’s well-being is brain neurosurgery. The operation is complicated by the fact that any mistakes by the surgeon lead to serious dysfunction of the human body, paralysis and death.

Removal of brain glioma is carried out using several methods:

Glioma has genetic causes of formation. Therefore, after surgery, the tumor may form again. The use of genetic engineering drugs can reduce the size of a malignant tumor and facilitate surgery.

These newer drugs target cancer cells, killing them. The size of the tumor does not change, the patient can live longer without pain. Genetic engineering drugs make it possible to avoid repeated surgery.

Surgical intervention

The course of the removal operation includes 3 main stages:

1. Visualization of process boundaries. This is possible with the use of special drugs that lead to the accumulation of protoporphyrin around the pathology. Thanks to this technique, the tumor is not only better visualized, but also slows down its spread.

2. Direct removal of tumor, including metastases. Unfortunately, due to the fact that the boundaries of glioblastoma are blurred, in some situations even parts of healthy tissue have to be removed. But this option is carefully discussed both with the patient himself and his relatives, because when some structures are removed, the consequences are worse than from the underlying disease.

3. Suturing soft flaps, suturing, aseptic dressing on the postoperative wound.

Due to the fact that it has unclear boundaries and an irregular shape, its individual elements, with all the efforts of the surgeon, can be missed and go unnoticed. For this reason, complete removal is often not possible, and there is always a high probability of relapse of the disease. In this regard, the course of surgical intervention is often supplemented with subsequent chemotherapy treatment.