Mixed gliomas

Mixed gliomas develop from a mixture of different glial cells, including astrocytes, ependymal cells and oligodendrocytes. Glial cells support and protect nerve cells in the brain (neurons).

Symptoms may include:

  • headaches
  • sickness (vomiting)
  • seizures (fits)
  • problems with coordination or or speech
  • weakness in an arm or leg.

To find out more about the tumour, you will have different tests. These can include an MRI scan, a CT scan, and a biopsy.

There are four grades of mixed gliomas. Lower grades grow slowly while higher grades grow more quickly.

Your specialist will talk to you about the best treatment for you and explain the benefits and disadvantages. They may prescribe steroids to help control your symptoms and drugs to prevent seizures, if needed.

Treatment depends on the tumour’s grade, its size, position and your health. Surgery and radiotherapy are the main treatments. Some people may have chemotherapy. You may have a combination of these treatments.

Treatment can cause side effects. Your doctors will explain what to expect and how side effects can be managed.

Understanding mixed gliomas

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 be read it along with our general information about brain tumours  which has more detailed information about tests, treatments and their side effects.

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.


The brain


Grading of mixed gliomas

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

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).


Symptoms of mixed gliomas

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.


Tests

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 scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. This scan takes around 30 minutes and is painless. We have more detailed information about having a CT scan.


MRI scan

This scan uses magnetism to build up a detailed picture of areas of your body. You may be given an injection of dye, into a vein, to improve the images from the scan. This test is painless and will take around 30 minutes. We have more detailed information about having an MRI scan.


Biopsy

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.


Treatment

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.


Surgery

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

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.

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.

Side effects

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 rest. The skin on your scalp may become itchy and red or darker and you will lose the hair on in 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.


Chemotherapy

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.

Side effects

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. We have more detailed information about the side effects of chemotherapy.


Steroids

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 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.


After treatment

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.


Driving

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.

You can contact the DVLA by phone on 0300 790 6806 or at dvla.gov.uk.


Back to Types of brain tumour

Acoustic neuromas

An acoustic neuroma is a of brain tumour of the hearing nerve. It is sometimes called a vestibular schwannoma.

Astrocytomas

Astrocytomas, also known as astrocytic tumours, are a type of brain tumour.

CNS lymphoma

Most lymphomas start in lymphatic organs. But CNS lymphoma starts in the central nervous system.

Ependymoma

An ependymoma is a rare type of brain tumour.

Haemangioblastoma

A haemangioblastoma is a rare brain tumour that starts in the cells that line blood vessels in the brain.

Medulloblastoma

A medulloblastoma is a rare form of brain tumour.

Meningioma

A meningioma is a brain tumour that starts in tissues called the meninges that protect the brain. Most are benign.

Oligodendroglioma

An oligodendroglioma is a type of brain tumour that starts in the cells that cover nerve cells.

Pineal region tumours

Pineal-region tumours develop in the area of the pineal gland in the brain. They can be benign or malignant.

Pituitary tumours

Pituitary tumours start in the pituitary gland, which is at the base of the brain. They are usually benign.