Astrocytomas

Astrocytomas belong to a group of tumours called gliomas. They can start in different parts of the brain and sometimes in the spinal cord. Common symptoms include headaches and seizures (fits). Other symptoms depend on the part of the brain the tumour affects.

You will have different tests to find out more about the tumour, such as an MRI scan or CT scan. Some people have an operation to remove a small piece of tissue (biopsy) from the tumour. This is examined to find out how slowly or quickly the tumour cells may grow (the grade).

Low-grade astrocytomas develop slowly. Anaplastic astrocytoma and glioblastoma multiforme are high-grade astrocytomas that grow more quickly.

Treatment depends on the grade and position of the tumour, and your general health. Your doctor will talk to you about the best treatment for you and explain the benefits and disadvantages.

Treatments include surgery, radiotherapy and chemotherapy. You may have a combination of these and other treatments to improve any symptoms. Your doctor will explain what side effects to expect and how they can be managed.

What are astrocytomas?

Astrocytomas are a type of tumour that usually start in the brain and sometimes in the spinal cord. It’s best to read this with our general information about brain tumours and spinal cord tumours. This has more detail about tests and treatments.

This information is about astrocytoma in adults. We also have information about brain tumours that is written for teens and young adults. If you need information about astrocytoma in children, you can contact the Children’s Cancer and Leukaemia Group at cclg.org.uk.

Astrocytomas belong to a group of tumours called gliomas. Gliomas are tumours that develop from the main supporting cells (glial cells) in the brain or spinal cord.

Different types of gliomas are named after the different types of glial cells. Astrocytomas are the most common type of glioma. They develop from a star-shaped glial cell called an astrocyte.

Astrocytomas can develop in most parts of the brain and sometimes in the spinal cord. They can sometimes spread from where they started to other parts of the brain or spinal cord. They don’t spread to other parts of the body.

These tumours can affect people of any age, but they are more likely in older people.


Grading astrocytoma

Gliomas can be slow growing or fast growing. Your doctor may talk about the grade of the tumour. The grade describes how the tumour cells look when they are examined under a microscope.

Gliomas can be graded from 1 to 4:

  • Low grade tumours (grade 1 and 2) are slow growing.
  • High grade tumours (grade 3 and 4) grow faster.

The grade and position of a glioma gives your doctors an idea of how the tumour may develop. This can help them plan your treatment.

Low grade astrocytoma

Low-grade astrocytoma is usually slow growing. This means it is not likely to spread to other areas of the brain or spinal cord.

Grade 1 tumours (called pilocytic astrocytomas) are often removed with surgery and need no further treatment.

Grade 2 tumours (called low-grade diffuse astrocytoma) are more likely to come back after treatment. They may eventually develop into higher-grade tumours (transformation).

High grade astrocytoma

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:

• grade 3 or anaplastic astrocytoma

• grade 4 or glioblastoma multiforme (GBM).


Causes of astrocytoma

The cause of astrocytoma is not known, but research is being done to find out more.


Symptoms of astrocytoma

Astrocytoma causes similar symptoms to other types of brain tumours.

The symptoms may develop slowly or quickly depending on how fast the astrocytoma grows and where it is in the brain. Common symptoms of astrocytomas include headaches and seizures (fits).

Sometimes symptoms are caused by increased pressure on the brain (called raised intracranial pressure). This can be caused by:

  • swelling around the tumour
  • the tumour itself
  • a build-up of the fluid that surrounds and protects the brain and spinal cord (cerebrospinal fluid).

Symptoms include headaches, feeling or being sick, problems with balance and with sight, and being confused.

The tumour may cause other symptoms depending on which part of the brain is affected. These can include:

  • changes in mood and personality
  • weakness or numbness of one side of the body
  • problems with coordination
  • problems with memory
  • problems with speech, understanding and writing.


Tests for astrocytoma

Your doctors need to find out as much as possible about the type, position and size of the tumour so they can plan the best treatment for you. You will usually have a number of different tests.

The doctor will examine you and do checks on your nervous system. This includes checking your reflexes, and the power and feeling in your arms and legs. They also shine a light at the back of your eye to check if the optic nerve is swollen, which can be a sign of raised pressure on the brain. Your doctor will ask some questions to check your reasoning and memory. You will also have blood tests taken to check your general health and to see how well your kidneys are working.

You will have an MRI scan or CT scan to find out the exact position and size of the tumour. You may also have a biopsy.

MRI scan

This scan uses magnetism to build up a detailed picture of areas of your body. You may be given an injection of dye, into a vein, to improve the images from the scan. We have more detailed information about having an MRI scan.

CT scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. We have more detailed information about having a CT scan.

Biopsy

Sometimes, a sample of cells is taken from the tumour (biopsy) and examined under a microscope before you have any treatment. This test involves an operation. Your doctor will explain if you need a biopsy and exactly what the operation involves. Sometimes the biopsy and surgery to remove the tumour are done at the same time.

A biopsy can be done under a general or local anaesthetic. The neurosurgeon (brain surgeon) makes a small hole in the skull and passes a fine needle through into the tumour. They remove a small sample of tissue. The sample is examined to find out the type and grade of cells in the tumour.


Treating astrocytoma

The main treatments for astrocytoma are surgery, radiotherapy and chemotherapy. You may have one or a combination of these treatments. These treatments may also be used if the tumour comes back.

Your treatment will depend on a number of things, including:

  • whether the tumour is slow growing (low grade) or fast growing (high grade)
  • the size and position of the tumour
  • your general health.

If the tumour is low grade, your doctor may suggest monitoring (watch and wait) it until treatment is needed.

For a grade 1 tumour, surgery may be the only treatment needed. Other tumours are usually treated with radiotherapy and chemotherapy after surgery. Sometimes chemotherapy is given at the same time as surgery or radiotherapy.

Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about the benefits and disadvantages of different treatment types. They will also explain the risks and side effects.

You will have time to talk this through with them before you make any treatment decisions. You may be given a choice of treatment options. Let your specialist know if you need more information or time.

You may have other treatments to help any symptoms caused by the tumour. You may be given steroids to reduce swelling around the tumour or other drugs to control seizures (fits). If you have raised pressure on the brain due to a build-up of CSF, you may have surgery to drain off the extra fluid.

Monitoring (watch and wait)

This may be an option for some people. It means choosing to wait and see if the tumour grows and causes symptoms, or if your symptoms get worse, before you have treatment. Your specialist doctor will explain the benefits and risks of monitoring.

Some people with low-grade astrocytoma may have monitoring after surgery if all of the tumour hasn’t been removed. This means you may be able to delay having further surgery or radiotherapy if you don’t have symptoms that are causing problems.

When monitoring the tumour, you will see your specialist doctor regularly at a clinic. You will have regular scans to check for changes in the size of the tumour. Your doctor will tell you about possible symptoms to look out for. They will ask you to tell them straight away if you have any new symptoms, or changes in your symptoms.

Surgery

If possible, surgery is the main treatment for astrocytoma. The aim is to remove as much of the tumour as possible without damaging nearby areas of the brain or spine. Your surgeon will explain what your operation will involve. They will talk to you about the possible complications and risks.

Depending on the size, position and spread of the tumour, it may not be possible to remove it completely. In this situation, radiotherapy and sometimes chemotherapy may be given after surgery to treat the remaining tumour cells.

Sometimes it’s not safe to do an operation because the position of the tumour makes it difficult to reach. Your doctor may talk to you about other treatments, such as radiotherapy and chemotherapy.

If the tumour has caused a build up of cerebrospinal fluid (CSF), you may need a small operation to drain away the extra fluid. The surgeon places a long thin tube (a shunt) into the brain to drain the extra fluid away to another part of the body.

Some people may need extra support to help with their recovery after surgery. This may be from a physiotherapist, who can help you to improve your balance, walking or strength. Occupational therapists can provide equipment and help you become more independent.

It can take a while to recover so it’s important to take good care of yourself. Get plenty of rest, try to eat well and follow the advice given to you by your surgeon and specialist nurse.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. This treatment is often used after surgery to reduce the risk of cancer coming back or to treat any remaining cancer cells. It may also be used as the main treatment or with chemotherapy, if surgery is not possible.

Your cancer doctor (oncologist) will explain how long your treatment will last and the type of radiotherapy you will have.

Some people with low-grade astrocytoma may delay having radiotherapy after surgery. Instead, they are closely monitored. They may decide to start radiotherapy when there are signs that the tumour is growing again.

Chemotherapy can be given at the same time as radiotherapy to treat some high-grade astrocytomas. This can cause more side effects than radiotherapy alone.

Radiotherapy makes you feel very tired. This can carry on for weeks or longer after it finishes. Get plenty of rest but try to balance this with some gentle activity, such as short walks. This can help you to feel less tired.

The skin in the treated areas may become itchy and red or darker. You will lose the hair in the area being treated. This usually grows back again after 2 to 3 months.

Your cancer doctor and specialist nurse will talk to you about the side effects of radiotherapy and how they are managed. They will also explain the risk of late side effects. These are side effects that sometimes start months or years after radiotherapy.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. This treatment may be given:

  • to treat any remaining cancer cells after surgery and/or radiotherapy
  • at the same time as surgery or radiotherapy for high-grade astrocytoma
  • if a tumour comes back after other treatments.

Chemotherapy can be given in several different ways. You may have chemotherapy given into a vein (intravenously) by a nurse in a chemotherapy day unit. Or you may have chemotherapy as tablets. The drugs most commonly used to treat astrocytoma are:

Chemotherapy may also be given by placing implants containing chemotherapy into the brain. This is done during an operation to remove or shrink the tumour. These implants are called Gliadel® implants. They are small wafers or discs, which contain the chemotherapy drug carmustine. The surgeon places up to eight wafers in the space where the tumour was. As the wafers dissolve, the drug is slowly released. This type of chemotherapy is used to treat some high-grade tumours.

Low-grade astrocytoma is not usually treated with chemotherapy, unless it comes back after other treatments. Temozolomide is often used to treat high grade astrocytoma. It may be given at the same time as radiotherapy, after radiotherapy or on its own.

Your doctors will let you know if these types of chemotherapy are suitable for you.

Side effects of chemotherapy include:

  • being more at risk of infection
  • tiredness
  • hair loss
  • feeling sick
  • a sore mouth.

You may have more side effects if you’re having chemotherapy at the same time as radiotherapy. Your cancer doctor or nurse will talk to you about the immediate side effects and ways of managing them. They will also discuss any possible long-term effects.

Steroids

Steroids are drugs that reduce the swelling around the tumour. You may be given them before or after surgery or during radiotherapy. They can improve your symptoms and help you feel better. If you have raised pressure on the brain, you will be treated with steroids straight away.

You usually have steroids as tablets. Some of the side effects include:

  • indigestion
  • weight gain
  • restlessness
  • agitation
  • sleep disturbance.

Let your doctor or nurse know if these are causing problems or you notice any other effects. Taking steroids with food can help reduce indigestion.

It is important to take steroids exactly as your doctor has prescribed them.

Anticonvulsants

If you have seizures (fits), you may be given drugs called anticonvulsants to help prevent them.


Driving

You may not be allowed to drive for a period of time. Although this can be upsetting, it’s important to follow the advice you are given.

You will need to contact the Drivers and Vehicle Licensing Association (DVLA) if you live in England, Scotland or Wales. If you live in Northern Ireland you will need to contact the Driver and Vehicle Agency (DVA). They will advise you of any restrictions on your right to drive:

If you’re not sure what you should do, check with your cancer doctor or specialist nurse. They will explain things to you.


Follow-up

After your treatment has finished, you’ll have regular check-ups, tests and scans. These appointments are a good opportunity to talk to your doctor about any worries or problems you have.

Many people find they get very anxious before appointments. This is natural. It can help to get support from family, friends, your specialist nurse or one of the organisations listed on our database. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.