Astrocytoma / Glioma

What are astrocytomas and gliomas?

Astrocytomas and gliomas are tumors that grow from brain cells called astrocytes. These cells are a type of glial cell. Glial cells make up the supportive tissue of the brain. An astrocytoma is a type of glioma.

Because the terms “astrocytoma” and “glioma” are commonly used to mean the same thing, “astrocytoma” is used here to refer to both.

Common sites for astrocytomas include the following:

• The cerebellum (the area just above the back of the neck that controls movement, balance and posture)
• The cerebrum (the largest part of the brain at the top of the head. Controls thinking, speech, emotions, reading, writing, problem-solving and movement)
• The brainstem (lowest part of the brain that connects to the spinal cord. Controls breathing, heart rate and all the nerves and muscles that are used in hearing, walking, talking, seeing and eating)
• The hypothalamus (located in the center of the brain and controls body temperature, thirst and hunger)
• The visual pathway (the group of nerves that connect your eyes with your brain)

Astrocytomas may be grouped by the way they look under the microscope:

• Grade I: Often called benign or low grade. They are closest to normal and grow slowly.
• Grades II, III and IV: All are cancerous. The more abnormal the cells look under the microscope, the higher the grade.
• Grades III and IV are the most aggressive types of astrocytoma/glioma.

Astrocytomas may be classified in this way:

• High-grade astrocytomas/gliomas: Tumors grow quickly and spread throughout the brain. They are aggressive and require intensive treatment as soon as possible. Common high-grade astrocytomas:

  • Anaplastic astrocytoma (AA), which are grade III tumors
  • Glioblastoma multiforme (GBM), which are grade IV tumors

• Low-grade astrocytomas: Tumors are usually localized and grow slowly. Common low-grade astrocytomas:

  • Pilocytic astrocytoma (PA) or juvenile pilocytic astrocytoma (JPA)
  • Pilomyxoid astrocytoma (PMA)
  • Fibrillary astrocytoma
  • Pleomorphic xanthoastrocytoma (PXA)
  • Diffuse astrocytoma

In children, most astrocytomas are low-grade. In adults, most are high-grade.

How common is astrocytoma?

• Astrocytoma is the most common type of glioma diagnosed in children.
• These tumors can occur in children and adults.
• These tumors account for almost half of all childhood tumors starting in the brain or spinal cord.

What are the symptoms of astrocytoma?

Astrocytoma symptoms vary widely. Some do not cause symptoms at all or not until they become large. In children, the types of symptoms depend on the following:

• Age and stage of growth
• Function of the affected part of the brain
• Location of the tumor in the brain or spinal cord
• Speed at which the tumor is growing

Symptoms may occur quickly in some children, slowly and gradually in others. Symptoms of astrocytoma include the following:

• Nausea and vomiting
• Early morning headaches
• Unexplained weight gain or loss
• Vision, hearing or speech problems
• Loss of balance or trouble walking
• Weakness, tingling or changes of feeling on one side
• Seizures
• Changes in personality or behavior
• Increased head size (in an infant)

How is astrocytoma treated?

• Surgery — is used to both diagnose and treat astrocytomas. A biopsy (removal of affected tissue to be examined) may be done to determine the tumor’s type and grade. If a biopsy finds cancer cells and the patient is still in surgery, the surgeon may take out as much tumor as can be removed safely.

  • In Grade I tumors, surgery is considered a curative option if the tumor can be removed completely. These tumors can also be followed closely with MRI if very little tumor is left behind.

Along with surgery, chemotherapy or radiation therapy may also be used to kill any remaining tumor cells:

• Chemotherapy (“chemo”) — may be used after surgery to treat children under age 3. It may also be used along with surgery and radiation therapy for older children. Chemo uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.

  • Chemo may be injected into the bloodstream, so that it can travel throughout the body.
  • Some chemo may be given by mouth.
  • Combination therapy uses more than one type of chemo at a time or refers to chemo with radiation and/or surgery.
• Radiation therapy — uses high-energy X-rays or other types of radiation to kill cancer cells or stop them from growing. Generally used in children older than 3 after surgery with Grade III and IV tumors. External radiation therapy is used to treat astrocytoma in children. The way the radiation is given depends on the type of tumor and where the tumor is located in the brain or spinal cord. Your radiation oncologist will discuss the types of radiation therapy with you to decide the best option for your child.

What are the survival rates for astrocytoma?

Survival rates for astrocytomas in children vary widely based on these factors:

• The specific type, location and grade of the astrocytoma
• Whether the tumor is localized (in one area) or has spread
• The child’s age at diagnosis
• Genetic changes in the child (such as NF1)
• Whether the astrocytoma is newly diagnosed or has returned (recurred)

Why choose St. Jude for your child’s astrocytoma treatment?

• St. Jude research for low-grade astrocytomas focuses on developing chemo treatments that control tumor growth with fewer side effects. Because these tumors grow slowly, the strategy is to give less intensive chemo over long periods of time. For older children and those whose tumors progress despite chemo, new radiation techniques are under study to “focally” deliver radiation to the tumor with few effects on the normal brain tissue.
• St. Jude research for high grade astrocytoma/gliomas focuses on developing targeted therapy by researching the different pathways found in these tumors. The goal is to increase the overall survival rate of children with high grade glioma. The clinical staff does this by working with the neurobiology department to test new drugs for future use in clinical trials while continuing to improve radiation delivery and surgical techniques.
• St. Jude has one of the largest pediatric brain tumor programs in the country.
• The St. Jude staff is dedicated to treating children who have serious illnesses. Here, you will find a hospital and staff that has only one focus—your child.
• St. Jude is committed to not only finding cures, but also helping children hold on to their quality of life. Children are not just small people. Their bodies and systems are unique, along with the disorders that affect them. For the best care, they need a specialized team. That is what you get from the St. Jude Brain Tumor Program.
• By working closely with the pediatric neurosurgeons at Le Bonheur Children’s Hospital in Memphis, the St. Jude Brain Tumor Program offers an expert team of doctors from many medical fields. The team includes: neuro-oncologists, who study and treat cancer in the brain and nervous system; neurosurgeons, who operate on the brain, skull, scalp and spinal cord; and radiation oncologists, who treat cancer with radiation. All of these doctors have devoted their careers to finding cures and providing treatment for children with brain tumors. This diverse knowledge is vital to the complete care of children with brain tumors.
• Our brain tumor doctors also work closely with support staff in nursing, rehabilitation services, neuropathology, pharmacy, neuroradiology, neuropsychology, clinical nutrition, child life and social work, along with many others. Support staff members have been specially trained to care for children with brain tumors.
• The nurse-to-patient ratio at St. Jude is unmatched—averaging 1:3 in hematology and oncology, and 1:1 in the Intensive Care Unit.
• The St. Jude Brain Tumor Program has made great advances in treatments for brain tumor patients. Some of the world’s best neuroscientists, cancer biologists and doctors from the St. Jude Neurobiology and Brain Tumor Divisions combine their efforts to seek cures. In this interactive program, discoveries about the biology of both normal and harmful cell growth are rapidly tested in clinic studies. These studies include Phase I, II and III trials of the most common and deadly forms of childhood brain tumors.
• Being able to take a drug directly from the lab to your child is one of the major advantages of centers like St. Jude. Before treating a patient with any new drug, the St. Jude staff does many tests in the lab. The tests show if the drug is safe, if it works, and the best way to use it to help patients.
• St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
• Along with the treatment studies constantly being developing at St. Jude, the staff also treats patients on studies developed by the Children’s Oncology Group, the Pediatric Brain Tumor Consortium and the Pacific Pediatric Neuro-Oncology Consortium. Many St. Jude staff members play key roles in developing these studies, which are large tests carried out at centers across the United States.
• St. Jude practices patient family-centered care. Patient family-centered care is health care that focuses on the family as a child’s primary source of strength, support and well-being. At the heart of patient family-centered care is the belief that health care staff and the family are partners, working together to best meet the needs of the child. Excellence in health care happens when we work together and honor the expertise each of us brings to every health care encounter.
• St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.