Low-grade Gliomas

WHAT YOU SHOULD KNOW:

• Low-grade gliomas (glee-O-mahs) are tumors (lumps) in the brain and spinal cord. The brain and spinal cord are made up of neurons (nerve cell). Neurons carry and transmit electrical signals (messages) within the nervous system. Glial cells support and nourish the neurons. Gliomas form when glial cells grow and divide without control or order. Gliomas may be grouped into grades based on how the tumor cells look under a microscope. The grade of glioma will tell how many abnormal cells are present in the tumor. Abnormal cells may range from grades 1 and 2 (low-grade) to grades 3 and 4 (high-grade).
  
  
• In low-grade gliomas, tumor cells may look like normal brain cells. Most low-grade gliomas are benign (noncancerous), but may become malignant (cancerous) over time. These tumors often grow very slowly and are not likely to spread. Low-grade gliomas usually affect those between 35 and 45 years of age. There are different types of low-grade gliomas. Astrocytoma is the most common type of low-grade glioma. Other types include central neurocytoma, ependymoma, mixed glioma, oligondendroglioma, optic nerve glioma, or subependymal giant cell astrocytoma.
  
  
• Signs and symptoms include seizures (convulsions), headaches, or trouble talking or seeing. You may also have nausea (upset stomach), vomiting (throwing up), and problems moving your limbs. Tests to diagnose low-grade gliomas may include computed tomography (CT) scan and magnetic resonance imaging (MRI). You may also have an angiography, blood tests, a biopsy, electroencephalogram (EEG), or neurological tests. The main treatment for low-grade gliomas is surgery. You may also have radiation, chemotherapy, or medicine to treat your signs and symptoms. Diagnosing and treating gliomas as soon as possible may relieve your symptoms, prevent life-threatening problems, and improve your quality of life.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Treatment for low-grade gliomas carries certain risks. Some medicines may cause more nausea (upset stomach), vomiting (throwing up), drowsiness (feeling sleepy), low blood pressure, or kidney problems. Problems may happen during a biopsy or surgery that may lead to more surgeries. Your brain, eyes, other bones and organs, blood vessels, or nerves may get injured while having surgery. You could also have trouble breathing, bleed too much, or get an infection with surgery. Chemotherapy and radiation may cause fatigue (tiredness), diarrhea (loose, watery bowel movements), hair loss, vomiting (throwing up), and headaches. You may also have memory and attention problems. Even after having treatment, there is a chance that your tumor may not be completely removed or may become malignant.
  
  
• Without treatment, a low-grade glioma may continue to grow, may push on other structures near it, or become malignant (cancerous). This may cause blood vessel or nerve problems. Your symptoms may become worse and your condition may become life-threatening. You may have problems seeing, speaking, breathing, or thinking clearly. This may lead to other serious medical problems, such as blindness, seizure (convulsion), stroke, or even death. The earlier a low-grade glioma is found and treated, the better your chances of being cured. Ask your caregiver if you are worried or have questions about your condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Blood transfusion: You may need a blood transfusion for certain medical conditions. You may also need a transfusion if you lose a large amount of blood during surgery. You may ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.

Medicines You may need any of the following:

• Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
  
  
• Anticonvulsant medicine: Anticonvulsants are given to control seizures.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up).
  
  
• Diuretics: You may get diuretic medicine to help decrease swelling in your brain. This may help your brain get better blood flow.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
  
  
• Steroids: Steroid medicine may be given for many reasons, such as to decrease inflammation (swelling) in the brain. This medicine may be very important for your disease, but may have side effects. Be sure you understand why you need steroids. Do not stop taking steroids without your caregivers OK. Stopping on your own can cause problems. Ask your caregiver for more information about steroids.

Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.

Tests: You may have any of the following:

• Neurologic signs: Neurologic signs are also called neuro signs, neuro checks, or neuro status. Caregivers check your eyes, your memory, and how easily you wake up. Your hand grasp and balance may also be tested. This helps tell caregivers how your brain is working after an injury or illness. You may need to have your neuro signs checked often. Your caregiver may even have to wake you up to check your neuro signs.
  
  
• Biopsy: Caregivers may need to remove a small part of your tumor and other brain tissue during stereotaxy or open surgery. Stereotaxy uses three-dimensional (3-D) pictures to help your caregiver know the exact location of the tumor. The tissue samples will then be sent to a lab for tests.
  
  
• Blood tests: Samples of your blood are sent to a lab for tests. These tests may check how well your body is doing. The amount of tumor markers (substance released by tumor cells) that are present in your blood may also be checked.
  
  
• EEG: This test is also called an electroencephalogram. Many small pads or metal discs are put on your head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of your brain. Caregivers look at the tracing to see how your brain is working.
  
  
• Imaging studies: You may be given dye through an IV in your vein during one of your tests. The dye helps tumors show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
  • Angiography: This test looks for problems with the arteries (blood vessel) supplying the low-grade gliomas. Before the x-ray, a dye is put into a thin tube through a small cut in your groin. The groin is the area where your abdomen (stomach) meets your upper leg. The dye helps the arteries show up better on these x-ray pictures.
    
    
  • Computed tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your brain. It may be used to look at bones, muscles, brain tissue, and blood vessels.
    
    
  • MRI: This test is called magnetic resonance imaging. During the MRI, pictures are taken of your head. An MRI may be used to look at the brain, muscles, joints, bones, or blood vessels. You will need to lay still during a MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
    
    
  • Positron emission tomography scan: This test is also called a PET scan. A PET scan shows how much blood and oxygen is flowing to an area of the brain. It may also show areas where there is a tumor.

Treatment options: Treatment of low-grade gliomas will depend on the signs, symptoms, location, and type of tumor that you have. Caregivers may also consider your age, condition, and the presence of other conditions. You may have any of the following:

• Surgery: Surgery called craniotomy (open brain surgery) or stereotaxy using a CT scan or MRI may be done to remove a part or all of your low-grade glioma. Brain mapping may be done during your surgery to check the activities in the different areas of the brain. These areas of the brain include those used for speaking, moving, seeing, smelling, and understanding. Surgery may also be done to place a shunt (tube) or remove a blockage so the fluid around your brain and in your spine can flow properly.
  
  
• Additional treatments:
  
  
  • Chemotherapy:
    
    
    • This medicine, often called chemo, is used to treat cancer. It works by killing tumor cells. Chemotherapy may also be used to shrink lymph nodes that have cancer in them. Once the tumor is smaller, you may need surgery to cut out the rest of the cancer.
      
      
    • Many different chemotherapy medicines are used to treat cancer. You may need blood tests often. These blood tests show how your body is doing and how much chemotherapy is needed. Chemotherapy can have many side effects. Caregivers will watch you closely and will work with you to decrease side effects. Chemotherapy can cure some cancers. Even if the chemotherapy does not cure your cancer, it may help you feel better or live longer.
    
    
  • Radiation: This is a treatment using x-rays or gamma rays to treat tumors. Radiation kills tumor cells and keeps them from spreading. It also keeps tumor cells from dividing into new cells, which is one way tumor cells spread. Radiation may also be given after surgery to kill any tumor cells that were not removed. Radiation may help decrease pain, control bleeding, and shrink tumors.

Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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