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NCCN Guidelines for Patients Brain Cancer: Gliomas

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NCCN Guidelines for Patients Brain Cancer: Gliomas 2021 Brain Cancer Gliomas Presented with support from: Available online at NCCN.org/patients Ü Gliomas It's easy to get lost in the cancer world Let NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients® Gliomas, 2021 1 About National Comprehensive Cancer Network® NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice NCCN Guidelines NCCN Guidelines in Oncology for Patients (NCCN Guidelines®) 9 An alliance of leading 9 Developed by doctors from 9 Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience 9 For people with cancer and education 9 For providers of cancer care those who support them all over the world Cancer centers 9 Explain the cancer care that are part of NCCN: 9 Expert recommendations for options likely to have the NCCN.org/cancercenters cancer screening, diagnosis, best results and treatment Free online at Free online at NCCN.org/patientguidelines NCCN.org/guidelines and supported by funding from NCCN Foundation® These NCCN Guidelines for Patients are based on the NCCN Guidelines® for Central Nervous System Cancers, Version 1.2021 – June 4, 2021. © 2021 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation seeks to support the millions of patients and their families NCCN Guidelines for Patients and illustrations herein may not be reproduced in affected by a cancer diagnosis by funding and distributing NCCN Guidelines for any form for any purpose without the express written permission of NCCN. No Patients. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived visit NCCN.org/patients. from, based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN Guidelines are a work in progress that may be redefined as often National Comprehensive Cancer Network (NCCN) / NCCN Foundation as new significant data become available. NCCN makes no warranties of any 3025 Chemical Road, Suite 100 kind whatsoever regarding its content, use, or application and disclaims any Plymouth Meeting, PA 19462 responsibility for its application or use in any way. 215.690.0300 Supporters Endorsed by EndBrainCancer Initiative (EBCI), formerly the Chris Elliott Fund Mission: Enhancing patient outcomes by expanding FDA-approved treatment modalities and fueling research in the pharma/bio/life sciences, device & diagnostic industries and by closing the existing GAP from initial diagnosis to IMMEDIATE AND EXPANDED ACCESS to specialists, researchers, advanced & innovative treatment, clinical trials and critical care with the ultimate goal of improving patient outcomes through updating and improving WHO & NCCN Guidelines and clinical practices related to Standard of Care for patients with brain cancer and patients with brain metastases. For assistance being connected to a brain cancer specialist prior and post-surgery and/or clinical trials and advanced treatments and to learn about what all of your surgery and treatment options include, please contact EBCI’s Clinical Research Nurse & Patient Navigator, contact [email protected] or call 425-444-2215. endbraincancer.org With generous support from • Melanie Moletzsky • Kerrin Rosenthal • Shannon Ryan • Lauren Seabury • Lorraine and Joseph Tumolo in memory of Marie Tumolo To make a gift or learn more, please visit NCCNFoundation.org/donate or e-mail [email protected]. NCCN Guidelines for Patients® Gliomas, 2021 3 Photo: King’s College Hospital NCCN Guidelines for Patients® Gliomas, 2021 4 Gliomas Contents 6 Glioma basics 11 Glioma testing 24 Glioma treatments 40 Low-grade glioma treatment 46 High-grade glioma treatment 55 Recurrent disease 59 Making treatment decisions 68 Words to know 70 NCCN Contributors 71 NCCN Cancer Centers 72 Index NCCN Guidelines for Patients® Gliomas, 2021 5 1 Glioma basics 7 What is a glioma? 7 What causes a glioma? 8 Are there different types of glioma? 8 How are gliomas identified? 9 Can gliomas be cured? 10 Key points NCCN Guidelines for Patients® Gliomas, 2021 6 1 Glioma basics What is aa glioma?glioma? | What causes a glioma? Being diagnosed with a brain tumor can be frightening and overwhelming. This book will help you make sense of all the information that’s out there. It will also describe your options for Gliomas occur in treatment. Taken together, you’ll have both children and the confidence to make well-informed adults. This book decisions. discusses gliomas only in adults. What is a glioma? A glioma is a cancer that grows in the brain. Gliomas develop from certain brain cells called glial cells. Glial cells support the function of Gliomas are very uncommon. An estimated nerve cells (neurons) in the central nervous 20,000 people are newly diagnosed with system. The central nervous system includes gliomas per year in the United States. Gliomas the brain and the spinal cord. Many types can happen in people of any age, but they of tumors can occur in the central nervous occur more often in adults. Gliomas are slightly system. Only those that start as glial cells more likely to develop in men than in women, become gliomas. and are somewhat more common in Whites than in Blacks, Hispanics, and Asians. Gliomas are malignant tumors. Malignant means cancer. Malignant tumors can grow quickly and out of control. This growth can disrupt the brain’s ability to function correctly. What makes gliomas so complicated is What causes a glioma? that they invade and blend into the normal No one knows exactly what causes most brain structures of the brain. So, gliomas can be tumors, including gliomas. What doctors do very difficult to treat without harming the know is that brain cancers often start with an healthy parts of the brain. abnormality (mutation) in the cells that become cancerous. This type of mutation happens Gliomas are also primary tumors. A primary on its own. It’s not a mutation in other cells tumor means it develops in the area of the or organs in your body. And, it’s not typically brain where it began. Secondary brain tumors passed down in families (hereditary mutation). start in another part of the body and spread However, you may have a higher risk for a to the brain to form new tumors. Gliomas very glioma if another family member also had a rarely spread to other parts of the body. glioma. NCCN Guidelines for Patients® Gliomas, 2021 7 1 Glioma basics Are there different types of glioma? Are there different types of glioma? There are several types of gliomas. The types are named based on their cell type. The main types discussed in this book include astrocytomas and oligodendrogliomas. What is cancer? Astrocytomas look like glial cells called astrocytes. The most aggressive astrocytoma is glioblastoma. Cancer is a disease where cells—the Oligodendrogliomas resemble glial cells building blocks of the body—grow out called oligodendrocytes. of control. This can end up harming the body. There are many types of cells in Each type can be further categorized into the body, so there are many types of grades. A glioma may be low-grade or high- cancers. grade. A grade indicates how fast it’s growing and its severity. For many reasons, it helps to Cancer cells don’t behave like normal put gliomas into categories. But, it’s important cells. Normal cells have certain rules. to note that each glioma has its own molecular Cancer cells don’t follow the rules. characteristics and behavior. That is, each Cancer cells develop genetic errors person’s glioma is unique. So, your progress (mutations) that cause them to make and experience will be unique to you. many more cancer cells. The cancer cells crowd out and overpower normal cells. How are gliomas identified? Cancer cells avoid normal cell death. Gliomas are often found because of the They can spread to other areas of the symptoms they cause. Symptoms may include: body. They can replace many normal cells and cause organs to stop working. Unusual or frequent headaches Scientists have learned a great deal Seizures about cancer. As a result, today’s Difficulty with walking or balance treatments work better than treatments in the past. Also, many people with cancer Changes in personality or mood have more than one treatment choice. Other things that seem out of the ordinary Several different tests, physical exams, and surgical procedures may be required before a glioma is diagnosed. NCCN Guidelines for Patients® Gliomas, 2021 8 1 Glioma basics Can gliomas be cured? Can gliomas be cured? Most gliomas are not curable, but they usually are treatable. New treatments have resulted in Don’t Google your diagnosis and more long-term survivors of glioma now than ever before. assume that statistics define your life! Every person’s brain tumor Treatment is given through three therapies: surgery, chemotherapy, and radiation therapy. “story and situation is different. My A clinical trial of a potential new treatment motto is to “live fearlessly” and is another option that people with glioma ignore those fears the internet can can consider. For many people, the glioma can come back at some point during or after give you.” treatment.
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