Glioma: symptoms, types, diagnosis and treatment

A glioma is a tumour that starts in the glial cells, which are the supporting cells of the brain and spinal cord. Cancer Research UK describes gliomas as cancerous brain tumours, and says some types grow faster than others.

The NHS explains that brain tumours are graded according to how fast they grow and how likely they are to grow back after treatment. Grade 1 and 2 tumours are low grade and grade 3 and 4 are high grade. Gliomas are a type of cancerous brain tumour that can be low grade (grade 2) or high grade (grades 3 and 4).

The NHS says the symptoms of a brain tumour vary depending on the part of the brain affected, and sometimes there are no symptoms to begin with or they develop very slowly. Cancer Research UK says symptoms can develop gradually over months or even years if the tumour is slow growing, or quickly over days or weeks if it is fast growing.

• Headaches.

• Seizures (fits).

• Persistently feeling sick (nausea), being sick (vomiting) and drowsiness.

• Mental or behavioural changes, such as memory problems or changes in personality.

• Progressive weakness or paralysis on one side of the body.

• Vision or speech problems.

A growing tumour takes up space inside the skull and can raise the pressure within the brain, which causes headaches, seizures, sickness, drowsiness, eye problems and personality changes. Other symptoms depend on the area affected, according to Cancer Research UK.

Headaches are very common and rarely mean a brain tumour. Cancer Research UK says it is unlikely you have a brain tumour if headaches are your only symptom, and that it is rare for sickness to be the only symptom.

It does, however, say to see a doctor if you have headaches with feeling or being sick, headaches you did not have before, headaches that wake you at night, or headaches with eye problems such as seeing flashing lights or blind spots that have got steadily worse over weeks. The NHS also says to see a GP about a headache that feels different from the type you usually get, or if headaches are getting worse.

Cancer Research UK says that some people with a brain tumour have symptoms that are severe and come on suddenly. You need to go to your local A&E department if you have severe symptoms such as fits (seizures).

For other symptoms, the NHS says to see a GP, particularly if you have a headache that feels different from your usual headaches or headaches that are getting worse. You may not have a brain tumour, but these symptoms should be checked.

To decide the type of glioma, a pathologist looks at a sample of the tumour: the type of glial cell it started in, changes to genes and proteins in the cells (for example the IDH gene), and how normal or abnormal the cells look, which gives the grade. The more abnormal the cells look, the higher the grade.

Cancer Research UK says doctors use the World Health Organisation (WHO) 2021 classification. You may still hear older terms: most grade 2 gliomas are called diffuse (no clear boundary with normal brain), and most grade 3 gliomas anaplastic (the cancer cells divide rapidly).

The NHS says the cause of most brain tumours is unknown, but there are several risk factors. The risk increases with age. Exposure to radiation accounts for a very small number of brain tumours, and some types are more common in people who have had radiotherapy or, very rarely, CT scans or X-rays of the head.

The NHS also lists family history and genetic conditions: some genetic conditions are known to increase the risk, including tuberous sclerosis, neurofibromatosis type 1 and type 2, and Turner syndrome.

You usually start by seeing your GP, who examines you and may refer you to a specialist. Cancer Research UK says your GP should arrange for you to see a specialist if you have symptoms that could be due to a brain or spinal cord tumour. There is no national screening programme for brain or spinal cord tumours in the UK.

The NHS says that if the GP cannot identify a more likely cause, they may refer you to a neurologist for further assessment and tests, such as a brain scan. Cancer Research UK adds that tests include scans of the brain and a test of the nervous system (neurological examination), and that a pathologist examines a sample of the tumour to identify its type.

The NHS says treatment depends on the type of tumour, where it is in the brain, how big it is and how far it has spread, how abnormal the cells are, and your overall health and fitness. Cancer Research UK says the main treatments for brain tumours are surgery and radiotherapy, and that some people might have chemotherapy.

Surgery aims to remove as much abnormal tissue as safely as possible, according to the NHS. It is not always possible to remove all of a tumour, so radiotherapy or chemotherapy may be needed to treat any abnormal cells left behind.

Steroids may be prescribed after diagnosis to reduce swelling around the tumour. Other medicines treat symptoms, such as anti-epileptic medicines for seizures and painkillers for headaches. If a brain tumour comes back, Cancer Research UK says you might have treatment with surgery, radiotherapy and chemotherapy again.

The NHS says the outlook depends on several factors, including your age, the type of tumour, where it is in the brain, how effective treatment is and your general health. It adds that survival rates are difficult to predict because brain tumours are uncommon and there are many different types, so your doctor is the best person to give you more information.

Cancer Research UK says coping with a brain tumour can be difficult, both practically and emotionally, particularly with a rare tumour, and that being well informed about the type of tumour and its treatment can make it easier. Your doctor and specialist nurse will explain your treatment and side effects and support you during and after care.

On the NHS the route is usually GP, then a scan and a referral to a neurology or neurosurgical team, with treatment planned by a specialist multidisciplinary team. If symptoms are severe or sudden, such as a seizure, go to A&E.

Some people seek a private consultation or a second opinion on imaging, pathology or treatment options, usually after a referral letter. Ask your specialist team about clinical trials, which Cancer Research UK has a database for.