It's hard to put into words what it feels like as a parent to hear that your child has brain cancer. There are so many questions that come to mind at a time like this. So, today we're going to talk about High-Grade Glioma, a serious, rapidly spreading type of brain tumor. We hope this information will give you some understanding and strength during this difficult journey.
What is High-Grade Glioma? Let's understand it very simply.
Simply put, high-grade glioma is a type of cancer that grows very quickly in your child's brain or spinal cord. "Glioma" means a tumor. These tumors form when a type of cell called "glial cells" begins to divide and grow rapidly without control. These glial cells are a type of cell that supports and nourishes the neurons, or nerves, in our central nervous system.
"High-grade" means that this type of glioma is very fast-growing and aggressive . In fact, high-grade gliomas may not always be completely curable. This is because they are more challenging to treat. This is because these cancer cells spread very quickly into the brain or spinal cord. They also grow by invading and intertwining with healthy cells. Imagine how difficult it is to remove just the cancer without harming healthy tissue when healthy cells and cancer cells are intertwined. That's why it is sometimes difficult to completely remove them with surgery.
What is the "grade" of high-grade gliomas?
The World Health Organization (WHO) classifies gliomas according to their growth rate and severity. Accordingly, there are two types: "low-grade" (less severe, grades 1 and 2) and "high-grade" (more severe, grades 3 and 4). High-grade gliomas are fast-growing tumors that are grade 3 or 4.
Some gliomas in adults may start out as low-grade and later become high-grade. However, surprisingly, high-grade gliomas in children usually start out as high-grade. However, low-grade gliomas in children are largely treatable and rarely become high-grade.
Where in the brain do high-grade gliomas most commonly occur?
High-grade gliomas most often develop in the "supratentorial compartment" of the brain, or the brainstem.
- Supratentorial compartment: This is the area of the brain that contains the cerebrum, thalamus, and hypothalamus. These tumors can develop from glial cells located here.
- Brainstem: These high-grade gliomas can also develop in the part of the brainstem called the "pons". This is called a special type, "Diffuse Intrinsic Pontine Gliomas (DIPG). This type of DIPG is very aggressive and difficult to treat.
The location of the tumor is very important, as it will determine the treatment options available to your child. For example, tumors in the brainstem often cannot be safely removed surgically.
Who is affected the most by this situation?
High-grade glioma can occur in infants, older children, young adults, and even adults. However, high-grade glioma in infants and young children is different from high-grade glioma in adolescents and adults. Because of these differences, the treatment for infants and young children may be different.
How common is high-grade glioma?
High-grade gliomas are the second most common type of malignant brain tumor in children. They account for between 10% and 20% of all tumors affecting the central nervous system in children.
What are the symptoms of high-grade glioma?
Symptoms can vary from child to child. They depend on which part of the brain (or spinal cord) the tumor has affected, the child's age, and how fast the tumor is growing. These symptoms are mainly caused by the tumor putting pressure on the brain and causing swelling.
The most common symptom is a headache. This is especially true if the headache is accompanied by nausea or vomiting. This headache is most severe in the morning. Sometimes, it can be so severe that it wakes you up at night. Imagine a small child having such a hard time.
Other symptoms that may be seen include:
- Difficulty seeing, hearing, or speaking (blurred vision, hearing loss, slurred speech).
- Loss of balance or muscle weakness (ataxia), such as difficulty walking or holding things.
- Confusion or memory loss.
- Constant drowsiness, feeling lethargic.
- Seizures (like a fit) .
Very young babies (infants) may notice unusual crying, irritability, changes in feeding patterns (such as not drinking milk). They may also sometimes notice their heads getting a little bigger, and the soft spots (fontanelles) or "swamps" on the top of their heads may become more prominent.
Why do these high-grade gliomas develop? What are the causes?
To be honest, researchers still don't know the exact cause. In adults, prior radiation therapy has been found to be a risk factor for developing these tumors. It's possible that children may also be affected by similar external or environmental risk factors, but more research is needed.
However, some very rare inherited genetic syndromes can increase the risk of high-grade glioma in children. A genetic condition is a defect or abnormality in the genes, which are the "code" that tells cells how to function.
Here are some such situations:
- Neurofibromatosis type-1 (`Neurofibromatosis type-1 - NF1`)
- Turcot syndrome
- Li-Fraumeni syndrome
However, it is important to remember that many children with high-grade glioma do not have a family history of this condition.
How is high-grade glioma diagnosed?
Your child's doctor will first take a careful look at your child's symptoms and medical history. Then, a brain scan, or `imaging`, can be done to see if a tumor is present and if it is causing the symptoms. If a tumor is present, a `biopsy` will be done to find out for sure whether it is cancerous (malignant) or benign (benign).
- Imaging: An MRI (Magnetic Resonance Imaging) scan and a CT scan (Computed Tomography scan) can help doctors see tumors in your child's brain or spinal cord. An MRI, especially a contrast-enhanced MRI, can produce clearer, more detailed images than a CT scan. An MRI uses magnets and radio waves to create images of things inside the body on a computer screen. In a contrast MRI, a harmless dye is injected into your child's arm. This makes the areas with tumors more visible on the screen.
- Biopsy: A special procedure called a "stereotactic biopsy" can pinpoint the exact location of the tumor and take a small piece of tissue from there and send it to the lab. Then, a specialist called a "pathologist" examines the cells to see if they are high-grade glioma cells. These tests can also identify certain characteristics of the cancer cells. These characteristics are sometimes used to determine treatment. For example, some new cancer treatments are designed to work only on certain types of cancer cells. So, these tests can also help determine if your child is a good candidate for that treatment.
Sometimes, if possible, doctors remove the entire tumor instead of just taking a small piece for biopsy. Then, the diagnosis is made and the treatment (surgery) is done at the same time.
However, a biopsy may not always be possible in high-grade gliomas. Depending on where the tumor is located (for example, in the brainstem), taking a piece of tissue can damage vital parts of the brain. In such cases, doctors rely on imaging tests to make a diagnosis.
Can high-grade glioma be completely cured?
This is the biggest question on everyone's mind. It's hard to give a straight answer. There are many factors that affect this, such as the child's age, what genetic changes are present in the cancer cells, and how much of the tumor was removed during surgery.
What are the treatments for high-grade glioma?
The main goals of treatment are to remove the tumor, stop or control the growth of the tumor, and provide relief to the child by reducing symptoms.
Depending on the type of tumor, its location, and other factors, several specialists may be involved in your child's care. The team may include a neurosurgeon, a neuro-oncologist, a radiation oncologist, an endocrinologist, a nurse practitioner, and a social worker.
One or more of the following may be used as treatment:
- Surgery: Surgery is the main treatment for high-grade gliomas that can be safely removed. Here, the doctor tries to remove as much of the tumor as possible without damaging the surrounding healthy tissue.
- Radiation therapy: Focal radiation therapy is a standard treatment for children over 3 years of age. Very young children are usually not given radiation therapy because it can affect their brain development. This treatment involves a machine that uses high-dose X-rays to target the tumor, taking care not to damage surrounding healthy tissue. Radiation therapy shrinks tumors, kills cancer cells, and reduces symptoms.
- Chemotherapy: Because very young children cannot receive radiation therapy, chemotherapy is used to control tumor growth. Chemotherapy uses drugs to kill cancer cells. However, there is still debate about how effective chemotherapy is for high-grade gliomas. While some chemotherapy drugs, such as temozolomide, work well for some types of gliomas in adults, the same drugs are not as effective in children.
- Palliative care: Palliative care professionals can help you make decisions that will help maintain your child's quality of life during treatment. They can suggest ways to help your child cope with the diagnosis and get relief from symptoms.
High-grade glioma is more likely to recur after treatment. If this happens, your doctor may suggest "targeted therapies." These are treatments that target only the abnormal molecules (caused by the genetic mutation) in your child's tumor. These "molecular targeted therapies" may be available through "clinical trials." Clinical trials are studies that test the safety and effectiveness of new treatments.
Sometimes, if these targeted therapy drugs are on the market, or if previous studies have shown them to be effective for your child's type of glioma, your doctor may be able to give them to you outside of a clinical trial.
What are the side effects of these treatments?
Talk to your doctor about the possible side effects of different treatments. While doctors try their best to avoid damaging healthy tissue during radiation therapy, some healthy tissue can still be affected. Depending on which parts of the brain are affected, radiation therapy can affect brain function, the baby's growth, and disrupt hormone production.
It is very important to carefully discuss and weigh the potential benefits and risks of treatment with the medical team treating the child.
What should I expect if my child has high-grade glioma?
Your child's prognosis depends on many factors, which your doctor can discuss with you. The type of cells affected, the characteristics of the cells, and how much of the tumor was removed during surgery all determine the outcome.
Ask your doctor what to expect based on your child's specific condition.
What is the survival rate for high-grade glioma?
This type of tumor is more likely to come back after treatment. The five-year survival rate for high-grade gliomas in children is less than 20%. However, it is important to note that these tumors are very different from each other. They grow in different places, and the characteristics of the cells in them are different. These differences can affect your child's future.
What questions should I ask the doctor?
There are countless questions that come to mind at a time like this. But don't forget to ask your doctor these questions:
- What treatment options are available for my child?
- How does the location of the tumor affect treatment options?
- What are the risks associated with treatment?
- What results should we expect from treatment?
- How should I care for my child during treatment?
- How often will my child need to come for treatment and follow-up?
Finally, things to remember
Receiving a diagnosis of high-grade glioma can be a very difficult thing to do. This cancer spreads quickly, and the tumors can come back even after treatment. You will often have to weigh the benefits of treatment against the side effects that you do not want your child to experience.
Use all the resources available to help you, your child, and the rest of your family during this time. Talk to your doctor about treatment options and clinical trials. If there are palliative care services available, reach out to them. Reassure your child that you will always support them as you face this diagnosis together. This will be a great source of strength for them.
` Glioma, Brain Cancer, Childhood Cancer, High-Grade Glioma, Neurosurgery, Radiation Therapy, Chemotherapy
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