AstrocytomaLast Updated: June 30, 2009 This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/09 Overview
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:
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 7.4% of all brain tumors are astrocytoma, and about half of all childhood brain tumors are astrocytoma. The five-year relative survival rate (the percentage of people 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 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. Find out more about basic cancer terms used in this section. Medical Illustrations
Risk Factors
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 children with cerebral astrocytoma. 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. Learn more about 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. Symptoms
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 a tumor. 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. Diagnosis
Doctors use many tests to diagnose a tumor 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. 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 metastasized. Your doctor may consider these factors when choosing a diagnostic test:
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). Learn more about what to expect when having common tests, procedures, and scans. Find out more about common terms used during a diagnosis of cancer. Staging and Grading
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 tumor 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 only 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 comes back after treatment. If it recurs, astrocytoma usually recurs near where it first started. Treatment
In general, cancer in children is 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 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. 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. A doctor who specializes in treating children with cancer is called a pediatric oncologist. 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, its type and grade, 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, stem cell or bone marrow transplantation may be done. Descriptions of these treatment options are listed below. Surgery Surgery is the most common treatment for astrocytoma. A neurosurgeon 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. A doctor who specializes in giving radiation therapy to treat cancer 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. 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 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. 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 is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some children may receive chemotherapy in their doctor’s office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time. 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 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. Learn more about chemotherapy and preparing for treatment. 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 by using searchable drug databases. Stem cell transplantation/bone marrow transplantation 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 cells: 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 then 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 10 days 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. Learn more about bone marrow and stem cell transplantation. Recurrent astrocytoma Treatment for recurrent astrocytoma depends on three factors:
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 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. Find out more about common terms used during cancer treatment. Clinical Trials Resources
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. The clinical trial may be evaluating a new drug, a new combination of existing treatments, a new approach to radiation therapy or surgery, or a new method of treatment or prevention. Children 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 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 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. Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill”. The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials. 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 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. For specific topics being studied for astrocytoma, learn more in the Current Research section.Side Effects
A tumor 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. Learn more about the most common side effects of a tumor and different treatments, along with ways to prevent or control them. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your child’s doctor. After Treatment
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 widely, 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 (thought-process) and endocrine (hormonal) 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. Find out more about common terms used after cancer treatment is complete. Current Research
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.
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 other drugs that may stop or slow tumor growth. Questions to Ask the Doctor
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:
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains list or national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
