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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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

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.

An IV

is a small tube placed in your vein that is used to give you medicine or liquids.

Intake and output:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

Medicines

You may need any of the following:

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

  • Anticonvulsant medicine: This medicine is given to control seizures. Take this medicine exactly as directed.

  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.

  • 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.

    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

  • 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 if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

Tests:

You may have any of the following:

  • Neurologic exam: This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

  • 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 scan uses powerful magnets and a computer to take pictures of your brain. It will also take pictures of the blood vessels and structures in your head. You may be given dye, also called contrast, before the test. Tell caregivers if you are allergic to dye, iodine, or seafood. Remove all jewelry, and tell caregivers if you have any metal in or on your body. Metal can cause serious injury. Tell caregivers if you cannot lie still or are anxious or afraid of closed spaces.

    • 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:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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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