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Astrocytoma - Childhood - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Childhood Astrocytoma. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

The brain and spinal column make up the central nervous system (CNS), where all vital functions of the body, including thought, speech, and strength, are controlled.

Astrocytoma is a type of CNS tumor that forms in cells called astrocytes. Healthy astrocytes provide the connecting network of the brain and spinal cord and form scar tissue when the CNS is damaged. Astrocytoma begins when healthy astrocytes change and grow uncontrollably, forming a mass called a tumor.

Astrocytoma can occur throughout the CNS, including in the following places:

  • The cerebellum, which is the back part of the brain responsible for coordination and balance.
  • The cerebrum, which is the top part of the brain that controls motor activities and talking
  • The diencephalon or the central part of the brain that controls vision, hormone production, and arm and leg movement
  • The brain stem, which controls eye and facial movement, arm and leg movement, and breathing
  • The spinal cord, which controls sensation and arm and leg motor function

In general, a tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Astrocytoma is more commonly referred to as either high grade or low grade. Grade is a measure of how much the tumor cells appear like healthy cells and depends on the number and shape of the tumor cells and how quickly they grow and spread. A low-grade tumor is less likely to grow quickly or spread. Once a tumor is found in the CNS, the doctor will usually perform a biopsy (see Diagnosis) to see if the tumor is an astrocytoma and to determine the grade of the tumor. A biopsy is the removal of a small amount of tissue for examination under a microscope.

This section covers astrocytoma diagnosed in children; learn more about brain tumors in adults.

Looking for More of an Overview?

If you would like additional introductory information, explore these related items. Please note these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics and it helps explain how many children are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Astrocytoma - Childhood - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find information about how many children are diagnosed with astrocytoma each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Approximately 4,000 CNS tumors are diagnosed each year in children younger than 20, and about 35% childhood brain tumors are astrocytomas.

Children with a type of astrocytoma that is unlikely to spread, called noninfiltrating astrocytoma, generally have a higher five-year survival rate. The five-year survival rate is the percentage of people who survive at least five years after the tumor is found. The five-year survival rate for children with low-grade astrocytoma is about 85%. For children with high-grade astrocytoma, the five-year survival rate is about 20%. There are additional factors that affect survival rates, including how much of the tumor can be removed during surgery.

Survival statistics should be interpreted with caution. These estimates are based on data from thousands of children with of this type of tumor, so the actual risk for a particular individual may be different. It is not possible to tell a person how long he or she will live with astrocytoma. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this tumor. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2015, and the ACS website.

The next section in this guide is Medical Illustrations and it offers drawings of body parts often affected by this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Astrocytoma - Childhood - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find basic drawings about the main body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Childhood CNS Anatomy

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Astrocytoma Anatomy

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The next section in this guide is Risk Factors and it explains what factors may increase the chance of developing this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing astrocytoma. To see other pages in this guide, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing a tumor. Although risk factors often influence the development of a tumor, most do not directly cause a tumor. Some people with several risk factors never develop a tumor, while others with no known risk factors do.

Doctors and researchers don’t know what causes most childhood tumors. There is some evidence that genetic factors may play a role in a small percentage of children with cerebral astrocytoma. The following factors may increase a child’s risk of developing astrocytoma:

The next section in this guide is Symptoms and Signs and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages in this guide, use the menu on the side of your screen.

Children with astrocytoma may experience the following symptoms or signs. Sometimes, children with astrocytoma do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a tumor.

  • Headaches
  • Feeling tired and listless
  • Seizures not related to a high fever
  • Eyesight problems, such as double vision
  • Changed growth or development

In a baby, the only symptom may be that the head is growing too fast. An infant’s skull can expand to make room for a growing tumor in the brain, so a baby with astrocytoma may have a larger than expected head.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your child’s doctor. The doctor will ask how long and how often your child has been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If a tumor is diagnosed, relieving symptoms remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with the health care team about symptoms your child experiences, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages in this guide, use the menu on the side of your screen.

Doctors use many tests to diagnose a tumor and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of tumors, a biopsy is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the tumor has spread.

This list describes options for diagnosing astrocytoma, and not all tests listed will be used for every person. Your child’s doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of tumor suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose astrocytoma:

  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.
  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.
  • Biopsy. Other tests can suggest that a tumor is present, but only a biopsy can make a definite diagnosis. For astrocytoma, a biopsy is done to determine the type and grade of the tumor. A doctor called a neurosurgeon will remove a small piece of tissue from the tumor. A neurosurgeon specializes in treating a CNS tumor using surgery. A pathologist then analyzes the sample. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

After diagnostic tests are done, your child’s doctor will review all of the results with you. If the diagnosis is astrocytoma, these results also help the doctor describe the tumor; this is called staging and grading.

The next section in this guide is Stages and Grades, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will learn about how doctors describe astrocytoma’s growth or spread. This is called the stage or grade. To see other pages in this guide, use the menu on the side of your screen.

Stage

Staging is a way of describing where a tumor is located, if or where it has spread, and whether it is affecting other parts of the body. Several types of childhood CNS tumors can spread through the spinal fluid that surrounds the brain and the spine. This information helps the doctor plan the treatment and determine the child’s prognosis, which is the chance of recovery.

Grade

In addition to staging, doctors also describe astrocytoma by its grade, which describes how much tumor cells look like healthy cells when viewed under a microscope. The doctor compares the tumor tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the tumor cells looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the tumor tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The tumor’s grade may help the doctor predict how quickly it will spread. In general, the lower the tumor’s grade, the better the prognosis.

The grades of astrocytoma are:

  • Low-grade tumor. A low-grade tumor has cells that look similar to healthy CNS cells under a microscope. The tumor usually does not grow quickly or spread to other parts of the CNS, although the tumor can sometimes grow and spread quickly. Tumors may appear in more than one spot in the brain, especially when the disease is linked with neurofibromatosis (see Risk Factors). One of the more common low-grade tumors in children is called juvenile pilocytic astrocytoma, or JPA.
  • High-grade tumor. A high-grade tumor has cells that do not look similar to healthy astrocytes. This type of tumor grows quickly and can spread throughout other parts of the CNS.
  • Recurrent astrocytoma. Recurrent astrocytoma is a tumor that has come back after treatment. Astrocytoma usually recurs near where it first started. If the tumor does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Information about the tumor’s grade and stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will learn about the different ways doctors treat children with astrocytoma. To see other pages in this guide, use the menu on the side of your screen.

In general, tumors in children are uncommon, so it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That’s why more than 60% of children are treated as part of a clinical trial. Clinical trials are research studies that compare standard treatments (the best known treatments available) with newer approaches to treatments that may be more effective. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Studying new treatments involves careful monitoring using scientific methods, and all participants are followed closely to track their health and progress.

To take advantage of these newer treatments, children with a CNS tumor should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children and have access to the latest research. A doctor who specializes in treating children with a tumor is called a pediatric oncologist. For astrocytoma, a neuro-oncologist may also be involved with treatment. This is a doctor who specializes in CNS tumors. If a pediatric cancer center is not nearby, general cancer centers sometimes have pediatric and neurology specialists who are able to be part of your child’s care.

In many cases, a team of doctors works with a child and the family to provide care; this is called a multidisciplinary team. Pediatric cancer centers often have extra support services for children and their families, such as child life specialists, dietitians, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.

Treatment overview

Descriptions of the most common treatment options for astrocytoma are listed below. Treatment options and recommendations depend on several factors, including the type and grade of the tumor, possible side effects, the family’s preferences, and the child’s overall health.

Three types of treatments are typically used for astrocytoma in children:

  • Surgery
  • Radiation therapy
  • Chemotherapy

Your child’s care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your child’s treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your child’s doctor and what you can expect during the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is the most common treatment for astrocytoma. During surgery, a neurosurgeon removes as much of the tumor as possible. Sometimes, a tumor is inoperable, meaning it cannot be reached by surgery because of its location. However, even for inoperable tumors, a surgical biopsy can usually still be done to find out the type and grade of the tumor (see Diagnosis).

If a low-grade tumor cannot be completely removed, the doctor usually watches for signs of tumor growth before considering other types of treatment. If a tumor causes symptoms and cannot be completely removed with surgery, radiation therapy or chemotherapy is often used. A child with a high-grade tumor often needs additional treatment regardless of whether the entire tumor was removed during surgery.

Learn more about the basics of surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most short-term side effects go away soon after treatment in finished. However, because radiation therapy can sometimes cause problems with the long-term growth and development of a child’s brain, the doctor may choose to treat the tumor in another way. To avoid or reduce the need for radiation therapy in young children, the doctor may first use chemotherapy to shrink the tumor.

Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy tumor cells, usually by stopping the tumor cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating a tumor with medication, or a pediatric oncologist.

Systemic chemotherapy gets into the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Chemotherapy for astrocytoma is often a combination of two or three drugs.

Chemotherapy may be used to delay or avoid using radiation therapy in young children with low-grade tumors, such as JPA, due to possible side effects. For a high-grade tumor, chemotherapy may be more effective when used with surgery and radiation therapy.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat CNS tumors are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications. Learn more about your child’s prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Astrocytoma and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the disease, an important part of care is relieving a child’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the child with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting children and their families. Any child, regardless of age or grade and stage of astrocytoma, may receive palliative care. It works best when palliative care is started as early as needed in the treatment process. Children often receive treatment for the tumor and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and families report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. Your child may also receive palliative treatments similar to those meant to eliminate the tumor, such as chemotherapy, surgery, or radiation therapy. Talk with your child’s doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your child’s health care team about the possible side effects of your child’s specific treatment plan and palliative care options. And during and after treatment, be sure to tell the doctor or another health care team member if your child is experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Remission and the chance of recurrence

A remission is when tumor cells cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it’s important to talk with the doctor about the possibility of the disease returning. Understanding your child’s risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.

If the tumor does return after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When astrocytoma recurs, it usually recurs near where the tumor originally started.

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your child’s doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your child’s doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

Treatment for recurrent astrocytoma depends on three factors:

  • Grade of the tumor
  • Where the tumor recurred 
  • The type of treatment the child received for the original tumor

If the tumor is a low-grade recurrent astrocytoma, the doctor may perform surgery to remove as much of the tumor as possible. Children who have not previously had radiation therapy or chemotherapy may receive one or both of these treatments for the recurrent tumor.

If the tumor is a high-grade recurrent astrocytoma, the doctor may suggest other types of chemotherapy or radiation therapy. Rarely, chemotherapy along with stem cell/bone marrow transplantation may be recommended.

A recurrent tumor may bring up emotions such as disbelief or fear. You and your family are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with a recurrence.

If treatment fails

Although treatment is successful for the majority of children with a tumor, sometimes it is not. If a child’s tumor cannot be cured or controlled, this is called an advanced or terminal tumor. This diagnosis is stressful, and an advanced tumor may be difficult to discuss. However, it is important to have open and honest conversations with your child’s doctor and health care team to express your family’s feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families.

Parents or guardians are encouraged to think about where the child would be most comfortable: at home, in a home-like setting elsewhere, in the hospital, or in a hospice environment. Hospice care is a type of palliative care for people who are expected to live less than six months. It is designed to provide the best possible quality of life for people who are near the end of life. Nursing care and special equipment can make staying at home a workable alternative for many families. Some children may be happier if they can arrange to attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced care planning.

The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.

The next section in this guide is About Clinical Trials and it offers more information about research studies that are focused on finding better ways to care for children with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages in this guide, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for children with astrocytoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was previously tested in clinical trials.  

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Children who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are the only way to make progress in treating astrocytoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future children with astrocytoma.

Sometimes people have concerns that, in a clinical trial, their child may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials in this way is rare overall and not done at all in childhood cancer research. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, parents and children must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

People who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that parents talk with the doctor and researchers about who will be providing their child’s treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of tumors. For specific topics being studied for astrocytoma, learn more in the Latest Research section.

Cancer.Net offers a lot of information about clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of tumor.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research and it explains areas of scientific research currently going on for astrocytoma. Or, use the menu on the side of your screen to choose another section to continue reading this guide.    

Astrocytoma - Childhood - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about astrocytoma and how to treat it. To see other pages in this guide, use the menu on the side of your screen.

Doctors are working to learn more about astrocytoma, ways to prevent it, how to best treat it, and how to provide the best care to children diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your child’s doctor about the diagnostic and treatment options best for your child.

  • Improved methods of imaging and surgery. Imaging techniques are being developed and improved that help surgeons better pinpoint the tumor’s location to reduce or prevent damage to the healthy parts of the CNS during treatment.
    • Functional MRI (fMRI) is an imaging technique that identifies the parts of the brain that control speech, hearing, vision, touch, and movement. The specific locations of these functions are slightly different in every person, so fMRI allows surgeons to plan surgery around these areas.
    • Image-guided stereotaxis allows surgeons to visualize and operate on the brain using three-dimensional outlines of the brain and the tumor. Along with specialized software, these images help guide the surgeon to the tumor. Tumors that were once considered inoperable often can be removed with this technique.
  • Improved ways to give radiation therapy. Conformal radiation therapy is a way to deliver high doses of radiation directly to a tumor and not healthy tissue. This technique produces detailed three-dimensional maps of the brain and tumor, so doctors know exactly where to direct the radiation treatment.
  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see below). Recently, researchers have found genetic changes that are common in low-grade astrocytomas. Researchers are particularly interested in changes on a gene called BRAF. Researchers have also discovered specific patterns of genetic changes in high-grade astrocytomas, but treatments targeting these changes are not yet being studied in clinical trials.
  • Targeted therapy. Targeted therapy is a treatment that targets the tumor’s specific genes, proteins, or the tissue environment that contributes to growth and survival. This type of treatment blocks the growth and spread of tumor cells while limiting damage to healthy cells. Specifically, researchers are studying new drugs that target changes on the BRAF gene as a treatment for children with recurrent astrocytoma.
  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the tumor. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Researchers are studying how well these drugs work and how safe they are for children with high-grade and low-grade astrocytoma.
  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current astrocytoma treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding childhood cancers, explore these related items that take you outside of this guide:

  • To find clinical trials specific to the diagnosis, talk with your child’s doctor or search online clinical trial databases now.
  • Visit ASCO’s CancerProgress.Net website to learn more about the historical pace of research for childhood cancers. Please note this link takes you to a separate ASCO website.
  • Visit the website of the Conquer Cancer Foundation to find out how to help support research for every cancer type. Please note this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Side Effects and it offers some guidance in how to cope with the physical, emotional, and social changes that astrocytoma and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages in this guide, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of astrocytoma, but it may help to know that preventing and controlling side effects is a major focus of your child’s health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every treatment for astrocytoma, but children don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how your child will feel during treatment. Common side effects from each treatment option for astrocytoma are described in detail within the Treatment Options section. Learn more about the most common side effects of a tumor and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the type of tumor, its grade, the length and dosage of treatment(s), and your child’s overall health. Also, side effects of newer treatments or treatments in clinical trials may be different and not as well studied as older treatments.

Talking with your child’s health care team about side effects

Before treatment begins, talk with your child’s doctor about possible side effects of each type of treatment your child will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving your child may need during treatment and recovery, as family members and friends often play an important role in the care of a child with astrocytoma. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your child’s care

During and after treatment, be sure to tell the health care team about the side effects your child experiences, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your child’s doctor.

The next section in this guide is Follow-up Care and it explains the importance of check-ups after treatment for astrocytoma is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Astrocytoma - Childhood - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will read about your child’s medical care after treatment for astrocytoma is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for children diagnosed with astrocytoma doesn’t end when active treatment has finished. Your child’s health care team will continue to check to make sure the tumor has not returned, manage any side effects, and monitor your child’s overall health. This is called follow-up care. All children treated for a tumor, including astrocytoma, should have life-long, follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. A child’s specific follow-up care plan depends on many factors, including the grade of tumor and its location, the child’s age, and the type of treatment given. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. A tumor recurs because small areas of tumor cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your child’s medical history can give you personalized information about the risk of recurrence. Your doctor will also ask specific questions about your child’s health. Some children may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects of astrocytoma

Sometimes, side effects may linger beyond the active treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Late effects can occur almost anywhere in the body and include physical problems, such as heart and lung problems and second cancers, and emotional and cognitive (memory, thinking, and attention) problems, such as anxiety, depression, and learning difficulties.

Based on the type of treatment your child received, the doctor will recommend what examinations and tests are needed to check for late effects. The risks and possible side effects of surgery vary widely, depending on the location and features of the tumor. Likewise, the risks of chemotherapy and the chance of secondary cancers are also based on the specific drugs used and their doses. Radiation therapy to the head and spine may cause cognitive (thought-process) and endocrine (hormonal) symptoms over time, although how serious these side effects are depends on the dose and the age of your child.  Follow-up care should address your child’s quality of life, including any developmental or emotional concerns.

The Children's Oncology Group (COG) has studied the physical and psychological effects that childhood cancer survivors face. Based on these studies, COG has created recommendations for long-term follow-up care for childhood, adolescent, and young adult cancer survivors that can be found on a separate website: www.survivorshipguidelines.org.

Keeping a child’s personal health record

You are encouraged to organize and keep a personal record of the child’s medical information. The doctor will help you create this. That way, as the child enters adulthood, he or she has a clear, written history of the diagnosis, the treatment given, and the doctor’s recommendations about the schedule for follow-up care. ASCO offers forms to help create a treatment summary to keep track of the treatment your child received and develop a survivorship care plan once treatment is completed.

Some children continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your family’s personal preferences. Talk with your health care team about your child’s ongoing medical care and any concerns you have about his or her future health.

If a doctor who was not directly involved in your child’s care for astrocytoma will lead the follow-up care, be sure to share the treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about the specific treatment given are very valuable to the health care professionals who will care for your child throughout his or her lifetime.

The next section in this guide is Survivorship and it describes how to cope with challenges in everyday life after a diagnosis of astrocytoma. Or, use the menu on the side of your screen to choose another section to continue reading this guide.
 

Astrocytoma - Childhood - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find some questions to ask your child’s doctor or other members of the health care team, to help you better understand your child’s diagnosis, treatment plan, and overall care. To see other pages in this guide, use the colored boxes on the right side of your screen, or click “Next” at the bottom.

Talking often with the doctor is important to make informed decisions about your child’s health care. These suggested questions are a starting point to help you learn more about your child’s care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your child’s next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your child’s care.

Questions to ask after getting a diagnosis

  • Where exactly is the astrocytoma located?
  • What is the grade of the tumor? What does this mean?
  • What is your familiarity with my child’s tumor type and its treatment?
  • Can you explain my child’s pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

  • What treatment options are available?
  • Are there other treatment options available at other cancer centers?
  • What clinical trials are open to my child? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the tumor, help my child feel better, or both?
  • Who will be part of my child’s health care team, and what does each member do?
  • Who will be coordinating my child’s overall treatment?
  • What are the possible side effects of this treatment?
  • How will this treatment affect my child’s daily life? Will he or she be able to go to school and perform his or her usual activities?
  • Could this treatment affect my child’s ability to become pregnant or have children in the future? If so, should I talk with a fertility specialist before treatment begins?
  • If I’m worried about managing the costs related to my child’s medical care, who can help me with these concerns?
  • What support services are available to my child? To my family?
  • Whom should I call for questions or problems?
  • Is there anything else I should be asking?

Questions to ask about surgery

  • What type of surgery will my child have?
  • How long will the operation take?
  • How long will my child be in the hospital?
  • Can you describe what recovery from surgery will be like?
  • What are the possible long-term effects of surgery?

Questions to ask about radiation therapy and chemotherapy

  • What type of treatment is recommended?
  • What is the goal of this treatment?
  • How long will it take to give this treatment?
  • What side effects can I expect during treatment?
  • What are the possible long-term effects of having this treatment?
  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the risk of the tumor returning? Are there signs and symptoms I should watch for?
  • What long-term side effects or late effects are possible based on the treatment my child received?
  • What follow-up tests will my child need, and how often will he or she need them?
  • How do I get a treatment summary and survivorship care plan to keep in my personal records? 
  • Who will be coordinating my child’s follow-up care?
  • What survivorship support services are available to my child? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will read about how to cope with challenges in everyday life after your child’s diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people, but it often describes the process of living with, through, and beyond cancer. In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every patient and his or her family.

After active treatment for astrocytoma ends, children and their families may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after the diagnosis. Other families stay very anxious about their child’s health and become uncertain of how to cope with everyday life.

One source of stress may occur when frequent visits to the health care team end following treatment. Often, relationships built with the health care team provide a sense of security during treatment, and children and their families miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, educational issues, emotional challenges, sexual development and fertility concerns, and/or financial issues.

Every family faces different concerns and challenges. With any challenge, a good first step is being able to recognize each fear and talk about it. Effective coping requires:

  • Understanding the challenge your family is facing,
  • Thinking through solutions,
  • Asking for and allowing the support of others, and
  • Feeling comfortable with the course of action your family chooses.

It may be helpful to join an in-person support group or online community of childhood cancer survivors. Support groups also exist for parents of children diagnosed with CNS tumors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Parents, other family members, and friends may also go through periods of transition. A caregiver plays a very important role in supporting a child diagnosed with astrocytoma, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to a child’s diagnosis will become much less or come to an end as your child gets older. Family counselors at pediatric cancer centers can help with this transition. You can also learn more about adjusting to life after caregiving in this article.

Healthy living after cancer

Survivorship often serves as a strong motivator to make positive lifestyle changes, often for the family as a whole.

Children who have had astrocytoma can enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating well, managing stress, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs. Learn more about making healthy lifestyle choices.

In addition, it is important that your child has recommended medical check-ups and tests (see Follow-up Care) to take care of his or her health. Rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, family or individual counseling, nutritional planning, and/or educational assistance. The goal of rehabilitation is to help survivors and their families regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your child’s needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • Survivorship Resources: Cancer.Net offers a lot of information and resources to help survivors cope, including specific sections for children, teens, and young adults. There is also a main section on survivorship for people of all ages.
  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) can help with the transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.
  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about childhood cancer survivorship.

The next section offers Questions to Ask the Doctor to help start conversations with your child’s health care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Astrocytoma - Childhood - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 03/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about medical care and treatment. This is the final page of Cancer.Net’s Guide to Childhood Astrocytoma. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of being diagnosed with a tumor, both for the patient and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Childhood Astrocytoma. Choose “Previous” (below, left) to review other pages in this guide, or use the colored boxes located on the right side of your screen to visit any section.