1.What is the incidence rate of glioma? Gliomas account for 50-60% of intracranial tumors, with an adult incidence of 8/100,000 per year. Among the various types of gliomas, astrocytoma is the most common (75%), followed by oligodendroglioma (8.8%), and ventricular meningioma (7.3%). 2.What is meant by glial cells? Brain tissue consists of neurons (nerve cells) and glial cells. Glial cells include astrocytes, oligodendrocytes, and ventricular cells. Glial cells play a role in supporting, nourishing, insulating and protecting neurons. Unlike neurons, glial cells maintain the ability to divide cells throughout their lives and play a role in repair and regeneration. As glial cells maintain the ability of cell division for life, they also have the possibility of being transformed into tumors. 3.What is glioblastoma? Glioblastoma is a tumor that originates from glial cells and is the primary brain tumor with the highest incidence. Gliomas are classified into grades I-IV, with grades I and II belonging to low-grade gliomas, and grades III and IV collectively referred to as high-grade brain tumors. 4.What are the pathologic types of glioma? There are four main pathological types: astrocytoma (including mesenchymal astrocytoma and glioblastoma), oligodendroglioma (including mesenchymal oligodendroglioma), ventricular meningioma and mixed glioma. 5. Are gliomas malignant? Gliomas are classified into grades I-IV, with grades I and II belonging to low-grade gliomas and grades III and IV collectively known as high-grade gliomas. Generally speaking, grade I is benign, grade II is low-grade malignant, and grades III and IV are malignant. Gliomas with low malignancy may be transformed into high malignancy gliomas after a period of time. 6.What are the characteristics of glioma growth? According to biological characteristics, gliomas can be divided into two categories: one type of glioma has clear boundaries and less infiltration into the surrounding brain tissues, including hairy cell astrocytoma, subventricular giant cell astrocytoma and pleomorphic yellow astrocytoma. The prognosis of these tumors is good. Another group of gliomas is characterized by diffuse infiltration of tumor cells into the surrounding brain tissue, with no clear cytological or even imaging boundaries, unlimited proliferation, and high aggressiveness. The prognosis of such patients is poor. 7.Can glioma be cured? Gliomas are divided into grades I-IV, grades I and II are low-grade gliomas, and grades III and IV are collectively referred to as high-grade gliomas. grade 1 gliomas have clear boundaries between the tumor and the brain tissue, and may be cured after total resection, without radiotherapy, with a good prognosis. gliomas of grades 2 or above tend to have invasive growth of tumor, and the boundaries between the tumor and the brain tissue are not clear, unless some kind of ultra-expanded resection is performed, and generally require auxiliary radiotherapy after surgery, which are theoretically difficult to be cured. Theoretically, it is difficult to cure. 8.What is the prognosis of glioma? The prognosis of glioma depends on many factors, including age, type, grade and location of the tumor, your current level of self-care, and the degree of resection of the lesion during surgery. After surgery, diagnostic pathology can determine the grade of the glioma, and molecular testing can clarify the biology of the glioma and predict sensitivity to radiation or chemotherapy, which are also important in developing an adjuvant treatment plan after glioma surgery, which you will need to discuss with your physician to understand the specifics of your individual case. Therefore, it is not possible to understand the prognosis of a patient like a math problem, and there is a great deal of uncertainty or no uniform answer. 9. How long can a glioma patient survive? Survival of gliomas of different degrees of malignancy is not the same, and even for the same degree of malignancy, survival can vary greatly. Some patients survive for so long that they are called “miracles of medicine”. Even for the most malignant type of glioma (whose median survival after surgery is less than one and a half years), there are some patients who are very sensitive to chemotherapeutic drugs, and through standardized treatment, the survival period can be several times longer than the median survival period. As treatment improves, more and more patients are achieving longer survival and better quality of life. How do you know you are not the one called “miracle man”. 10. How do gliomas develop? It is currently believed that the occurrence of glioma is the result of the interaction between genetic factors within the organism and external environmental factors. The two risk factors that can be identified at present are exposure to high doses of ionizing radiation, and genetic mutations associated with some specific rare diseases. 11. Can I get a glioma from hitting my cell phone often? Research on this question has not yet reached a definitive conclusion, because in the past, when cell phones were not widespread, the incidence of gliomas was not low. There is no evidence that there is a clear correlation between playing cell phone and getting glioma. 12. What are the symptoms of patients who have glioma? The symptoms of glioma patients are closely related to the growth rate of the tumor and its location in the brain. Patients with glioma mainly have headache, vomiting, blurred vision and other indeterminate symptoms, while others have epileptic seizures, commonly known as “crohns”, and others have paralysis of a single limb, poor speech, or mental indifference, or mood changes. 13.What are the examination methods for glioma? At present, glioma mainly relies on CT or MRI examination to obtain imaging diagnosis, and tumor resection or biopsy to obtain specimens for clear pathological diagnosis. 14.What are the treatment methods for glioma? Surgical resection is the main treatment for glioma, and malignant glioma is treated with radiotherapy, chemotherapy and other therapies. 15.What is the significance of surgery for glioma? Surgery can relieve clinical symptoms, prolong survival, and obtain enough specimens for definitive pathological diagnosis and molecular level research. The goal of surgery is to remove the tumor to the maximum extent under the premise of safety. 16.What is the significance of radiotherapy for glioma? Postoperative radiotherapy for malignant gliomas is beneficial for survival. Due to the characteristics of aggressive growth of glioma and due to the presence of functional brain area, super-expanded resection is difficult to realize. Therefore, for malignant gliomas, even if the resection is complete on imaging, we have to take radiation therapy of the brain tissue around the tumor bed. It helps to delay tumor recurrence and prolong the survival of patients. 17.What is the significance of chemotherapy for glioma? The use of chemotherapy can further kill the residual cells of solid tumors, which can help to improve the progression-free survival time and average survival time of patients, and the role of chemotherapy in the treatment of malignant glioma is now more and more valued. Especially, the development of new drugs makes the treatment of tumors have new means again. 18.Does glioma recur? Only a few gliomas can be clinically cured, and most of the gliomas, especially high-grade gliomas, will recur, and most of them will be elevated in grade when recurring. 19. How to prevent and manage recurrent glioma? First of all, it is necessary to insist on the regular review of glioma. Low-grade glioma should be reviewed every 3-6 months and once a year after 5 years. MRIs are performed 2-6 weeks after radiation therapy for high-grade gliomas, and MRIs are performed every 2-3 months for the next 2-3 years, and every 3-6 months after three years. When recurrence occurs, it is important to contact the attending physician for professional advice. 20.Can recurrent glioma be operated again? Surgery can be firstly considered if the following conditions are met: 1. The patient can tolerate surgery and the recurrence manifests itself as focal and can be surgically resected; 2. Even if complete resection of the lesion cannot be achieved, the tumor occupying effect is obvious and good intracranial decompression can be achieved by surgery. When recurrence and post-treatment reaction (e.g., radionecrosis) cannot be identified, reoperation should be carefully considered, but surgery is preferred when the occupying effect of the lesion is obvious. 21. What is the treatment for gliomas that start with epilepsy? Gliomas cause abnormal discharges of neurons in the brain, and patients often have epilepsy, especially in oligodendrogliomas; epilepsy is the main symptom in many patients with low-grade gliomas. With surgery, seizure symptoms disappear in most patients. Postoperative antiepileptic drugs are recommended for glioma patients with a history of epilepsy, and the drugs are discontinued after one year if there are no seizures. 22. Can I have surgery if I have glioma but I am old enough? Age is an important factor affecting prognosis, but there are still many elderly patients who can benefit from surgery, radiotherapy and/or chemotherapy. However, only supportive treatment is recommended for those with poor systemic conditions or significant comorbid underlying diseases. 23. Is there any other treatment for glioma besides surgery, radiation and chemotherapy? Glioma is currently a research hotspot because it is difficult to be cured, and now there are advances in molecular targeted therapy, immunotherapy, gene therapy, electric field therapy and so on, most of which are still in the stage of preclinical or clinical research, and they can be used as experimental treatments in the research units that have the conditions. 24.What are the commonly used molecular markers for glioma? IDH mutation Isocitrate dehydrogenase (IDH), there are three isoenzyme forms (IDH1/2/3), IDH1/2 exists in somatic mutations. Patients with IDH mutations have a better prognosis and longer progression-free survival and overall survival. patients with IDH wild-type have a poorer prognosis and relatively shorter progression-free survival and overall survival. MGMT promoter methylation Hexa-oxo-methylguanine-DNA-methyltransferase (MGMT) is an important DNA repair enzyme that rapidly repairs DNA alkylation damage induced by alkylating agents, thus making the cells resistant to alkylating agents.MGMT promoter methylation suggests that patients with glioblastoma (GBM) have a better prognosis. Chromosome 1p/19q co-deletion In gliomas, deletions of 1p and 19q are associated with the oligodendrocyte component of the tumor. patients with co-deletions respond well to radiation and chemotherapy, suggesting a longer survival and a relatively good prognosis. 25. What is the significance of genetic testing in the diagnosis and treatment of glioma? It is undeniable that molecular features can play a role in indicating the typing and prognosis of glioma. However, according to the latest guidelines, molecular testing also only indicates the prognosis of glioma, but is not very helpful in choosing treatment.