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A visual guide

Understanding glioma,
from diagnosis to care

Gliomas explained through the WHO 2021 classification and current research — in plain language, for patients, caregivers, and clinicians.

WHO 2021 aligned Plain-language explanations Evidence-based
Epidemiology
25,000–28,000

Estimated new glioma cases per year in the United States.

Classification
WHO 2021

Diagnosis now starts with molecular features like IDH status — not just appearance under the microscope.

Treatment model
Team-based care

Most plans combine surgery, radiation, systemic therapy, and ongoing supportive care.

Understanding glioma

What is a glioma, and how is it classified?

Gliomas arise from glial cells — the brain’s supportive cells. The WHO 2021 update shifted classification from how a tumor looks to its molecular markers, so diagnosis now begins with a single question: is IDH mutated?

IDH-mutant1p/19q codeleted

Oligodendroglioma

The most favourable diffuse glioma. Codeletion of 1p/19q predicts longer survival and chemo-sensitivity.

Grade 2Grade 3
IDH-mutant1p/19q intact

Astrocytoma

Astrocytic lineage, marked by ATRX loss and TP53. Can progress to grade 4 over time.

Grade 2Grade 3Grade 4
IDH-wildtypeGrade 4

Glioblastoma

The most aggressive adult glioma, defined by TERT, +7/−10, and EGFR amplification.

TERTEGFR amp
Tumor grading

WHO tumor grades 1–4

Grade reflects how abnormal the cells look and how fast the tumor grows. Higher grade means faster growth.

Grade 1 · slowGrade 4 · aggressive
1
Low grade

Grau 1

2
Low grade

Grau 2

3
High grade

Grau 3

4
High grade

Grau 4

Molecular markers

The biomarkers that define your tumor

Modern classification depends on specific molecular markers — each revealing something different about the tumor and its likely behaviour.

Diagnostic
IDH1 / 2
Isocitrate dehydrogenase

The single most important test. Splits diffuse gliomas into IDH-mutant (more favourable) and IDH-wildtype (glioblastoma).

~80% of grade 2–3 gliomas
Diagnostic
1p / 19q
Chromosome 1p/19q codeletion

Defines oligodendroglioma when paired with an IDH mutation. Codeletion means significantly longer survival.

~15–20% of diffuse gliomas
Diagnostic
ATRX
Alpha-thalassemia / MR X-linked

Loss points to astrocytic lineage. Mutually exclusive with 1p/19q codeletion.

~70% of IDH-mutant astrocytomas
Predictive
MGMT
MGMT promoter methylation

Methylation predicts a better response to temozolomide chemotherapy.

~40–50% of glioblastomas
Prognostic
TERT
TERT promoter mutation

Common in glioblastoma and associated with aggressive behaviour.

~70–80% of glioblastomas
Prognostic
CDKN2A / B
CDKN2A/B homozygous deletion

Upgrades an IDH-mutant astrocytoma to grade 4, marking higher-grade disease.

Marks higher-grade disease
Treatment

Treatment options for glioma

Treatment depends on tumor type, grade, location, and overall health. Most plans combine several approaches.

Surgery

Resection to reduce tumor mass, relieve pressure, and obtain tissue for diagnosis.

Radiation therapy

Targeted high-energy beams to destroy remaining cancer cells after surgery.

Chemotherapy / TMZ

Temozolomide (oral) or other medications to attack cancer cells throughout the brain.

Targeted therapy

Drugs designed for specific molecular targets, such as IDH inhibitors (vorasidenib).

Clinical trials

Access to cutting-edge experimental treatments and emerging therapies.

Watch & wait

Active observation with regular MRI scans for low-grade tumors not yet requiring treatment.

Care team

Your multidisciplinary care team

Glioma care is delivered by a team — specialists who diagnose and treat, and those who protect day-to-day quality of life.

Core specialist

Neurosurgeon

Performs brain surgery for tumor removal or biopsy.

Best for: resection strategy, biopsy decisions, and surgery-related risk.

Core specialist

Neuro-oncologist

Brain-tumor specialist who leads treatment planning.

Best for: integrating pathology, imaging, medication, and trial options into one plan.

Core specialist

Radiation oncologist

Plans and delivers precision radiation therapy.

Best for: dose planning, side effects, and timing around surgery or chemo.

Support role

Nurse navigator

Guides you through appointments, insurance, and logistics.

Best for: referrals, scheduling, records, and getting the right people in the room.

Support role

Neuro-oncology nurse

Day-to-day care coordination and symptom management.

Best for: new symptoms, medication questions, and urgent care coordination.

Support role

Mental health

Psychological support for patients and caregivers.

Best for: coping with uncertainty, caregiver strain, and adjustment after diagnosis.

Ready to explore clinical trials?

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