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Low-Grade Glioma: Diagnosis and Treatment | Sheba | Sheba

Gliomas, also known as glial tumors, are a type of cancerous brain tumor arising from glial cells responsible for nourishing and supporting brain neurons. Gliomas are divided into four different grades, and the grades determine how serious the patient’s condition is.

Grade 1 and grade 2 are considered low-grade gliomas, while grade 3 and grade 4 are high-grade gliomas. Low-grade gliomas are cancerous but slow-growing as well as highly treatable with an extremely high cure rate.

To help you gain a better understanding of low-grade gliomas, we have prepared a throughout guide to take you through the most important aspects of the diagnosis and treatment process for this disease. 

Treatment options at Sheba for pediatric glioma include:

Low-Grade vs High-Grade Glioma

As mentioned, gliomas are classified as either low-grade or high-grade.

Low-grade gliomas have a well-differentiated cell structure, an excellent prognosis and not-so-aggressive tendencies. High-grade gliomas, on the other hand, have an undifferentiated cell structure, a worse prognosis and aggressive tendencies, meaning they’re extremely malignant.

Grade 1 low-grade gliomas grow slowly, have a normal structure when examined under a microscope and are often only treated with surgery. Pilocytic astrocytoma is the most common grade 1 glioma

Grade 2 low-grade gliomas also grow slowly but do have the potential to spread to nearby healthy brain tissue and, if left untreated, can grow into a high-grade glioma. Typically, grade 2 tumors might need additional treatment after surgery. Some of the different types of grade 2 gliomas include astrocytoma and oligodendroglioma.

Grade 3 high-grade gliomas are fast-growing and malignant. They have a tendency to quickly attack and invade nearby tissue and grow into a grade 4 tumor. The first line of treatment for this glioma is surgery, which is then followed up with chemotherapy and radiotherapy. Different grade 3 gliomas include anaplastic astrocytomas and anaplastic oligodendrogliomas.
Grade 4 high-grade gliomas are the quickest-growing, most aggressive and most malignant type of brain tumor. The cells of this tumor are extremely abnormal and grow very rapidly. Unfortunately, grade 4 gliomas can’t be cured, but they can be controlled with surgery, chemotherapy and radiotherapy. The most common grade 4 glioma is glioblastoma.

Low-Grade Glioma Symptoms

Low-grade gliomas can display a variety of symptoms, and they all differ from person to person. The symptoms each individual patient experiences will depend on a few different factors including the location of the tumor and its size.

Some of the most common symptoms low-grade glioma patients experience include:

Strong and persistent headaches that can appear at any time, but especially in the mornings.
Being clumsy and finding it difficult to walk and/or keep your balance.
Sleepiness, tiredness and overall weakness.
Unexplained weight fluctuations including both weight loss and weight gain.
Frequent and severe nausea and vomiting along with other signs that accompany gastrointestinal illness.
Entering into premature puberty (only for pediatric low-grade gliomas)
Problems with vision and eyesight, including blurry vision, double vision, or even blindness.
Unexplained seizures.

Low-Grade Glioma Diagnosis

If you notice any of the aforementioned symptoms, it could be an indication of the presence of low-grade glioma. Of course, experiencing symptoms doesn’t necessarily mean that you do have the disease, and the only way to know for sure is to go to a specialist who will be able to provide you with a proper diagnosis.

There are a couple of tests and examination techniques a doctor will go through to reach a low-grade glioma diagnosis.

Physical Exam and Medical History

The first step any doctor will take not just for diagnosing low-grade glioma but any disease is to perform a physical exam and check the patient’s health history.

For patients experiencing brain tumor symptoms, the doctor will perform a neurological exam in lieu of a physical exam that will check the following:

  • Fine motor skills.
  • Response to pain.
  • Coordination, balance and reflexes.
  • Reasoning and judgment skills.
  • Speech.
  • Muscle strength.
  • Simple arithmetic problems.

As for the patient’s medical history, the doctor will ask about:

  • Potential previous radiation exposure.
  • Any inherited conditions or disorders that are considered to be a risk factor for glioma.
  • The presence of any conditions that are known to cause weakening of the immune system.
  • A family history of any cancers, but especially brain and spinal cord tumors.

Computed Tomography (CT) Scan

A CT scan takes 3D and cross-sectional images of the patient’s body with the use of specialized X-ray equipment. This scanner takes images of the organs, tissues, blood vessels and bones, and they can be extremely useful for diagnosing any type of brain tumor.

With a CT scan, the doctor can get a good overview of the tumor, examine the bone structure near it, and get detailed images of blood vessels in the patient’s brain. This is not only beneficial for diagnosing a glioma but also for planning surgery to remove the tumor.

Magnetic Resonance Imaging (MRI)

An MRI is another useful examination technique used for diagnosing brain tumors because it can create cross-sectional images of the patient’s organs, blood vessels, tissues, and bones. These images are created thanks to a combination of powerful magnetic forces and radiofrequency waves.


While imaging tests such as a CT scan and an MRI are beneficial for determining the presence, shape, size and location of the tumor, the doctor will still need to know more about the specific glioma the patient is suffering from. And to get that information, they will perform a biopsy.

To perform a biopsy, a medical professional will remove cells or tissue from the tumor and send them to a laboratory to be examined by a pathologist. During the biopsy, the pathologist will be able to examine the cellular structure of the tumor under the microscope and determine the type of tumor the patient has.

The most important part of any biopsy for gliomas is a lumbar puncture, also known as a spinal tap. During a lumbar puncture, the doctor uses a needle to extract a small amount of cerebrospinal fluid.

This type of biopsy is not only useful for determining the type of brain tumor the patient has, but it also shows whether the tumor has spread to the cerebrospinal fluid.

Molecular Testing

Each glioma has specific genes and proteins in its composition that allow doctors to distinguish between different types and stages of the tumor. The best way to see these distinctions is through molecular testing and profiling.

The results of this test will help the doctor determine what kind of treatment option would be the best for the patient’s specific case.

Low-Grade Glioma Treatment

After all the necessary tests are performed and the doctor reaches a low-grade glioma diagnosis, they will be able to administer the appropriate treatment. There are three different treatment options offered for this specific disease:


Surgery is usually the first, and sometimes only treatment option needed for low-grade glioma, especially grade 1. The goal of surgery is to safely remove the entire tumor but, if that can’t be done, as much of the tumor as possible.

Unfortunately, surgery sometimes isn’t an option because the tumor is located in a specific part of the brain that would cause too much damage if surgery is performed.

Chemotherapy for Glioma

If surgery isn’t an option, or if the procedure didn’t remove the entire tumor, the next step in the treatment process is chemotherapy. During chemotherapy, special drugs are administered with the goal of destroying any cancer cells that are left in the patient’s body.

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Radiotherapyfor Glioma

Radiation therapy, or radiotherapy for short, is also used to remove cancer cells that linger in the patient’s body after surgery. It’s often used in combination with chemotherapy, especially if surgery isn’t an option.

However, radiotherapy is very rarely used in pediatric low-grade glioma patients because radiation can be harmful to still-developing children.

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Bone marrow/stem cell transplant with high-dose chemotherapy

Bone Marrow Transplant with High Dose Chemotherapy
When a glioma patient has a severe case of high-grade glioma, it’s impossible to treat them with regular chemotherapy or radiotherapy, which is why a more substantial method is used – high dose chemotherapy.

High dose chemotherapy can be extremely effective for high-grade glioma, however, this type of treatment must be closely controlled due to the negative side effects it can have. The biggest reason why high doses of chemotherapy are rarely given is because doing so would severely damage the patient’s bone marrow, which is responsible for creating new blood cells.

Luckily, doctors can now use this treatment option with more freedom thanks to bone marrow transplants. These transplants can be performed with the patient’s own cells or a donor’s cells.

With a successful bone marrow transplant, the patient’s bone marrow can repair itself more quickly after chemotherapy, and it will also have a positive effect on the immune system.

Some of the most common symptoms of bone marrow transplant with high dose chemotherapy include:

  • Hair loss
  • Diarrhea
  • Nausea and vomiting
  • Liver problems
  • Loss of appetite
  • Mouth sores
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Targeted Therapy for Glioma

Targeted therapy is one of the least aggressive forms of cancer treatment because, unlike chemotherapy and radiotherapy, it doesn’t destroy healthy cells. As the name suggests, this therapy only targets and destroys cancerous cells.

Targeted therapy can be used alone, but this is done in very rare cases. It’s typically used in combination with chemotherapy, when previous treatment has failed, or when there is still a small number of cancerous cells that need to be eradicated.

This type of therapy is administered in the form of drugs that are given to the patient either orally or intravenously.

Some of the most common side effects of targeted therapy for glioma include:

  • Low white blood cell count
  • High blood pressure
  • Fluid buildup
  • Headaches
  • Diarrhea
  • Rashes
  • Nausea and loss of appetite

Follow-Up Care

Cancer treatment doesn’t end when the patient is in remission, because they still require regular follow-up care.This part of the treatment involves regular checkups to keep track of the patient’s condition, if there are any signs of tumor recurrence, and help them manage any side effects. This is done via physical examinations and medical tests.

During follow-up care, the patient will also be examined by a neuropsychologist to check their cognitive abilities. 

Side Effects of Low-Grade Glioma Treatment

Just like with any other treatment, low-grade glioma treatment can come with its own side effects. Not every patient will have the same side effects, and some people may not experience them at all.

The general side effects that occur due to chemotherapy include hair loss, flu-like symptoms, headaches, weakness and dizziness and constipation, just to name a few. For radiation, these symptoms include headaches, nausea and vomiting, fatigue, scalp dermatitis, and hair loss.

However, it’s important to note that there are also some long-term side effects that can appear years after the treatment process is complete. The most concerning one is impaired cognition abilities that occur due to the damage made to healthy brain cells around the tumor.

Other long-term side effects include focal neurologic deficits, seizures, spinal cord myelopathy, radiation necrosis, hearing loss, and optic neuropathy.

Robotic Surgery for Low-Grade Glioma

As we already mentioned, surgery is often the first line of treatment for low-grade glioma patients. However, inadequate surgical excision is a common problem, especially relevant in cases of low-grade bilateral thalamic gliomas.

Robotic surgery, or robot-assisted surgery, allows surgeons to perform complex and minimally invasive procedures with precision and accuracy through the use of robotic arms. These arms are controlled by the surgeon through a dedicated console.

Widely accepted as one of the most advanced surgical systems available, the new da Vinci Xi represents the 4th generation of surgical robotic technology, taking surgical treatment to an entirely new level. The da Vinci Xi features 3D high definition visualization that provides the clearest possible view of the surgical site, a greatly expanded range of motion, and improved manipulator capabilities. Additional features include a tremor filtration system which eliminates natural hand tremors and significantly enhances surgical precision.

Greatly contributing to the precise detection and removal of tumors, advanced surgical robotic systems, such as the da Vinci Xi, offer many glioma patients a new hope for a full, healthy life.

At Sheba Medical Center, we are proud to stand at the forefront of surgical innovation and operate many advanced robotic systems, including the da Vinci Xi.

Choosing Sheba for Low-Grade Glioma Treatment

Sheba Medical Center, one of the 10 best hospitals in the world according to Newsweek magazine, is a comprehensive medical facility dedicated to providing patients from around the world with cutting-edge compassionate care.

Following are just a few of the many reasons to choose Sheba for low-grade glioma treatment:

Sheba operates the latest robotic surgical systems, including the Da Vinci Xi.
Sheba is dedicated to performing procedures that minimize pain and suffering, with deep consideration for the physical and emotional needs of children and adults alike.
Sheba treats children with a holistic approach, keeping in mind that cancer can have devastating effects on the physical and emotional wellbeing of your child and his/her entire family, which is why we offer a variety of support services.
As a government institution, we have no hidden costs, and our fees are transparent. Although we offer advanced treatments that are available only in select medical institutions around the world, our prices are affordable.
Sheba treats each patient as a unique individual, personalizing every therapy program.
Sheba has a 360-degree care approach to every patient, which means that Sheba’s professionals will assist you with arranging medical record reviews, travel, visas, accommodations, and language interpretation as needed.
Sheba has full accreditation from the Joint Commission International (JCI), the premier international healthcare accrediting group.
Sheba has both advanced treatment and laboratory facilities. At Sheba, patients receive every aspect of their treatment in a single facility.
Our physicians are actively involved in the latest research and application of progressive treatments.

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Sheba Medical Center provides innovative, personalized medical care to patients from around the world. We are the largest, most comprehensive hospital in the Middle East and dedicated to providing advanced and compassionate medicine for everyone. We welcome all cases, including the rarest and the most challenging. Our medical teams collaborate to provide the best possible health outcomes. From your initial inquiry through the long-term follow-up care, we are here for you.

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