Childhood astrocytoma is a type of central nervous system (CNS) tumor that forms when cells called astrocytes begin to grow uncontrollably and form a mass. Normal astrocytes provide the connecting network of the brain and spinal cord and form scar tissue when the CNS is damaged. Astrocytoma can occur throughout the CNS, including the following places:
Cerebellum (the back part of the brain responsible for coordination and balance)
Cerebrum (the top part of the brain that controls motor activities and talking)
Diencephalon or central part of the brain (controls vision, hormone production, and arm and leg movement)
Brainstem (controls eye and facial movements, arm and leg movement, and breathing)
Spinal cord (controls sensation and arm and leg motor function)
Astrocytoma is classified as high grade (a measure of how much the tumor cells appear like normal cells) or low grade, depending on the number and shape of the tumor cells and how quickly they grow and spread. Low-grade tumors are less likely to grow quickly or spread to other parts of the body. Once a tumor is found in the CNS, the doctor will usually perform a biopsy 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.
Statistics
About 35% of all brain tumors are astrocytoma, the most common type of brain and spinal cord tumor. About half of all childhood brain tumors are astrocytoma.
The five-year relative survival rate (the percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) for low-grade astrocytoma in children is more than 80%. For children with high-grade astrocytoma, the five-year relative survival rate is about 49%. Children with noninfiltrating astrocytoma (a tumor that is unlikely to spread) generally have a higher five-year relative survival rate.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer, but the actual risk for a particular individual may differ. 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 (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Source: American Cancer Society and Central Brain Tumor Registry of the United States.
A risk factor is anything that increases a person’s chance of developing a tumor. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do.
Doctors and researchers don’t know what causes most childhood tumors. Some evidence indicates that genetic factors may play a role in a small percentage of cerebral astrocytoma cases. For example, children who have neurofibromatosis may have an increased risk of developing astrocytoma. Neurofibromatosis is an inherited disorder that causes neurofibromas (a type of noncancerous tumor) to form on peripheral nerves in the body, brown spots on the skin, and tissue and bone deformities. Neurofibromatosis is also called Recklinghausen’s disease or von Recklinghausen’s disease. For more information, review Cancer.Net’s Guides to Neurofibromatosis Type 1 and Neurofibromatosis Type 2. Other, less common genetic conditions associated with a higher risk of CNS tumors include Li-Fraumeni syndrome, tuberous sclerosis, nevoid basal cell carcinoma syndrome, and Turcot syndrome.
Children with astrocytoma may experience the following symptoms. Sometimes, children with astrocytoma do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your child’s doctor.
The child may have headaches, be lethargic (tired and listless), or have seizures that are not related to a high fever. He or she may have eyesight problems, such as double vision, and the child may have altered 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 normal head.
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). 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 of cancer. 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 cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer suspected
Severity of 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. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.
Biopsy. Other tests can suggest that cancer 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 neurosurgeon (a specialist who operates on the head, brain, and central nervous system) will remove a small piece of tissue from the tumor. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Staging is a way of describing a tumor, such as its size, where it is located, if or where it has spread, and if it is affecting the functions of other organs in 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 (chance of recovery). In addition to staging, tumor grade strongly affects prognosis, with a low-grade tumor having a better prognosis than a higher-grade tumor. The grades of astrocytoma are:
Low-grade tumor. A low-grade tumor has cells that look similar to normal CNS cells under a microscope. The cancer usually does not grow quickly or spread to other parts of the CNS, although both rapid growth and spread can sometimes occur. Tumors may appear in more than one spot in the brain, especially when they are associated with neurofibromatosis (see Risk Factors). One of the more common low-grade tumors occurring almost exclusively in children is called juvenile pilocytic astrocytoma, or JPA.
High-grade tumor. A high-grade tumor has cells that do not look similar to normal astrocytes. This type of tumor grows quickly and can spread extensively to 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.
Clinical trials are the standard of care for the treatment of children with cancer. In fact, more than 60% of children with cancer are treated as part of a clinical trial. Clinical trials are research studies that compare standard treatments (the best treatments available) with newer treatments that may be more effective. Cancer in children is rare, so it can be hard for doctors to plan treatments unless they know what has been most effective in other children. Investigating new treatments involves careful monitoring using scientific methods, and all participants are followed closely to track progress.
To take advantage of these newer treatments, all children with cancer should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. Many times, a team of doctors treats a child with cancer. Pediatric cancer centers often have extra support services for children and their families, such as nutritionists, social workers, and counselors. Special activities for kids with cancer may also be available.
The treatment of astrocytoma depends on the size and location of the tumor, whether the cancer has spread, and the child’s overall health. Three types of treatments are typically used to treat children with astrocytoma: surgery, radiation therapy, and chemotherapy. In some situations, high-dose chemotherapy followed by stem cell or bone marrow transplantation may be done.
Surgery
Surgery is the most common treatment for astrocytoma. The doctor removes as much of the tumor as possible during surgery. Even if a tumor cannot be reached by surgery because of its location, a surgical biopsy can usually still be done to determine the type and grade of the tumor.
If a low-grade tumor cannot be completely removed, the child is often monitored by his or her doctor to watch for tumor growth before considering other types of treatment. If a tumor causes symptoms and cannot be completely removed surgically, the remaining cancer is often treated with radiation therapy or chemotherapy. A high-grade tumor often requires additional treatment regardless of whether the entire tumor was removed during surgery.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. 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. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment in finished. Because radiation therapy can sometimes interfere with the normal growth and development of the child’s brain, the doctor may choose to treat the cancer in another way. To avoid or reduce the need for radiation treatment in young children, the doctor may use chemotherapy to shrink the tumor.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy may be used to delay or avoid using radiation therapy in young children with low-grade tumors, such as JPA. For a high-grade tumor, chemotherapy may be more effective in combination with surgery and radiation treatment. Chemotherapy for astrocytoma is often a combination of two or three drugs.
The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The medications used to treat cancer 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 through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
A stem cell transplantation/bone marrow transplantation may be used if astrocytoma recurs. A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because blood stems cells are typically what is being transplanted, not the actual bone marrow tissue.
There are two types of stem cell transplantation depending on the source of the replacement blood stem cell: allogeneic (ALLO) and autologous (AUTO). AUTO transplantations are used to treat astrocytoma.
In an AUTO transplant, the patient’s own stem cells are used. The stem cells are obtained from the patient when he or she is in remission from previous treatment. The stem cells are frozen until they are needed, usually after the high-dose treatment (explained below) is completed.
The goal of transplantation is to destroy cancer cells in the marrow, blood, and other parts of the body and have replacement blood stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts.
Before recommending transplantation, doctors will talk with the patient about the risks of this treatment and consider several other factors, such as the type of cancer, results of any previous treatment, and patient’s age and general health.
In stem cell transplantation, replacement cells engraft (begin to make new blood cells) and turn into healthy, blood-producing tissue in two to three weeks. Destroying the patient’s own marrow reduces the body’s natural defenses, temporarily leaving the patient at an increased risk of infection. Until the patient’s immune system is back to normal, patients may need antibiotics and blood transfusions.
In an AUTO transplant, there is little risk of tissue rejection because the replacement stem cells are the patient’s own cells. However, there is a risk in an autologous transplant that some of the cells that are put back into the patient could still be cancerous.
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 received radiation therapy or chemotherapy may now benefit from one or both of these treatments.
If the tumor is a high-grade recurrent astrocytoma, the doctor may suggest other types of chemotherapy or radiation therapy.
Doctors and scientists are always looking for better ways to treat children with astrocytoma. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are 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.
People decide to participate in clinical trials for many reasons. For some people, 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 finding new drugs and other therapies is 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.
To join a clinical trial, people must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.
Fear of treatment side effects is common after a diagnosis of astrocytoma, but it may be helpful to know that preventing and controlling side effects is a major focus of your child’s health-care team. Before treatment begins, talk with your child’s doctor about possible side effects of the specific treatments your child will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the child’s overall health.
Ask your child’s doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects your child experiences during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent of control them, visit Cancer.Net’s section on Managing Side Effects, based on ASCO’s curriculum.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient.
For more information on late effects or long-term side effects, please read the After Treatment section or talk with your child’s doctor.
After treatment for astrocytoma ends, talk with your child’s doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. All children treated for cancer, including astrocytoma, should have life-long, follow-up care.
A child’s specific follow-up care plan depends on many factors, including the type of tumor and its location, the child’s age, and the type of treatment given.
Based on the type of treatment your child received, the doctor will determine what examinations and tests are needed to check for long-term side effects and the possibility of secondary cancers. The risks and potential side effects of surgery vary dramatically, depending on the location and characteristics of the tumor. Likewise, the risks of chemotherapy and the likelihood of secondary cancers are also strongly influenced by the specific drugs used and their doses. Craniospinal (head and spine) radiation therapy may cause cognitive and endocrine symptoms over time, although the severity can vary greatly depending on the dose and the age of the child. Your child’s doctor can recommend the necessary screening tests. Follow-up care should also address the child’s quality of life, including any developmental or emotional concerns. Learn more about Childhood Cancer Survivorship.
The child’s family is encouraged to organize and keep a record of the child’s medical information, so that as the child enters adulthood, he or she has a clear, written history of the diagnosis and details of the treatment given. The doctor’s office can help you compile this, and it should include recommendations from the doctor about the schedule for follow-up care. This information will be valuable to doctors who care for your child during his or her lifetime.
Children who have had cancer can also 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 a balanced diet, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs.
Research for astrocytoma is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your child’s doctor.
Improved methods of imaging and surgery. Imaging techniques are being developed that help surgeons better pinpoint the tumor’s location, to reduce or prevent tissue 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 individual, 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 methods of delivering 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 deliver the radiation treatment.
Other advances that are under investigation in clinical trials include new chemotherapy and drugs that may stop or slow tumor growth.
Regular communication with your child’s doctor is important in making informed decisions about his or her health care. Consider asking the following questions of your child’s doctor:
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 to me?
What treatment options are available?
What clinical trials are open to my child?
What treatment do you recommend? Why?
What are the chances for success with the planned therapy?
Who is part of the treatment team, and what does each team member do?
What are the possible side effects of this treatment, both in the short term and the long term?
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?
What follow-up tests will my child need, and how often will he or she need them?
What support services are available to my child? To my family?
Alliance for Childhood Cancer 1900 Duke St., Ste. 200
Alexandria, VA 22314
Phone: 703-299-1050 www.childhoodcanceralliance.org
American Brain Tumor Association
2720 River Rd.
Des Plaines, IL 60018
Phone: 847-827-9910
Toll Free: 800-886-2282 www.abta.org
Beyond the Cure
1 South Memorial Dr., Ste. 800
St. Louis, MO 63102
Toll Free: 800-5-FAMILY (532-6459) www.beyondthecure.org
The Brain Tumor Foundation
1350 Avenue of the Americas, Ste. 1200
New York, NY 10019
Phone: 212-265-2401 www.braintumorfoundation.org
The Brain Tumor Society
124 Watertown Street, Ste. 3-H
Watertown, MA 02472
Phone: 617-924-9997
Toll Free: 800-770-TBTS (8287) www.tbts.org
Candlelighters Childhood Cancer Foundation
P.O. Box 498
Kensington, MD 20895
Phone: 301-962-3520
Toll Free: 800-366-2223 www.candlelighters.org
The Childhood Brain Tumor Foundation
20312 Watkins Meadow Dr.
Germantown, MD 20876
Phone: 301-515-2900
Toll Free: 877-217-4166 www.childhoodbraintumor.org
Children's Brain Tumor Foundation 274 Madison Ave., Ste. 1004
New York, NY 10016
Toll Free: 866-228-4673 www.cbtf.org
The Children's Cause for Cancer Advocacy
1010 Wayne Ave., Ste. 770
Silver Spring, MD 20910
Phone: 301-562-2765 www.childrenscause.org
Children's Hospice International
1101 King St., Ste. 360
Alexandria, VA 22314
Toll Free: 800-24-CHILD (800-242-4453)
Phone: 703-684-0330 www.chionline.org
CureSearch
4600 East West Hwy., Ste. 600
Bethesda, MD 20814
Toll Free: 800-458-6223 www.curesearch.org
Make-A-Wish Foundation
3550 N Central Ave., Ste. 300
Phoenix, AZ 85012
Phone: 602-279-WISH (9474)
Toll Free: 800-722-WISH (9474) www.wish.org
National Brain Tumor Foundation
22 Battery St., Ste. 612
San Francisco, CA 94111
Phone: 415-834-9970
Toll Free: 800-934-CURE (2873) www.braintumor.org
National Children's Cancer Society
1 South Memorial Dr., Ste. 800
St. Louis, MO 63102
Phone: 314-241-1600
Toll Free: 800-532-6459 www.children-cancer.com
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