Prognostic Factors and Grades of Brain Tumor

Executive Summary

The staging system is explained for determining the prognostic factors in cancer. But in brain tumor, no standard staging system is determined beyond the CNS. The grading system is used for determining cancer and how it can grow. The best treatment for the Grades of Brain Tumor is suggested based on type and grade. Several factors help doctors determine the appropriate brain tumor treatment plan and a patient’s prognosis. Tumor histology includes determining the type of tumor, the grade, and additional molecular features that predict how quickly the tumor can grow. Grade describes certain features in the tumor that are linked with specific outcomes. Grade I, II, III and IV are the grading systems used to determine glial tumors. Several symptoms among the patients are used for determining the prognosis. Age, tumor location, molecular features, and extension of tumor residuals are some of the prognostic factors. Functional neurologic status is also determined. Metastatic spread and recurrent tumor help in determining the prognosis level of disease.

Prognostic factors and Grades of Brain Tumor

About the Prognostic Factors and Grades of Brain Tumor, Most types of cancer, a staging system is used to describe where the tumor is present and if it has spread and is affecting other parts of the body ^​1​. However, there is no standard staging system for adult brain tumors as most primary ones do not generally spread beyond the CNS. The grading system described here is always used instead because the specific features of a brain tumor determine how cancerous it is and how likely it is to grow.

Tumors in the brain or spinal cord can spread to other parts of the central nervous system, but they rarely metastasize to other organs. These tumors are dangerous because they can interfere with essential brain functions. 

To decide the best treatment for the Grades of Brain Tumor, the type and grade must be determined. Several factors help doctors determine the appropriate brain tumor treatment plan and a patient’s prognosis:

Tumor histology

Tumor histology includes finding out the type of tumor, the grade, and additional molecular features that predict how quickly the tumor can grow.

Grade describes certain features in the tumor that are linked with specific outcomes. For example, doctors may consider whether the tumor cells are growing out of control or if there are a lot of dead cells. Tumors with features generally linked with growing more quickly are given a higher grade. For most tumors, the lower the grade, the better the prognosis.

Specifically for glial tumors, the Grades of Brain Tumor is determined by its features, as seen under a microscope, according to the following criteria ^​2​:

• Grade I – These tumors are slow-growing and unlikely to spread. They are often cured with surgery.
• Grade II – These tumors are less likely to grow and spread but are more likely to return after treatment.
• Grade III – These tumors are more likely to have rapidly dividing cells but no dead cells. They can proliferate.
• Grade IV – In a grade IV tumor, cells in the tumor are actively dividing. In addition, the tumor has both abnormal blood vessel growth and areas of dead tissue. These tumors can grow and spread quickly.

Also Read: Symptoms based on Cancer types

Symptoms 

A patient’s symptoms and how long they last can help determine prognosis. For instance, seizures and having symptoms for a long time are linked with a better prognosis.

• Age – In adults, diagnosing a person’s age and level of functioning is one of the best ways for a patient’s prognosis. Generally, a younger adult has a better prognosis.
• Tumor location – A tumor can form in any part of the brain. Some tumor locations cause more damage than others, and some tumors are harder to treat because of their location.
• Molecular features – Certain genetic mutations found in the tumor may help decide the prognosis. These include – IDH1, IDH2, MGMT, and a 1p/19q co-deletion. Whether a tumor has any of these mutations determines the Grades of Brain Tumor diagnosed.
• Extension of tumor residual – Resection is surgery for tumor removal. Residual refers to how much of the tumor remains in the body post-surgery. A patient’s prognosis is superior when all of the tumors can be surgically removed. There are four classifications:
• Gross total – The microscopic cells remain, and the entire tumor that can be seen is removed.
• Subtotal – Larger portion of the tumor was removed. 
• Partial – Only some part of the tumor is removed.
• Biopsy only – Only a tiny portion was removed and used for diagnostic tests. 

Functional neurologic status 

The doctor will test how well a patient can function and carry out everyday activities using a functional assessment scale, outlined below, such as the Karnofsky Performance Scale (KPS). A higher score suggests a finer functional status. Typically, a person who can walk better and care for themselves has a better prognosis. Which is also a part of Grades of Brain Tumor

• 100 – Normal and no evidence of disease
• 90 – Able to carry on regular activity; minor symptoms of the disease
• 80 – Normal activity with effort; some symptoms of the disease
• 70 – Cares for self; unable to continue on a regular activity or active work
• 60 – Requires occasional assistance but can care for needs
• 50 – Needs considerable assistance and frequent medical care
• 40 – Disabled, requires special care and assistance
• 30 – Severely disabled; hospitalization is indicated, but death not imminent
• 20 – Very sick, hospitalization necessary; active treatment necessary
• 10 – Moribund, fatal processes progressing rapidly

Metastatic spread

Even though it is cancerous, a tumor that begins in the brain or spinal cord seldom spreads to other parts of the body in adults, but it can grow within the Central nervous system. For that reason, with few exceptions, tests looking at the body’s other organs are typically not needed. A tumor that does spread to other parts of the brain or spinal cord is linked with a poorer prognosis.

Recurrent tumor 

A recurrent tumors has come back after treatment. If the tumor returns, the doctor performs another round of tests to know the extent of the recurrence. These tests resemble those done initially at the time of diagnosis.

Presently, the factors listed above are the best indicators of a patient’s prognosis. As discussed in diagnosis, researchers are now looking for biomarkers in the tumor tissue that could make a Grades of Brain Tumor easier to diagnose and allow for the staging of an adult brain tumor in the future. 

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