BASIC INTRODUCTION TO GLIOMA
Gliomas are tumors of neuroepithelial origin derived from glial cells or cell precursors. Glioma is a more inclusive classification encompassing two major basic histopathological subtypes: astrocytoma and oligodendroglioma.
GRADES OF ASTROCYTOMA
Grade I: Pilocytic astrocytomas
Grade II: nuclear atypia alone: Diffuse low-grade astrocytomas
Grade III: higher degrees of mitosis and nuclear atypia : Anaplastic astrocytomas (viz. Anaplastic oligodendrogliomas and anaplastic oligoastrocytomas).
Grade IV: microvascular proliferation, invasion or necrosis and metastatic potential: Glioblastomas.
Malignant tumor : III and IV tumors and grade II astrocytomas with high rate of malignant degeneration.
SIGNS AND SYMPTOMS
Symptoms of gliomas depend on which part of the central nervous system is affected. A brain glioma can cause headaches, vomiting, seizures, and cranial nerve disorders as a result of increased intracranial pressure. A glioma of the optic nerve can cause visual loss. Spinal cord gliomas can cause pain, weakness, or numbness in the extremities. Gliomas do not usually metastasize by the bloodstream, but they can spread via the cerebrospinal fluid and cause "drop metastases" to the spinal cord.
- Hereditary disorders
- Infection with cytomegalovirus
- Inherited polymorphisms of the DNA repair genes
High-grade gliomas are highly vascular tumors and have a tendency to infiltrate diffusely. They have extensive areas of necrosis and hypoxia. Often, tumor growth causes a breakdown of the blood–brain barrier in the vicinity of the tumor. As a rule, high-grade gliomas almost always grow back even after complete surgical excision, so are commonly called recurrent cancer of the brain
Conversely, low-grade gliomas grow slowly, often over many years, and can be followed without treatment unless they grow and cause symptoms.
Treatment for brain gliomas depends on the location, the cell type, and the grade of malignancy. Often, treatment is a combined approach, using surgery, radiation therapy, and chemotherapy. The radiation therapy is in the form of external beam radiation or the stereotactic approach using radiosurgery. Spinal cord tumors can be treated by surgery and radiation. Temozolomide is a chemotherapy drug which can be administered easily in an outpatient setting and is able to cross the blood–brain barrier effectively.
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Journal of Molecular Oncology Research