Navigating a Glioma Diagnosis: Understanding Your Tumor Type & Treatment Options

“These three groups all wind up getting treated somewhat differently. Astrocytoma is typically a little more on the aggressive side,” Dr. Burt Nabors, a neuro-oncology expert at University of Alabama Birmingham (UAB) Medicine in Birmingham, Alabama, tells SurvivorNet.

While all gliomas arise from different types of brain cells, their treatment approaches can vary significantly depending on their characteristics and how they behave in the brain.

Here’s a breakdown of the three types of cells and how they function.

Oligodendrocytes

Oligodendrocytes are specialized cells responsible for producing myelin, a fatty substance that acts as insulation around nerve fibers. Just like electrical wires need insulation to conduct signals efficiently, the brain’s nerve cells (neurons) need myelin to send messages quickly and accurately. When a tumor arises from these cells, it is called an oligodendroglioma.

Astrocytes

Astrocytes are star-shaped cells that play a crucial role in brain function. They help regulate immune responses, control brain chemistry, and provide structural support to neurons. They are essential in maintaining the brain’s delicate balance of chemicals and protecting against harmful substances. When a tumor forms from astrocytes, it is called an astrocytoma, and these tumors tend to be more aggressive than some other types of gliomas.

Ependymal Cells

Ependymal cells line the ventricles of the brain and help regulate cerebrospinal fluid, which cushions the brain and spinal cord. This fluid helps remove waste and provides essential nutrients. When tumors develop from ependymal cells, they are known as ependymomas.

Understanding Glioma Treatments

Each type of glioma requires a specific treatment approach. The goal of treatment is to remove or shrink the tumor while preserving brain function and improving the patient’s quality of life. Let’s take a closer look at how different types of gliomas are treated.

Oligodendrogliomas

Oligodendrogliomas tend to grow more slowly than some other brain tumors, which can influence the treatment approach.

Treatment options may include:

1. Surgery: The first step in treating oligodendrogliomas is often surgical removal. The extent of removal depends on the tumor’s location and how much can be safely extracted without damaging essential brain functions.
2. Radiation Therapy: High-energy beams are used to target and kill cancer cells, often recommended if the tumor cannot be completely removed with surgery.
3. Chemotherapy: Some patients benefit from chemotherapy, particularly with a combination of drugs like temozolomide or PCV (procarbazine, lomustine, and vincristine).
4. IDH targeting therapy with vorasidenib for low-grade oligodendrogliomas with IDH mutations should be discussed with your doctor.
5. Targeted Therapy & Clinical Trials: Researchers are exploring new drugs that specifically target molecular changes in oligodendrogliomas, and clinical trials may offer promising new treatments.

Astrocytomas

Astrocytomas can be more aggressive than oligodendrogliomas, meaning treatment often needs to be more intensive. The treatment plan may include:

1. Surgery: Removing as much of the tumor as possible is the first step. However, astrocytomas can infiltrate surrounding brain tissue, making total removal difficult.
2. Radiation Therapy: This is often used after surgery to target any remaining cancer cells and prevent regrowth.
3. Chemotherapy: Drugs like temozolomide are commonly used, especially for higher-grade astrocytomas.
4. Tumor-Treating Fields (TTFields): This is a newer therapy that uses electric fields to disrupt cancer cell growth and is sometimes used alongside chemotherapy.
5. IDH targeting therapy with vorasidenib for low-grade astrocytoma with IDH mutations should be discussed with your doctor.

Ependymomas

Ependymomas can vary in aggressiveness, and treatment is typically tailored to the patient’s specific situation. Treatment approaches often include:

1. Surgical Removal: The primary treatment is surgical excision, with the goal of removing as much of the tumor as possible.
2. Radiation Therapy: This is often recommended after surgery to kill any remaining tumor cells, particularly for tumors that cannot be entirely removed.
3. Chemotherapy: While chemotherapy is not always the first-line treatment for ependymomas, it may be used in certain cases, especially in young children or when tumors recur.
4. Clinical Trials & Emerging Therapies: Some patients may be eligible for new treatments being tested in clinical trials, which could offer additional options beyond standard therapies.

Navigating a Glioma Diagnosis

Being diagnosed with a glioma can be overwhelming, but understanding your specific tumor type and the available treatments can help you make informed decisions about your care. Here are some steps to take if you or a loved one is facing a glioma diagnosis:

1. Work with a Specialized Medical Team: A neuro-oncologist, neurosurgeon, and radiation oncologist can help guide your treatment plan.
2. Ask About Genetic Testing: Some gliomas have specific genetic markers that can influence treatment decisions and prognosis.
3. Consider Second Opinions: Seeking a second opinion at a major cancer center can provide more treatment options and access to clinical trials.
4. Stay Informed & Engaged: Learn as much as you can about your diagnosis and ask your doctors about the latest research and treatment advancements.
5. Seek Support: Support groups, counseling, and patient advocacy organizations can help you navigate the emotional and practical challenges of living with a brain tumor.

Questions to Ask Your Doctor

If you are facing a glioma diagnosis, understanding all the new information you are getting can be really overwhelming. Consider taking the following questions to your doctor at your next visit.

• What type of glioma do I have?
• Is there a standard treatment approach we will take?
• Should I undergo genetic testing?
• How will I be monitored after treatment?

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