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Gliomas

Última revisión: 12 Aug 2025
Última actualización: 23 Apr 2025

Resumen

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
Full details

Other diagnostic factors

  • estado mental alterado
  • cefaleia
  • náuseas e/ou vômitos
  • anormalidade de marcha
  • ataxia
  • fraqueza
  • convulsões
  • distúrbios visuais
  • deficit discursivo
  • afasia/disfasia
  • deficit sensorial
  • fraqueza motora
  • alteração visual
  • paralisia do nervo craniano
  • papiledema
  • alterações de personalidade/instabilidade emocional
Full details

Risk factors

  • ascendência branca
  • sexo masculino
  • neurofibromatose do tipo 1
  • complexo da esclerose tuberosa
  • síndrome de Li-Fraumeni
  • síndrome de Turcot
  • radiação ionizante
Full details

Diagnostic investigations

1st investigations to order

  • ressonância nuclear magnética (RNM) de crânio
  • avaliação oftalmológica; teste de campo visual
  • tomografia computadorizada (TC) do crânio
  • espectroscopia por RM cerebral
  • RNM de perfusão cerebral
  • histopatologia
  • análises moleculares
Full details

Investigations to consider

  • testes de hormônios hipofisários
  • exame de imagem por tensor de difusão (DTI)
Full details

Emerging tests

  • espectroscopia por ressonância magnética direcionada a 2-hidroxiglutarato

Treatment algorithm

INITIAL

hipertensão intracraniana ou edema vasogênico

ACUTE

glioma circunscrito: astrocitoma pilocítico/pilomixoide (Organização Mundial da Saúde [OMS] grau 1)

glioma circunscrito: astrocitoma subependimário de células gigantes (grau 1 da OMS)

glioma circunscrito: xantoastrocitoma pleomórfico (grau 2 da OMS)

glioma infiltrante difuso: grau 2

glioma infiltrante difuso: graus 3 e 4

Glioma de linha média difuso, com alteração em H3 K27M

ONGOING

glioma circunscrito recorrente

Glioma infiltrante difuso progressivo

Contributors

Authors

L. Nicolas Gonzalez Castro, MD, PhD

Instructor in Neurology

Center for Neuro-Oncology

Dana-Farber Cancer Institute and Brigham and Women's Hospital

Harvard Medical School

Boston

MA

Disclosures

LNGC has received consulting fees from Elsevier, Oakstone Publishing, and Teladoc. LNGC has received research funding from Merck & Co. (to Dana-Farber Cancer Institute). LNGC is an author of a number of references cited in this topic.

Acknowledgements

Dr L. Nicolas Gonzalez Castro would like to gratefully acknowledge Dr Timothy C. Ryken, Dr Linton T. Evans, Dr Manmeet S. Ahluwalia, Dr Susan Chang, and Dr Karine Michaud, previous contributors to this topic.

Disclosures

TCR is an author of a number of references cited in this topic. MSA has acted as a consultant for Elekta, Incyte, AstraZeneca, Novocure, Caris Life Sciences, Bristol-Myers Squibb, Monteris Medical, AbbVie, MRI Solutions, Elsevier, and Prime oncology. MSA has received clinical trial investigations grants from Tracon, Bristol-Myers Squibb, AstraZeneca, Novartis, and Novocure. SC has received research support from Agios, Novartis, Quest, Roche, and Schering Plough. KM and LTE declare that they have no competing interests.

Peer reviewers

David A. Reardon, MD

Associate Professor

The Preston Robert Tisch Brain Tumor Center

Duke University Medical Center

Durham

NC

Disclosures

DAR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Louis DN, Perry A, Wesseling P, et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol. 2021 Aug 2;23(8):1231-51.Full text  Abstract

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: central nervous system cancers [internet publication].Full text

Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2021 Mar;18(3):170-86.Full text  Abstract

Liau LM. Guidelines for newly diagnosed glioblastoma. J Neurooncol. 2008 Sept;89(3).Full text

American Association of Neurological Surgeons; Congress of Neurological Surgeons. Updated AANS/CNS guidelines for progressive glioblastoma patients. Jun 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Guidelines

    • NCCN clinical practice guidelines in oncology: central nervous system cancers
    • Therapy for diffuse astrocytic and oligodendroglial tumors in adults: ASCO-SNO guideline
    More Guidelines
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