Glioma Treatment Options: What to Know
- “Bachelor in Paradise” star Joe Amabile, 40, revealed he is preparing for brain surgery after a whole-body MRI led doctors to discover a “blueberry-sized lesion” believed to be an early-stage glioma.
- Glioma treatment requires a multi-step approach, starting with diagnosis through biopsy or surgery, followed by comprehensive testing to determine the tumor’s molecular makeup.
- Surgery is often the first step to remove as much of the tumor as possible, but chemotherapy and radiation are crucial to targeting the remaining cancer cells.
Amabile, 40, also known as “Grocery Store Joe,” said his results from a whole-body magnetic resonance imaging (MRI) scan, he recently had done through Prenuvo, led doctors to find the lesion, which is believed to be a glioma. [A glioma is a type of tumor that develops in the brain or spinal cord, arising from glial cells—the supportive cells that protect, nourish, and help maintain the brain’s neurons.]
Read MoreHe continued, “So I now need to get brain surgery next week to get it removed and get it tested, and then we’re gonna go from there. So it’s been a wild couple weeks. I definitely wasn’t expecting this. I think it’s one of those things where you’re like, ‘oh, something like this, never happen to me.'”
Amabile, who hopes surgery will completely remove the tumor and promised to update fans on his recovery, noted that his doctors suspect the lesion was discovered at an early stage.
View this post on Instagram
Amabile wrote alongside the footage of himself, “This past month has been a lot of ups and downs to say the least. After multiple scans and MRIs I have what looks to be an early stage brain tumor.
He says he’s scheduled to undergo a craniotomy—a surgical procedure where doctors remove part of the skull and resect [take out] the tumor—in two weeks at Memorial Sloan Kettering Cancer Center.
“I’m doing my best to stay positive during this time and am lucky to have a lot of support from family and friends,” Amabile added.
“I’ve gone back and forth about what I wanted to share on social media but ultimately this is now part of my life now, so might as well. Onto a new journey.”
Amabile, who is married to fellow “Bachelor in Paradise” alum Serena Pitt, 28, previously took to Instagram with his wife, to show their recent outing to Prenuvo in New York City.
Prenuvo offers a full-body MRI screening service designed to provide detailed images of the body and help detect potential health concerns before symptoms appear.
It’s important to note that although these types of scans are available to the public via Prenuvo, and it’s competitors Ezra, Neko Health, and SimonMed, it’s important to understand these MRI scans are not part of regular screening guidelines and experts say this should absolutely not replace traditional screenings.
View this post on Instagram
Amabile, who hosts a podcast called “Not Married To This with Serena & Joe,” received heartfelt comments from fans and loved ones after sharing the news.
“If there’s one thing the Grocer knows, it’s produce. This little blueberry doesn’t stand a chance!” one person commented.
Another wrote, “Wow, Joe, I can imagine this is an extremely confusing and difficult experience for you and your loved ones. Praying for a successful surgery, and for the careful precision and clarity of your care team. Sending you love and support.”
Prenuvo also commented, “We are sorry to hear about your diagnosis but grateful that we were able to identify the tumor at an early stage. We wish you strength as you navigate the next steps.”
“I’m so sorry you are going through this brother and know that words can only do so much but you will be surrounded by prayers from countless people for strength and protection for both you and Serena. You’re not alone,” wrote a fourth supporter.
Understanding Gliomas
When you or a loved one is diagnosed with a glioma, it can be a difficult time and confusing time. Hearing a term like ‘glioma’ can be alarming, especially when you’re not familiar with it. Here, we’ll go over the basics of the disease, from what a glioma is to the different types of glioma to the diagnosis and treatment paths.
A glioma is a type of tumor that originates in the central nervous system, specifically in the brain or spinal cord. They originate in glial cells. Glial cells are supportive cells in the brain which serve to protect and maintain the neurons. They perform these tasks by maintaining the right chemical environment for electrical signaling, creating protective coverings for neurons, and removing debris and acting as scavengers. Neurons are the key cells in the brain and spinal cord which are responsible for transmitting messages in the brain. While the signals and messages that allow you to think, move, and speak are created by neurons, the glial cells are critical in maintaining brain function.
So essentially, a glioma is a tumor that comes from the brain’s own support cells.
Those glial cells, like many other cells in the body, have the potential to grow abnormally and form a mass, and that is when a glioma is formed. Gliomas, as they arise from the brain or spinal cord, are considered a primary brain tumor. They do not spread from elsewhere in the body.
Gliomas: Benign vs. Malignant
To answer this question it is important to understand what it means for a tumor to be cancerous versus benign. A benign tumor often grows slowly and has clear borders, meaning it does not invade into surrounding tissue or other parts of the body. Meanwhile when something is described as cancerous or malignant it often grows more quickly and has a propensity to invade into surrounding tissue and spread to other sites of the body.
That being said, gliomas can vary widely in their behavior, meaning some are benign while others are considered malignant or cancers. Whether a glioma is benign or malignant depends on several factors including its type and grade.
Glioma is a general term that describes several different types of tumors. The different types of glioma depends on which specific glial cell is involved. Examples include:
- Astrocytomas – Gliomas originating from astrocytes, a type of glial cell that maintains the chemical environment around neurons and provides nourishment
- Oligodendrogliomas – Gliomas from oligodendrocytes, which are glial cells that create the myelin sheath that insulates nerve fibers and make neurons transfer signals more quickly and efficiently
- Ependymomas – Gliomas that from ependymal cells, which are cells that line the cavities of the brain and spinal cord and produce cerebrospinal fluid
Each of these types of gliomas behaves differently and can be considered more or less malignant or aggressive. Each type of glioma is typically classified further by their grade, which is a measure of how aggressive the tumor is.
The Grading System of Gliomas
Gliomas are graded on a scale of I to IV, with higher grades indicating a more aggressive tumor. This grading is based on several factors including the type of glioma, the genetics of the cancer, as well as the appearance of the tumor cells under a microscope. The more abnormal the cells look, the higher the grade, and the faster the tumor is likely to grow and spread. Here’s a quick overview:
- Grade I-II gliomas – These are considered low-grade and tend to grow slowly. “The grade one is a very indolent, benign tumor that basically can be cured with surgery alone,” Dr. Henry Friedman, Deputy Director of the Preston Robert Tisch Brain Tumor Center at Duke, tells SurvivorNet.
- Grade III gliomas – These are considered high-grade and tend to grow more rapidly. Grade III gliomas are typically classified as malignant and typically require more aggressive treatment which can include surgery, radiation, and chemotherapy.
- Grade IV gliomas – These are the most aggressive gliomas which are locally aggressive and require treatment intensification. Glioblastomas are the most common grade IV glioma, “which is by far the most well known and most feared tumor in the lay population and quite frankly, the medical population as well,” Dr. Friedman explains.
Although Grade IV gliomas are the most aggressive glioma and may require several types of treatment including surgery, radiation, and chemotherapy, there can be challenges in treating low grade gliomas as well. When making decisions on treatment, several factors are taken into consideration including location of the tumor, ease of surgery and ability to resect, neurologic deficits, patient age, tumor size, and overall health.
Understanding How Glioma’s Present
Gliomas can present a variety of ways. The symptoms are often non-specific, meaning there is no slam-dunk symptom or key finding that is common to all gliomas. Symptoms can also be related to tumor location, and more commonly the increased pressure caused by the mass inside the skull, which can disrupt blood flow and block the flow of cerebral spinal fluid. Based on the location of the glioma there can be associated symptoms that arise including personality and speech changes.
With increased pressure in the skull you can experience symptoms such as headaches, nausea, vomiting, and changes in vision.
Other symptoms that can sometimes be seen include:
- Seizures
- Cognitive difficulties, like memory loss or trouble concentrating
- Weakness or numbness in certain parts of the body
- Vision or speech problems
Again, none of these symptoms are specific to gliomas and can be caused by a variety of medical conditions. There are several steps in the workup needed before you can be diagnosed with a glioma.
Diagnosis and Imaging
Often patients present with non-specific symptoms as described above to their primary care doctor, an urgent care, or an emergency room. If there is concern for a glioma or primary brain tumor, several tests will be performed which typically include:
- A thorough history and neurologic exam
- Blood tests which look at total blood counts (CBC) and metabolic markers (CMP)
- Brain MRI
The MRI allows doctors to obtain the most detailed images of the brain and clarify the size, shape, and location of a suspected glioma.
Although MRIs are great for gathering information and helping the medical team create a potential surgical plan, a biopsy is required in order to confirm the diagnosis of glioma and also provide specific information including the type of glioma of grade.
Biopsy
During a biopsy, a sample of the tumor is taken and examined under a microscope.
A biopsy is a surgical procedure, but it can be done in different ways. Sometimes it’s performed as part of a larger surgery to remove the tumor, or it can be done separately as a stereotactic biopsy, which is minimally invasive. Advanced imaging techniques are used to guide the biopsy so a sample can be safely obtained.
According to Dr. Friedman, when making a diagnosis of glioma, this “includes looking at it under the microscope through our pathology team. Everybody’s doing next generation sequencing now to really get an idea of the molecular composition of the tumor. And with that information we can then see if they fit into a clinical trial paradigm and if they do, terrific. If not, there is standard of care.”
This means that sometimes based on the testing performed on biopsy specimens, patients can be eligible for clinical trials testing new forms of therapy based on mutations and changes specific to the tumor. Additionally patients could also be considered for certain FDA approved therapies (i.e. BRAF/MEK inhibitors, NTRK fusion inhibitors, and pembrolizumab if TMB-high).
Treatment Options
“The first step is always the neurosurgery. How much can you take out? Is it safe to do surgery? Do you have to rely on a biopsy? Can you even do a biopsy?” says Dr. Friedman. These are all questions and considerations that need to accounted for when deciding what treatment is most appropriate.
Once the biopsy is obtained and the diagnosis of glioma is made, various treatment options can be recommended. The recommendations take into account the type of the glioma, the tumor grade, and well as patient specific factors including tumor location, size, your age, and overall health.
The main treatment options are:
- Observation – Some gliomas that are benign, small, and without symptoms or tumors located in inoperable locations can be recommended for observation.
- Surgery – Surgery is often the first-line treatment for gliomas, with the goal of achieving maximal safe resection where the largest amount of tumor is removed without causing significant neurologic deficits. For low-grade gliomas, surgery alone can sometimes be curative.
- Radiation therapy – This uses high-energy x-rays to target and kill tumor cells. Radiation is often used after surgery to target residual tumor cells.
- Chemotherapy – These medications kill or slow the growth of cancer cells. Chemotherapy can be used alongside radiation, or following radiation and is often used in higher-grade tumors.
- Targeted therapy and immunotherapy – These are newer treatments that are designed to target specific genetic mutations in the tumor or to stimulate the immune system to fight the cancer. Their role in the treatment for gliomas is continuing to evolve.
The important thing to remember is that every treatment plan and recommendation made by your healthcare team is personalized based off of details specific to your disease, your overall health, and treatment goals.
Inside Brain Tumor Surgery and Recovery: What Patients Can Expect
Surgery to remove a brain tumor is delicate by nature, and every movement inside the skull must balance precision with safety.
“We take off the bone overlaying the area we need to get to. We open the little envelope around the brain called the dura, and then we move through the brain tissue to get to where the tumor is to try to cut out as much as we can safely—without hurting the patient’s function or other important things like big blood vessels that can cause things like a stroke,” Dr. Kimberly Hoang, a board-certified neurosurgeon at Emory University School of Medicine, previously explained to SurvivorNet.
Following surgery, patients are closely monitored and often receive radiation to prevent tumor regrowth—particularly in cases where multiple tumors or metastatic disease are involved.
“Because many patients can have more than one brain tumor or metastasis from their cancer, it was not reasonable to think about surgery for them,” Dr. Hoang adds. “They also get radiation for those spots as well, to try to keep those tumors from growing or shrink them down.”
Treatment Advancements & the Challenge of the Blood-Brain Barrier
Chemotherapy, immunotherapy, and targeted therapies have long been effective in treating cancer throughout the body. But the brain’s natural defense — the blood-brain barrier — makes these treatments less effective when it comes to brain tumors.
This barrier is “a network of blood vessels and tissue…made up of closely spaced cells and helps keep harmful substances from reaching the brain,” according to the National Cancer Institute.
Still, Dr. Hoang notes that recent advancements in drug design are beginning to improve treatment efficacy in the brain.
Understanding Side Effects of Brain Tumor Treatment
Side effects vary depending on the tumor’s size, location, and number of lesions present.
“Radiation treatment can cause swelling in the tumor as the tumor ‘dies,’ and the surrounding tissue can also become swollen as the treatment takes effect,” Dr. Krishanthan Vigneswaran, a neurosurgeon with UT Health Houston and Memorial Hermann, tells SurvivorNet.
“This swelling can cause symptoms of headache, nausea, vomiting, and neurological loss of function…Surgical resection can also induce swelling, but this is more transient.”
Tumor location often determines what symptoms emerge:
“If it’s near your movement area, movement on one side of the body can be affected. If it’s near your speech area, your speech and the way you form words and express them can be affected,” Dr. Hoang explains.
She also notes brain surgery tends to be less painful than other types — like spinal or abdominal — due to fewer nerves in the surgical area.
Recovery & Long-Term Monitoring
“An oncology team will have to monitor a patient indefinitely during remission,” Dr. Vigneswaran says, referring to a patient battling late-stage brain cancer.
Many experts recommend joining a support group — especially one with people who’ve undergone similar procedures. Their lived experience can offer comfort and practical advice.
“Support groups can be incredibly helpful to patients and are commonly offered at major cancer centers and hospitals,” says Dr. Jennifer Moliterno, Chief of Neurosurgical Oncology at Yale Cancer Center.
Mental health professionals are also often part of the care team, helping patients manage the emotional effects of surgery, treatment, and recovery.
Questions Surrounding Full-Body MRIs
Not commenting directly on Prenuvo, but rather the idea of getting full-body scans to check for cancer without doctor recommendation, board-certified medical oncologist Dr. Larry Norton, MD, FASCO, FAACR, who is truly renowned in the oncology community and serves as the Medical Director of the Evelyn H. Lauder Breast Center at Memorial Sloan Kettering Cancer Center, suggested to SurvivorNet in an earlier interview that more head-to-head studies need to be conducted to better understand whether these types of scans are beneficial.
Dr. Norton, who also serves Memorial Sloan Kettering’s Norna S. Sarofim Chair and Senior Vice President in the Office of the President, told SurvivorNet, “The basic bottom line is that just because you can do something doesn’t mean that you should do it. Is it possible to scan a whole body with an MRI apparatus? Absolutely. We know that’s possible. The question is, and the big question is utility, does it help people, does it lead to better outcomes?
“Does it lead to increased survival, for example, does it lead to finding things earlier so they can be taken care of most efficiently with these side effects and with better outcomes? And none of that’s been shown. The point is that it’s not been studied with the kind of rigor that we have evolved in our field. I’m expecting of diagnostic or screening tests. Can it be done? Yes. Does it give results? Yes. Can you find things in it that properly should be attended to most likely? Does it find things that if you never found them, they never would’ve caused any problem?”
“Most likely to find things that are not abnormalities, but that requires extensive evaluation, including surgery sometimes to find out that they’re not abnormalities. Definitely, that’s a problem. That’s the false positives,” he added.
He explained, “Also, the false negatives … if somebody’s getting these scans and think they’re fine and then they have a symptom, they say, ‘Well, why should I go to the doctor when I had a whole body scan and the test didn’t find anything wrong? Why should I go for my colonoscopy? Why should I go for my mammography? Why should I go for my routine skin check when I just had a whole body scan and it came out totally negative.’ So there’s that aspect of it. There are a lot of issues here that really require formal evaluation.
“And the formal evaluation would be a group of people would go there, get their scans annually, a group of people would not get scans, and then you’d see what the ultimate benefit was to the individuals who got the scans. If there is benefit, then it’s something that should be done routinely and insurance companies should pay for it, or countries that have national health systems should pay for it. But you’ve got to do the science first, and unless you do the science, you are shooting the dark and making assumptions about the benefits when you don’t really have the evidence to support that it’s actually beneficial for people.”
To further emphasize the importance of recommended cancer screenings, Dr. Norton adds, “Things like a mammography … colonoscopy, those things have been subject to the appropriate evaluation procedures and found to be beneficial. And so, those are the things that people should do.
“And it’s kind of remarkable that there’s such interest in this [full body scans] when people are not doing the things that we know work such as colonoscopy, such as mammography. Roughly half the people who should be getting annual mammograms are getting them, for example, in the United States, in other countries it’s worse. So that’s really the message, we have proven methods of early detection that do make a difference, and that’s the things that people should be doing. The other point is that from a biology point of view, we don’t know for sure that early diagnosis of some things, of some cancers, for example, we do not know that early diagnosis actually beneficial to the patient.”
Dr. Norton concludes, “We know the advantage of colonoscopies is we find polyps that are not cancerous yet, but could turn into cancer if they’re not removed. So a colonoscopy is actually a cancer prevention test as well as a screening test. For example, mammography extensive research is done that actually shows that it not only can save lives, but it can save breasts because you can do breast conservative surgery, and if you find things at an early stage, it requires much less aggressive therapy to achieve high cure rates. But all of that’s been shown by careful research. None of that’s been shown with total body MRIs.”
Prenuvo’s Chief Medical Officer Dr. Daniel Durand also previously spoke with SurvivorNet, stressing the importance of being informed before undergoing any type of testing.
For anyone worried about receiving a false positive after undergoing a Prenuvo scan, Dr. Durand explained, “Every single test has limitations, every single test has benefits and every single test has risks. So with regard to false positives, it really depends on how you define a false positive.
“When you go to the doctor and they do a physical exam and they see something they’re worried about and they say, maybe you should see a specialist about this. Perhaps it’s a little lesion on your skin. And they send you the dermatologist and the dermatologist looks at it and they say, I think it’s okay. Most people don’t then run around talking about how their primary care doctor gave them a false positive. They’re usually thankful that, ‘hey, we found something, it got further detection and ultimately the patient got reassurance.’ So what we’re doing at Prenuvo, is we’re practicing medicine.”
Dr. Durand continued, “This isn’t a binary test, like a covid test, that’s just yes or no. We have specialist physicians, the radiologists, each of whom have anywhere between five or six years of training after medical school just to be able to read exams and they’re doing an exam using the MRI machine to look inside of you. And then on top of that, we have a nurse practitioner or a primary care doctor that claims the results and contextualizes them for the patients.
“We also aren’t a replacement for primary care. We’re something new and innovative that’s in between to give people access imaging at the front of the health care experience rather than after going through lots of other steps. So what I would say to them [someone worried about false positives] is, there’s a chance we’ll find something early that you need to know, that you haven’t had symptoms about yet.”
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
