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A brainstem glioma is a cancerous glioma tumor in the brainstem.

They are most often found in children under the age of twenty (75% of the time), but have been known to affect adults as well.^[1] Brainstem gliomas are often primary brain tumors, and rarely metastasize, or spread, to affect another part of the body.

Cause

The cause is still unknown. Researchers have not found any direct genetic link. Children irradiated for tinea capitis have been found to have an increased risk for other central nervous system tumors, such as meningiomas, gliomas, and nerve sheath tumors, but not necessarily tumors of the brain stem.

Signs and symptoms

Common symptoms include, but are not necessarily limited to:

• Lack of facial control, (droopy eyelids)
• Double vision
• Headache or headache that gets better after vomiting
• Nausea and vomiting
• Weakness and fatigue
• Seizures
• Balance problems

Symptoms can develop slowly and subtly and may go unnoticed for months. In other cases, the symptoms may arise abruptly. A sudden onset of symptoms tends to occur with more rapidly growing, high-grade tumors.

Diagnosis

Neuroimaging, such as MRI, is the main diagnostic tool for brain stem gliomas. In very rare cases, surgery and biopsy are performed.

Treatment

Unlike most brain tumors, brainstem glioma is not often treated with neurosurgery due to complications in vital parts of the brain. More often, it is treated with chemotherapy and/or radiation therapy (though past use of radiation therapy has yielded mixed results.)^[2]

There are several new clinical trials in the works that are offering hope to patients and their families. One such trial being dendritic cell immunotherapy which uses the patient’s tumor cells and white blood cells to produce a chemotherapy that directly attacks the tumor.

However, these treatments do produce side effects; most often including nausea, the breakdown of the immune system, and fatigue. Hair loss can occur from both chemotherapy and radiation, but usually grows back after chemotherapy has ceased. Steroids such as Decadron may be required to treat swelling in the brain. Decadron can lead to weight gain and infection. Patients may also experience seizures, which need to be treated to avoid complications. For some patients there is a chance of a neurological break down, this can include, but is not limited to, confusion and memory loss.

The use of topotecan has been investigated.^[3]

Prognosis

Brainstem glioma is an aggressive and dangerous cancer. Without treatment, the life expectancy is typically a few months from the time of diagnosis. With appropriate treatment, 37% survive more than one year, 20% survive 2 years. and 13% survive 3 years.

References

1. ^ Salmaggi A, Fariselli L, Milanesi I, et al. (February 2008). "Natural history and management of brainstem gliomas in adults. A retrospective Italian study". J. Neurol. 255 (2): 171–7. doi:10.1007/s00415-008-0589-0. PMID 18293027. http://dx.doi.org/10.1007/s00415-008-0589-0.  
2. ^ Broniscer A, Laningham FH, Kocak M, et al. (March 2006). "Intratumoral hemorrhage among children with newly diagnosed, diffuse brainstem glioma". Cancer 106 (6): 1364–71. doi:10.1002/cncr.21749. PMID 16463390. http://dx.doi.org/10.1002/cncr.21749.  
3. ^ Sanghavi SN, Needle MN, Krailo MD, Geyer JR, Ater J, Mehta MP (January 2003). "A phase I study of topotecan as a radiosensitizer for brainstem glioma of childhood: first report of the Children's Cancer Group-0952". Neuro-oncology 5 (1): 8–13. PMID 12626128. PMC 1920667. http://neuro-oncology.dukejournals.org/cgi/pmidlookup?view=long&pmid=12626128.  

• Foer, Dana R, and Paul G. Fisher. "Brain Stem Gliomas in Childhood ." Brain Tumor Types and Imaging. The Childhood Brain Tumor Foundation. 23 Oct. 2008 <http://www.childhoodbraintumor.org/index.php/articles/34-brain-tumor-types-and-imaging/57-brain-stem-gliomas-in-childhood.html>.
• "Brain Stem Gliomas." Brain Tumor Society. 25 Oct. 2008 <http://www.tbts.org/assets/files/Fact%20Sheets/Brain_Stem_Gliomas.pdf>.
• "Brain Stem Glioma." Tumor Types. National Brain Tumor Foundation. 25 Oct. 2008 <http://www.braintumor.org/BrainStemGlioma>.
• Landolfi, DO, Joseph, and Anita Venkataramana, MBBS. "Brainstem Gliomas : Article by Joseph Landolfi." eMedicine (Aug. 29 2006): 24 Oct. 2008 <http://www.emedicine.com/neuro/TOPIC40.HTM>.
• Phuphanich, MD, Surasak . "Immunotherapy for Patients With Brain Stem Glioma and Glioblastoma." 1 Dec. 2007. ClinicalTrials.gov. 23 Oct. 2008 < http://clinicaltrials.gov/ct2/show/NCT00576641?term=glioblastoma&rank=30>.
• Vogt, Tom. "Herb may be potent cancer fighter ." Columbian. 20 Oct. 2008. 30 Oct. 2008 <Herb may be potent cancer fighter >.