Overview
Glioma is the most common intracranial tumor, accounting for more than half of brain tumors. Among systemic malignancies, malignant glioma has the third highest mortality rate after pancreatic cancer and lung cancer. The prognosis of patients with glioma is closely related to the age, physical condition, size, location, and pathological grading of the tumor.
Glioma has no envelope, no boundary with surrounding normal brain tissue, and infiltrative growth. For tumors with high malignancy, tumor cells have proliferative and migratory characteristics and can spread from one hemisphere to the opposite hemisphere along the corpus callosum and the myelin structure of the anterior cross, which makes surgery not easy for total excision and treatment effect is poor.
The survival period of malignant gliomas is calculated in weeks even with various treatments. Even though low-grade gliomas are pathologically benign and less aggressive, many patients do not survive more than 5 years before the tumor progresses from a less malignant glioma to a more malignant glioma, and almost all patients die from tumor recurrence, local spread, local invasion, or even whole brain dissemination.
Although mature techniques such as surgical resection, radiation therapy, chemotherapy and gene therapy and immunotherapy under clinical research are available, the overall treatment effect is not ideal.
Family genetic history, individual immune status, contaminated components, history of specific occupational exposure, dietary habits, smoking, alcohol consumption, history of head trauma, epileptic outbreaks, daily life, ionizing radiation, and even social life status and level of education may be associated with the development of glioma.
It has been shown that 0.0001 grams of tumor tissue contains 100,000 tumor cells and 1 gram of tumor tissue contains 100,000,000 tumor cells. Malignant glioma grows rapidly and the cell cycle of active cells is often only a few days, which means that 100,000 active glioma cells today will become 200,000 in a few days and increase geometrically, endangering the brain tissue, the life center of human body. Therefore, the danger of glioma cannot be ignored, and symptoms should be promptly examined and treated in a regular professional hospital.
Clinical manifestations of glioma
The volume of normal adult cranial cavity is about 1400-1500ml, and the contents of cranial cavity have 3 components: brain tissue, cerebrospinal fluid and blood. Among them, the volume of brain tissue is 1150-1350cm3, accounting for more than 80%, the total amount of cerebrospinal fluid is about 150ml, accounting for about 10%, and the amount of blood accounts for 2%-11%.
The unrestricted growth of glioma leads to the increase of intracranial pressure or due to tumor compression, infiltration and destruction as well as tumor hemorrhage, necrosis and edema, all of which will lead to a series of clinical manifestations and even brain herniation, endangering patients’ lives.
The general clinical manifestations are in the following aspects.
1. The occupying effect of tumor causes increased intracranial pressure, headache is the most common. In addition, there are vomiting and optic nerve papillary edema.
2.Local functional disorders. Hemiparesis, aphasia, abnormal sensation, etc.
3.Epilepsy: The stimulation of tumor makes one-third of glioma patients have epilepsy as the first symptom.
Treatment methods of glioma
At present, the domestic and foreign treatment for glioma is surgery, radiotherapy, chemotherapy, X-knife, γ-knife and other comprehensive treatment.
1.Surgical treatment of glioma
Due to the growth characteristics of glioma, it is theoretically impossible to completely remove glioma, and the surgical effect is even worse for tumors growing in important areas such as brainstem, so surgical resection can only be limited to the following five purposes.
① clarify the pathological diagnosis?
②Reducing the tumor volume and reducing the number of tumor cells?
③Improve the symptoms and relieve the symptoms of increased intracranial pressure?
④Prolong the patient’s life and create opportunities for subsequent comprehensive treatment?
⑤ To obtain tumor cell kinetic information to provide a basis for finding effective treatment.
2.Radiotherapy for glioma
General radiotherapy
Radiotherapy is the routine treatment for almost all types of glioma, but the efficacy evaluation is different. Except for medulloblastoma, which is highly sensitive to radiotherapy, and ventricular meningioma, which is moderately sensitive, all other types are not sensitive to radiotherapy. In addition, the impact of radiation damage on brain function should not be underestimated. Radiotherapy can cause local alopecia, ischemia, necrosis, poor healing of incision and even septic infection in some patients, and it can also cause cerebral edema, ischemia and necrosis of brain tissue and other serious consequences.
Special radiotherapy methods: X-knife and R-knife treatment
It depends on the location of the tumor, the size of the tumor (usually limited to 2.0cm or less than 3.0cm), the age of the patient and other factors.
3.Chemotherapy for glioma
Intravenous chemotherapeutic drugs: Nowadays, the intravenous chemotherapeutic drugs commonly used in the market for the treatment of human malignant tumors do not easily cross the blood-brain barrier, so they are not easy to produce effects on glioma, and can cause toxic side effects such as lowering of white blood cells, hair loss, loss of appetite and lowering of immunity, and their efficacy is not yet certain. BCNU, CCNU, VM-26, etc. are commonly used.
Oral chemotherapy drugs: Temozolomide capsule is a new type of oral capsule for the treatment of glioma, which has been introduced to China from abroad in recent years. It is highly targeted and specific, can cross the blood-brain barrier, and has the advantages of toxicity and low side effects, which can partially prolong patients’ survival time and improve the quality of survival. However, it is more expensive, generally patients need to undergo 6 courses of treatment, each course of treatment lasts 28 days, and each course of treatment costs about 10,000 RMB.
Advances in medical care will enable some patients with glioma to improve their symptoms, extend their survival time and improve their quality of life. Therefore, patients should have enough confidence to overcome the disease and cooperate with doctors and nurses to complete the whole medical process.
Patients need to go through the following steps after admission to the hospital
1.Conduct routine physical examination, including blood routine, blood biochemistry, liver and kidney function, immunological examination, blood group analysis, electrocardiogram, chest radiograph, etc.
2.Some patients whose diagnosis is still unclear will undergo necessary cranial CT, MRI plain and enhanced examinations, etc., to further clarify the diagnosis.
3.Medication for some patients with clinical symptoms to relieve the disease and improve the symptoms.
4.Consultation by doctors from related departments and hospitals as necessary.
5.Evaluate the results of the completed examinations and systemic conditions, consultation opinions, etc., and explain the pros and cons of various treatment methods as well as prognosis and approximate financial requirements, etc.
6.Other matters.
Appendix 1: Clinical manifestations of common gliomas.
Astrocytoma
The general symptoms are increased intracranial pressure, headache, vomiting, optic nerve papillary edema, visual field changes, epilepsy, diplopia, cranial enlargement (in children) and changes in vital signs.
Local symptoms of glioma vary depending on the location of tumor growth.
(1) Cerebral hemispheric astrocytoma: about 1/3 patients have epilepsy as the first symptom, and about 60% patients have epilepsy.
(2) Cerebellar astrocytoma: ataxia of the affected limb, clumsy movement, unstable holding, low muscle tone and tendon reflex, etc.
(③) Thalamic astrocytoma: light paralysis, sensory disorders and hemiplegia, ataxia and choreiform movements of the affected limb, mental disorders, endocrine disorders, ipsilateral blindness, supraoptic disorders and hearing disorders.
(4) Optic nerve astrocytoma: The main manifestations are visual impairment and abnormal eye position.
⑤ Third ventricular astrocytoma: Patients with obstructive hydrocephalus often present with severe episodic headache, sudden loss of consciousness, mental disorders, and memory loss.
(6) Brainstem astrocytoma: central tumors often present with oculomotor disorders, pontocerebral tumors often present with limited eye abduction, facial nerve and trigeminal nerve involvement, and medullary tumors often present with swallowing disorders and changes in vital signs.
Glioblastoma
The tumor is highly malignant with fast growth and short course. Most of the tumors are diagnosed within 3 months from the appearance of symptoms to the time of consultation, and the symptoms of high intracranial pressure are obvious. 33% of the patients have seizures, and 20% of the patients show psychiatric symptoms such as apathy, dementia and mental retardation.
Oligodendroglioma and mesenchymal (malignant) oligodendroglioma
Epilepsy is often the first symptom, psychiatric symptoms are mainly emotional abnormalities and dementia, invasion of motor and sensory areas may produce hemiparesis, hemianesthesia and aphasia, etc. High cranial pressure symptoms appear later.
Medulloblastoma
①Tumor growth is fast and high cranial pressure symptoms are obvious.
(2) Cerebellar function damage is manifested by staggering gait and unstable walking.
③ Diplopia, facial palsy, cranial enlargement (in children), choking and coughing, etc.
④Tumor metastasis is an important feature of medulloblastoma.
Ventricular meningioma
①Symptoms of increased intracranial pressure
②Symptoms of brainstem compression (vomiting, choking cough, difficulty in swallowing, hoarseness, dyspnea), cerebellar symptoms (unsteady walking, nystagmus, etc.), hemiparesis, supraocular motility disorder, etc.
The recurrence rate after surgery is almost 100%, and intravertebral metastasis is likely to occur.
Appendix 2: Dietary contraindications for glioma
Appropriate.
1.It is advisable to eat foods with anti-brain tumor, such as wheat, barley, water chestnut, jellyfish, asparagus, fried gecko, fried whole scorpion, fried centipede, fried silkworm pupa, horseshoe crab, kelp.
2, it is advisable to eat foods with the role of protecting intracranial blood vessels: celery, capers, chrysanthemum brain, wild rice, sunflower seeds, kelp, jellyfish, oysters, clams.
3.It is advisable to eat food with the effect of preventing intracranial hypertension: corn beard, adzuki beans, walnuts, nori, carp, duck, Ulva, kelp, crab, clams.
4.It is advisable to eat foods with the effect of protecting eyesight: chrysanthemum, marjoram, shepherd’s purse, lamb liver, pig liver, eel.
5.It is advisable to eat foods with protection against side effects of chemotherapy and efficacy therapy: shiitake mushroom, silver fungus, black fungus, yellow fungus, walnut, sesame, sunflower seed, kiwi, sheep blood, pig blood, goose blood, chicken blood, lotus seed, mung bean, barley, carp, green bean, sturgeon, shark, plum, almond.
Avoid.
1, avoid coffee, cocoa and other excitatory drinks.
2, avoid spicy and stimulating foods, such as onion, garlic, leek, pepper, chili, cinnamon, etc..
3, avoid moldy, burnt food, such as moldy peanuts, moldy soybeans, burnt fish.
4, avoid greasy, preserved fish, fried, smoked food.
5, avoid too salty food.
6, avoid smoking, avoid alcohol.