High grade glioma

High grade gliomas are malignant (cancerous) tumours that develop from brain cells called astrocytes.

In this section

In children, only 20% of astrocytomas are high grade. High grade gliomas are classified according to the grade of aggressiveness (how quickly they grow) as either anaplastic astrocytomas (grade III) or glioblastoma multiforme (GBM).

These tumours often spread into the healthy tissue that surrounds the tumour. This makes them difficult to remove surgically. They most commonly arise in the cerebral hemispheres (frontal, parietal and temporal lobes) or centre of the brain (thalamus). The tumour can spread to other parts of the brain and spinal cord.

Who gets a high grade glioma?

Less than 30 children a year develop high grade glioma in the UK. This is about 8% of all childhood brain and spinal cord tumours. High grade gliomas are the most common type of adult brain tumour and although they look the same under the microscope, they may be different biologically.

Like most brain tumours the cause of high grade gliomas is unknown.

Signs and symptoms

The symptoms depend on where in the brain the tumour is and also whether there is increased pressure in the head (raised intracranial pressure).

Symptoms include:

  • Nausea and vomiting (most common)
  • Lethargy and irritability
  • Headaches
  • Clumsiness
  • Seizures (fits)
  • Difficulty with tasks like handwriting
  • Gradual decline in school work
  • Changes in personality and behaviour
  • Abnormal gait (the way the child walks)

If the tumour spreads or is located in the spinal cord, the signs and symptoms may include:

  • Back pain
  • Difficulty walking
  • Problems with bowel and bladder control

Tests / investigations

We will need to carry out some tests to find out as much as possible about the type, position and size of the tumour. This will help us to decide on the best treatment for your child. These tests include:

  • CT scan – it is likely a CT scan of your child’s brain was the first specific test carried out at your local hospital. Although MRI scans are usually the best way of seeing the tumour and the effects of treatment, sometimes CT scans are also useful
  • MRI scan – this scan allows us to see the brain and spine in great detail and is used regularly to diagnose and follow the effect treatment is having on your child’s tumour

Staging

Staging is a measure of how far the tumour has spread beyond its original site. It is important to know in high grade glioma whether the tumour can be completely removed. This is rarely possible. Occasionally the tumour can spread to the cerebrospinal fluid (CSF) and spine.

Treatment of high grade glioma

High grade glioma are very difficult tumours to treat due to the problems in completely removing the tumour and their resistance to radiotherapy and chemotherapy. As there is no ideal treatment, patients are often treated on clinical trials investigating new therapies.

Common treatments include:

Surgery

All children will have an operation to confirm the diagnosis and if necessary to relieve pressure. The surgeon will try and remove as much of the tumour as possible without causing severe disability for the child.

Radiotherapy

Radiotherapy is routinely used after surgery to try and destroy any remaining cancer cells.

In young children (especially under the age of three years), radiotherapy will be delayed, reduced or possibly avoided. Due to the significant effects of radiotherapy on a young child’s brain chemotherapy will be used instead.

See the Children’s Unit booklet called Radiotherapy treatment for more details on this type of treatment.

Chemotherapy

Chemotherapy has been shown to be of some benefit in high grade glioma but the best drugs and schedules are still being investigated.

Treatment with anti-cancer drugs is used to destroy the tumour cells. It may be given by injections or by mouth. The type of chemotherapy varies in intensity and duration depending on the age of your child.

If your child takes part in a clinical trial, the treatment is explained in more detail in the specific trial information sheet. You will be given an outline of the treatment in the form of a ‘road map’.

Clinical trials

Clinical trials are medical research trials involving patients that are carried out to try and find new and better treatments. In cancer, clinical trials are most commonly used to try and improve different forms of treatment such as surgery, radiotherapy or chemotherapy.

The treatment being tested may be aimed at:

  • Improving the number of people cured (for example: trying new types of surgery or chemotherapy)
  • Improving survival
  • Relieving the symptoms of the cancer
  • Relieving the side effects of treatment
  • Improving the quality of life or sense of well-being for people with cancer

Clinical trials may also involve research aimed at understanding more about the tumour’s biology. You may be asked to allow us to do research on the tumour sample removed at surgery, or on blood samples.

Well-run clinical trials have led to a significant improvement in the treatment of children with cancer. You can find more general information on clinical trials in the separate information sheet. If you are asked to consider entering your child into a clinical trial you will be given specific information about the trial before deciding whether to take part.

Effects of treatment

Young children (under three years) appear to respond better to chemotherapy. Those children with grade III tumours (anaplastic astrocytoma) and a complete removal of the tumour respond better to both chemotherapy and radiotherapy.

Unfortunately, the prognosis is poor for many children with high grade gliomas. Clinical trials are ongoing to improve the outcome.

General side effects of chemotherapy

Bone marrow suppression (myelosuppression)

Chemotherapy drugs decrease the production of blood cells by the bone marrow for a variable period of time. This results in low red blood cells (anaemia), low white blood cells (neutropenia) and platelets (thrombocytopenia). Your child may need blood or platelet transfusions and will be at increased risk of infections. The doctors and nurses caring for your child will tell you more about these side effects.

Nausea and vomiting

Some of the chemotherapy drugs used may make your child feel sick or vomit. We will give anti-sickness drugs at the same time to stop nausea and vomiting. These are usually very effective.

Sore mouth (mucositis)

Some of the chemotherapy drugs make the lining of the mouth and throat very sore and ulcerated. We will give your child painkillers for this, and explain how to care for your child’s mouth during treatment.

Hair loss

Temporary hair loss is common.

Specific drugs

For details of the side effects of individual drugs please see Macmillan specific drug information leaflets.

What are the possible long-term effects of treatment?

High grade gliomas can cause long-term problems related to where they are located and the treatment received. Tumours can result in growth, hormonal and behavioural changes with possible learning problems and difficulties with coordination. Physical disabilities and seizures can be a problem even when the tumour is controlled and need to be monitored. Treatment can reduce fertility and there is a small risk of developing a second cancer later in life.

All children are followed up after treatment is finished in the long-term brain tumour follow-up clinic. Your child will be seen at regular intervals in this clinic.