Advanced glial tumors are tumors that originate from glial cells of the brain or spinal cord, but more often from astrocytes, and grow aggressively. These tumors are generally classified as malignant and tend to spread more rapidly to other parts of the brain.
Some names of advanced glial tumors include:
Glioblastoma multiforme (GBM): It is the most common and aggressive brain tumor. It arises from astroglial cells.
Anaplastic astrocytoma: A rapidly growing tumor arising from astroglial cells.
Anaplastic oligodendroglioma: It is an aggressively spreading tumor arising from oligodendroglial cells. The exact cause of advanced glial tumors has not been determined, but some risk factors and genetic changes are thought to play a role. Radiation exposure, genetic syndromes such as neurofibromatosis type 1 and type 2, familial glioma history and some hereditary factors may be effective in the formation of advanced glial tumors. Such tumors can occur at any age, but are more common in older adults (over 60 years of age). Advanced age, male gender, Caucasian race, familial history of glioma and radiation exposure are among the risk factors. Advanced glial tumors can sometimes occur with the progression of slow-growing low-grade tumors. Most low-grade glial tumors progress to advanced stage and show malignant transformation. These tumors, which are benign and low-grade in the early stages, may acquire a more aggressive structure over time with the effect of genetic changes or the effect of radiation treatments during treatment. :
Magnetic resonance imaging (MRI): It is used to view the brain and spinal cord in detail. It provides information about the location, size, and spread of the tumor. Contrast enhancement of the tumor in contrast-enhanced MRI is also important in diagnosing glioblastoma.
Computed tomography (CT): It can help show the presence of the tumor and some details. Investigation of the relationship of CT tumor with skull bones and conditions such as ossification (calcification), bleeding in its content It is superior to MR. It can also provide information on the malignancy of the tumor with contrast-enhanced imaging.
Biopsy: A sample is taken from the tumor with a surgical procedure and examined for laboratory tests. It is an important diagnostic method to determine the nature and stage of the tumor. When glioblastoma is diagnosed on MRI, the first option is always surgical removal of the entire tumor. However, if the tumor is located in very small or deep vital areas that are not suitable for surgery, or if the patient's condition is not suitable for surgery (elderly patients with bypass, advanced COPD and heart failure), a biopsy sample can be taken to directly diagnose and proceed to radiotherapy and chemotherapy. Brain biopsy can be performed under local anesthesia by attaching a stereotactic frame to the head and by drilling a precise millimetric hole in the skull with coordinate calculation. Biopsy patients are discharged home after being kept in the hospital for one day, and further treatment is planned according to the result by waiting for the pathology result. Treatment Treatment of advanced glial tumors usually requires a multidisciplinary approach.
Treatment options may include:
Surgical intervention: It is aimed to remove the tumor as completely as possible. However, sometimes it may not be possible to completely remove the tumor. The tumor will recur in these patients, despite the complete removal of the tumor and then the administration of radiotherapy and chemotherapy. The more the tumor can be removed in the first operation, the longer the recurrence time will be delayed and the better the clinical course of the patient will be. Many patients are operated more than once for recurrent glioblastoma from the same tumor bed. The most important factor that determines the course of the disease and how well he will respond to radiotherapy and chemotherapy after surgery is the patient's good general condition (being able to do his own daily work, caring for himself and not having any disability that prevents him from walking and speaking). Patients who can remain independent in their daily life before and after the surgery are the ones who get the most promising results in the treatments.
Radiotherapy: It is aimed to kill or control tumor cells by using high-energy rays. According to the size of the tumor and its localization, the whole brain Tumor bed can be irradiated by irradiation or modern stereotactic radiosurgery methods (such as Gamma-Knife, True Beam, Cyber Knife). The risk of side effects is high in whole brain irradiation and this risk can be reduced by experienced radiation oncologists using modern devices.
Chemotherapy: It is aimed to kill or stop the growth of cancer cells by using drugs. Chemotherapy can often be administered together with radiotherapy. Its side effects are very acceptably low compared to other cancer chemotherapies. However, these patients should be treated according to their body-mass index and followed closely for side effects. The most common side effects of the drug are nausea and anemia due to blood cell destruction.
Targeted therapies: Treatments aimed at specific genetic changes or molecular targets can be used in some advanced glial tumors. These treatments aim at inhibiting the growth or killing of cancer cells. Today, in addition to pathology, molecular biological tests help explain the behavior of these tumors. These parameters, documented by genetic tests such as MGMT and IDH, help us to predict how well this tumor will respond to treatment (prognosis), but unfortunately it does not contribute to prolonging the patient's life and does not change the treatment as the available treatment options are limited. The treatment plan is determined depending on the stage, size, location of the tumor and the general health of the patient. Evaluation is made by a team consisting of a specialist neurosurgeon, an oncologist and a radiation oncologist, and the patient's preferences are also taken into account. Treatment of advanced glial tumors usually focuses on controlling the disease and relieving symptoms, complete recovery is often not possible.
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