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An astrocytoma is a type of brain tumour. They belong to a group of tumours called gliomas. Gliomas are tumours that develop from the glial cells. Glial cells support nerve cells in the brain or spinal cord. The terms ‘astrocytoma’ and ‘glioma’ are often used interchangeably. 

Astrocytomas are the most common type of glioma. They develop from star-shaped glial cells called astrocytes. An astrocyte is a cell that supports the nerve cells in the brain. This type of tumour can develop in most parts of the brain and sometimes in the spinal cord.

The most common types of astrocytomas are:

  • Juvenile pilocytic astrocytoma (JPA), a slow-growing tumour, usually in the back of the brain (cerebellum). This type of tumour is referred to as a low grade glioma.
  • Glioblastoma multiforme (GBM), a fast-growing tumour that usually starts in the upper part of the brain. This type of tumour is referred to as a high grade glioma.
  • Anaplastic astrocytoma, a fast-growing tumour that usually starts in the upper part of the brain. This type of tumour is referred to as a high grade glioma.

Treatment

Treatments used for astrocytomas include surgery, radiotherapy and chemotherapy. You may have a combination of treatments. Your treatment may depend on:

  • the size and position of the tumour
  • the grade of the tumour
  • the symptoms you have
  • sometimes, the biomarker results.

Treatment for low-grade astrocytoma

If the tumour is not causing you problems, your doctor may suggest active monitoring. Treatment may cause side effects, and some of these may be permanent. Active monitoring means regularly checking the tumour to find out if it is growing. Instead of starting treatment, you may see your specialist doctor regularly to have scans. Scans and monitoring can help your doctor know if and when to recommend treatment.

Treatment for high-grade astrocytoma

High-grade tumours grow more quickly and need to be treated straight away. If surgery is possible, the surgeon will remove as much of the tumour as they can. After surgery, you will usually have radiotherapy or chemotherapy, or both.

Surgery

Your neurosurgeon will work to remove as much of the astrocytoma as possible. The goal is to remove all of the cancer, but sometimes the astrocytoma is located near sensitive brain tissue that makes that too risky. Even removing some of the tumour may reduce your signs and symptoms.

For some people, surgery may be the only treatment needed. For others, additional treatments may be recommended to kill any cancer cells that might remain and reduce the risk of the cancer returning.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays or protons to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing beams to precise points in your brain.

Radiation therapy might be recommended after surgery if your cancer couldn't be removed entirely or if there's an increased risk your cancer will return. Radiation is often combined with chemotherapy for aggressive cancers. For people who can't undergo surgery, radiation therapy and chemotherapy may be primary treatments.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is often used after surgery to kill any cancer cells that might remain. It may be combined with radiation therapy for aggressive cancers.

Clinical trials

Clinical trials are studies of new treatments. These studies give you a chance to try the latest treatment options, but the risk of side effects may not be known. 

Palliative care

Palliative care is specialised medical care that focuses on providing relief from pain and other symptoms of a severe illness. Palliative care specialists work with you and your doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

Risk factors

While the cause of astrocytomas is unknown, they can affect people of any age, but they are more common in older people.

Astrocytomas occur with greater frequency with certain genetic disorders, including:

  • Turcot syndrome.
  • Neurofibromatosis type-I tuberous sclerosis.
  • Ollier's disease.
  • Li-Fraumeni syndrome.

Grade I astrocytoma occurs most often in children and teens and account for 2% of all brain tumours.

Grade II astrocytoma occurs most often in adults between the ages of 20 and 60. 

Grade III astrocytoma occurs most often in adults between 30 and 60, is more common in men and accounts for 4% of all brain tumors. 

Grade IV astrocytoma occurs most often in adults between 50 and 80, is more common in men and accounts for 23% of all primary brain tumours.

Early symptoms

As a tumour grows, it can press on or grow into nearby areas of the brain. This can cause symptoms because it stops that part of the brain from functioning as usual. Some symptoms can happen because the tumour causes a build up of pressure inside the skull. This is called raised intracranial pressure.

Symptoms can depend on the size and position of the tumour and how slowly or quickly it grows. They may develop suddenly or gradually over months or even years.

Common symptoms include headaches and seizures (fits). Other possible symptoms include:

  • Feeling sick or nauseous.
  • Problems with balance and coordination.
  • Problems with sight.
  • Feeling confused.
  • Problems with memory.
  • Changes in mood and personality.

The tumour may also cause other symptoms, depending on which part of the brain is affected. Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.

Diagnosis/diagnosing

Tests and procedures used to diagnose astrocytoma include a neurological exam, imaging tests and a biopsy.

Neurological exam

During a neurological exam, your doctor will ask you about your signs and symptoms. They may check your vision, hearing, balance, coordination, strength and reflexes. Problems in one or more of these areas may provide clues about the part of your brain that could be affected by a brain tumour.

Imaging tests

Imaging tests can help your doctor determine the location and size of your brain tumour. MRI is often used to diagnose brain tumours, and it may be used along with specialised MRI imaging, such as functional MRI, perfusion MRI and magnetic resonance spectroscopy.

Other imaging tests may include CT and positron emission tomography (PET).

Biopsy

A biopsy can be done with a needle before surgery or during surgery to remove your astrocytoma, depending on your particular situation and the location of your tumour. The tissue sample is analysed in a laboratory to determine the types of cells and their level of aggressiveness.

Specialised tests of the tumour cells can tell your doctor the types of mutations the cells have acquired. This gives your doctor clues about your prognosis and may guide your treatment options.

Prognosis (Certain factors affect the prognosis and treatment options)

The prognosis for astrocytomas is often dependant on the grade of the tumour.

Low-grade astrocytoma

A low-grade astrocytoma is usually slow growing. This means it is not likely to spread to other areas of the brain or spinal cord. Your doctor may describe a low-grade astrocytoma as one of the following:

  • Grade 1 astrocytoma, or a pilocytic astrocytoma, is often removed with surgery and may not need further treatment.
  • Grade 2 astrocytoma, or a low-grade diffuse astrocytoma, are more likely to come back after treatment. They may eventually develop into higher-grade tumours (transformation).

High-grade astrocytoma

A high-grade astrocytoma is more likely to grow quickly and spread to other parts of the brain or spinal cord. It is common for this tumour to come back after treatment.

Further treatment is often needed. Your doctor may describe a high-grade astrocytoma as one of the following:

  • Grade 3 astrocytoma, or an anaplastic astrocytoma.
  • Grade 4 astrocytoma, or a glioblastoma multiforme (GBM).

References

Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.