Mixed gliomas are a type of brain tumour. They are more common in men than women. This information is about mixed gliomas, their symptoms and treatments. It should ideally be read along with our general information about brain tumours.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.
The brain and spinal cord make up the central nervous system (CNS). The brain controls different functions of the body, how we think, feel, learn and move. The spinal cord is made up of nerves that run down the middle of the back (spine). Messages from the brain go back and forwards to organs in the body through the spinal cord.
Gliomas start in glial cells, which support and protect nerve cells in the brain (neurons). Astrocytomas, ependymomas and oligodendrogliomas are all types of glioma. They are named after the glial cells they develop from: astrocytes, ependymal cells and oligodendrocytes.
A mixed glioma contains more than one of these cell types. For example a tumour that contains both astrocytes and oligodendrocytes is called an oligo-astrocytoma. The most common site for a mixed glioma is the cerebrum, which is the main part of the brain.
Grading of mixed gliomas
Back to top
Grading is about how the tumour cells look when they are examined under a microscope. The grade gives an idea of how quickly the tumour may grow. There are four grades - grades 1 and 2 are low-grade which means the tumour grows slowly, and grades 3 and 4 are high-grade which means the tumour grow more quickly.
Causes of mixed gliomas
Back to top
As with most brain tumours, the cause is unknown but research is going on to find out more. Some risk factors are having had previous radiation to the head or certain rare genetic (hereditary).
Sometimes the first symptoms are caused by increase in pressure in the brain (called raised intracranial pressure). This may be caused by a blockage in the ventricles (fluid-filled spaces of the brain), which leads to a build-up of the cerebrospinal fluid (CSF). CSF is the fluid that surrounds and protects the brain and the spinal cord. This increased pressure may also be caused by swelling around the tumour itself.
Raised intracranial pressure can cause headaches, sickness (vomiting) and vision problems.
Common symptoms include headaches and fits (seizures). Other symptoms may relate to the area of the brain that is affected:
frontal lobe may cause gradual changes in mood and personality, weakness or numbness of one side of the body
temporal lobe problems with coordination and speech, and it may affect memory
parietal lobe may cause problems with writing and weakness or numbness of one side of the body.
Your doctors need to find out as much as possible about the type, position and size of the tumour, so they can plan the best treatment for you. You will usually have a number of different tests.
The doctor will examine you and do checks on your nervous system. This includes checking your reflexes and the power and feeling in your arms and legs. They also shine a light at the back of your eye to check if the optic nerve is swollen, which can be a sign of raised pressure in the brain. Your doctor will ask some questions to check your reasoning and memory. You will also have blood tests taken to check your general health and to see how well your kidneys and liver are working.
You will have a CT brain scan or MRI brain scan to find the exact position and size of the tumour.
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and only takes a few minutes. CT scans use small amounts of radiation, which will be very unlikely to harm you or anyone you come into contact with.
You will be given an injection of a dye, which allows particular areas to be seen more clearly. For a few minutes this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
Watch our video about having a CT scan at macmillan.org.uk/testsandscans
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it’s safe for you to have an MRI scan.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy but you’ll be given earplugs or headphones.
To diagnose a mixed glioma, you usually need to have a small sample of tissue removed from the tumour (biopsy). This involves an operation. A neurosurgeon makes a small hole in the skull and passes a fine needle into the tumour to remove a small sample from it. A CT scan is done at the same time to help guide the surgeon to the exact area. Your doctor will explain whether a biopsy is necessary in your case, and what the operation involves.
Your treatment will depend on a number of factors. This includes whether the tumour is slow growing (low-grade) or fast growing (high-grade), its size and position, and your general health.
A team of different specialists will plan your treatment. This will usually include doctors who specialise in treating conditions of the brain (a neurologist or neurosurgeon), a cancer doctor who specialises in treating brain tumours (oncologist) and a specialist nurse.
Your doctor will explain the aims of your treatment, its benefits and disadvantages and the risks of treatment. You and your doctor can then decide on the treatments that are right for your situation.
If the pressure in the skull is raised, it’s important to reduce it before any treatment is given for brain tumours. Steroid drugs may be used to reduce the swelling around the tumour. If raised intracranial pressure is due to a build-up of CSF, a tube (shunt) may be inserted to drain off the excess fluid.
Where possible, surgery is the main treatment for mixed gliomas. The aim is to remove as much of the tumour as possible without damaging the surrounding brain tissue. Depending on the size and position of the tumour, it may not be possible to remove it completely. You may need further treatment, usually with radiotherapy, after surgery. Sometimes an operation may not be possible. This may be because the position of the tumour makes it too difficult to reach and surgery would not be safe. Radiotherapy can be used when surgery is not possible.
Radiotherapy treatment uses high energy rays to destroy cancer cells and is often used after surgery. The aim of the radiotherapy is to destroy any remaining brain tumour cells. If surgery is not possible you may have radiotherapy on its own.
Your doctor and specialist nurse will talk to you about the likely side effects. Radiotherapy makes you feel very tired and this can carry on for weeks or longer after it finishes. Try to get plenty of rest. The skin on your scalp may become itchy and red or darker and you will lose the hair on the area being treated. This usually grows back again after 2- 3 months. Your nurse will give you advice on looking after the skin on your scalp and coping with hair loss.
Radiotherapy to the whole brain may cause a long term risk of some changes to your memory or thinking. Your cancer doctor and nurse will talk this over with you. Newer ways of giving radiotherapy aim to give a higher dose of radiotherapy to the tumour without damaging the surrounding normal brain.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given alone to treat mixed gliomas or with surgery and/or radiotherapy.
A nurse usually gives you chemotherapy drug or drugs into a vein (intravenously). You may also have chemotherapy as tablets.
Watch our video about having chemotherapy intravenously at macmillan.org.uk/chemotherapyintoavein
Your doctor or specialist nurse will tell you what to expect. They can prescribe drugs to reduce some side effects and give you advice on what you can do to manage side effects. One of the main side effects is risk of infection. Chemotherapy temporarily reduces the number of white blood cells which help fight infection. Other side effects can include, feeling sick, sore mouth, or possible hair loss. Always let them know about any side effects you have.
Steroids are drugs that are used to reduce swelling around the tumour. They improve symptoms and help you to feel better. If you have raised pressure in the brain you will be treated with steroids straightaway.
You usually have them as tablets. Some of the side effects include: indigestion, weight gain, restlessness, agitation and sleep disturbance. Let your doctor or nurse know if these are causing problems or you notice any other side effects. Taking steroids with food can help reduce indigestion. Your doctor may also prescribe medication to prevent it. It is very important to take steroids exactly as they have been prescribed.
Medicines and seizures
If you have a seizure (fit), you may be given a medicine called an anticonvulsant to help prevent them.
Some people may need support to help them to recover from their symptoms or after treatment. This may be from a physiotherapist to help improve your balance, walking or strength. Occupational therapists can provide equipment and help you be more independent. Other services such as speech therapy or psychological support services are also available.
You will be monitored very closely after treatment with regular scans and check-ups at clinic.
Being diagnosed with a brain tumour may feel very frightening at times. You may have many different feelings, including anxiety, anger, fear or feeling low or depressed. Many people go through these in coping with their illness. It’s important to get the support you need.
You may find it helpful to talk things over with family and close friends and with your doctor or nurse. You can also talk to one of our support service nurses. Sometimes people need more help to cope with difficult feelings of anxiety or depression. Your doctor can refer you to a counsellor or psychologist for more support.
You may not be allowed to drive for a period of time depending on the treatment you have had and if you have had any fits (seizures). Although this can be upsetting it’s important to follow the advice you are given.Your doctor will ask you to contact the Drivers and Vehicle Licensing Association (DVLA). It is your responsibility to contact the DVLA. Your doctor or nurse will explain what you need to do.
This information has been compiled using information from a number of reliable sources, including:
Guidelines on management of low-grade gliomas: report of an EFNS–EANO* Task Force. European Journal of Neurology 2010, 17: 1124–1133
High-Grade Malignant Glioma: ESMO Clinical Practice Guidelines 2014
Packer and Schiff. Neuro-oncology. 1st edition. 2012. Wiley-Blackwell.
With thanks to Dr Fiona Harris, Consultant Clinical Oncologist, who reviewed this edition.
Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to grow.
You could help us too when you join our Cancer Voices Network - find out more.