Astrocytoma

All kinds of people get diagnosed with a common brain tumor called an astrocytoma. If you’re one of them, you may be wondering what it is and what to do about it. Your health care team at Aurora Health Care will work together to bring you the best options for treatment.

What is an astrocytoma?

An astrocytoma is a type of glioma that starts growing from star-shaped cells in the brain or spine called astrocytes. Healthy astrocytes support nerve cells.

Astrocytomas can form in any part of the brain or in the spinal cord. They occur most often between the ages of 20-60 and are more common in men than in women. They may be benign (noncancerous) or malignant (cancerous).

Astrocytomas can be life-threatening even if they’re benign because they may:

• Be hard to reach and treat with surgery
• Grow into other areas of the brain

Astrocytoma risk factors

Having radiation therapy treatment of the head and neck during childhood is a risk factor for astrocytoma. These hereditary conditions may increase the risk of developing an astrocytoma.

• Li-Fraumeni syndrome
• Neurofibromatosis type 1 (NF1)
• Tuberous sclerosis
• Turcot syndrome

Researchers continue to search for other risk factors.

Genetics & astrocytomas

Your doctor may recommend genetic testing for you. Recent research has uncovered things about astrocytomas that have helped us understand the disease process.

Some types of astrocytomas are related to mutations in certain genes.

The immune system has a process for limiting growth of cancer cells. We’ve discovered that, for some astrocytomas, that immune process gets turned off. Researchers are confident that discovering a way to turn the immune system response back on will improve treatment of these types of astrocytomas.

Depending on what genetic testing shows us about your tumor, we may be able to recommend targeted therapy that attacks specific parts of cancer cells and doesn’t affect healthy tissues.

Types of astrocytoma tumors

Astrocytoma tumors are often described based on what grade they are. A grade is assigned to a tumor based on these criteria:

• How abnormal the cells look compared to normal brain or spinal cord tissue
• How much the cells grow
• Whether there are new blood vessels within the tumor

A biopsy (tissue sample) of the tumor is evaluated by a neuropathologist to determine whether it’s grade 1, 2, 3 or 4.

Astrocytoma tumor grade 1

There are three kinds of grade 1 astrocytomas. Removing them is usually considered a cure.

• Pilocytic astrocytoma: Slow-growing tumor that doesn’t grow into surrounding areas of the brain. It’s the most common astrocytoma among children. Also known as Juvenile Pilocytic Astrocytoma (JPA).
• Pleomorphic xanthoastrocytoma (PXA): Rare, slow-growing tumor that may be related to seizures.
• Subependymal giant cell astrocytoma (SEGA): Usually affects young people and is associated with tuberous sclerosis. Grows deep into the ventricles (fluid-filled spaces) of the brain and can cause swelling of the brain.

Astrocytoma tumor grade 2

Grade 2 astrocytomas are known as diffuse astrocytomas. The cells of these invasive tumors look abnormal under a microscope and there are more of them than normal. Surgery alone might not cure these tumors.

Astrocytoma tumor grade 3

Cells of anaplastic astrocytoma grow faster and look more abnormal under a microscope. They’re seen as more malignant than lower grade tumors and surgery is never enough to cure them.

Astrocytoma tumor grade 4

Also known as glioblastoma (GBM), grade 4 astrocytomas grow very quickly and are the most common cancerous brain tumor in adults. Glioblastoma cells appear very abnormal, form many new blood vessels and cause tissues to die.

Primary tumors vs. secondary tumors

Primary brain tumors are ones that start in the brain. Astrocytoma tumors usually affect only brain or spine tissues and don’t spread to other areas of the body.

Some brain and spine tumors may be secondary tumors (metastatic tumors), which means they have spread to the brain or spine from cancer that started in another part of the body. Most metastatic brain tumors come from cancers of the colon, lungs, breasts, or kidneys, or from a melanoma (a type of skin cancer).

Astrocytoma tumor symptoms

Astrocytoma symptoms depend on the location of the tumor. If a tumor is growing in an area where there’s lots of room to grow, it might not cause symptoms until it gets bigger.

Cancerous tumors may cause symptoms earlier than benign tumors because they cause swelling in the brain, destroy healthy tissues and grow more quickly.

Common astrocytoma symptoms include:

• Double or blurred vision
• Headaches which are worse in the morning or cause awakening from sleep
• New seizures
• Persistent headaches
• Problems with thinking, concentrating and making decisions
• Speech problems
• Weakness in arms or legs

Astrocytoma diagnosis

When you see your doctor about potential astrocytoma symptoms, they’ll perform a physical and talk to you about your family medical history and symptoms. They’ll also ask questions and do tests to check your mental status, coordination, vision, ability to walk normally, and how well your muscles, senses and reflexes work.

Testing for astrocytoma

Imaging tests provide a full picture that shows the size and shape of the astrocytoma. This includes a magnetic resonance imaging (MRI) scan, that’s usually the first test. Your scan may be done both with and without a contrast dye injected into your bloodstream. If more contrast dye is picked up by the tumor, your doctor will be able to tell it’s a high grade one.

Different kinds of special MRI tests gather different details.

• MRI spectroscopy (MRS): Provides information about levels of chemicals related to the tumor.
• Functional MRI (fMRI): Used to see which parts of the brain are used when you’re asked to do things like moving your legs or talking. Using fMRI scans, your doctor can find out what functions the tumor is likely to affect, and it can help them plan any needed surgery.

If the results of imaging tests show that a tumor is too difficult to remove with surgery, a biopsy (tissue sample) may be removed as a separate procedure to confirm your diagnosis and help your doctor decide what treatment you need. For tumors that can be removed with surgery, a part of the tumor will be used for biopsy purposes.

Astrocytoma treatment

The first step in treatment for both cancerous and benign astrocytoma tumors is brain surgery to remove as much of the tumor as possible. Surgery may cure low-grade tumors.

For grade 3 or grade 4 tumors, surgery can also relieve most of the effects of swelling. It also makes any subsequent cancer treatments of the remaining parts of the tumor work better.

If part of a cancerous tumor isn’t able to be removed, it may be treated with radiation therapy. Chemotherapy may also be used for residual parts of a tumor. We may also recommend immunotherapy or available clinical trials for your treatment.

Through all treatments, your multidisciplinary cancer care team will provide support, answer your questions and keep your primary care doctor informed about what’s going on. We also offer comprehensive support for personal needs related to your disease that go beyond the medical aspects of your care.