Astrocytomas (astrocytic tumours)
Astrocytomas, also known as astrocytic tumours, are a type of brain tumour. This information is about astrocytic tumours, their symptoms and treatments. It should be read with our general information about brain tumours which has more detailed information about tests, treatments and their side effects.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.
The brain and spinal cord make up the central nervous system (CNS). The brain controls the different functions of the body, how we think, feel, learn and move. The spinal cord is made up of nerves that run down the middle of the back (spine). Messages from the brain go back and forwards to organs in the body through the spinal cord.
Cells in the CNS normally grow in an orderly and controlled way. If for some reason this process gets out of control, the cells continue to divide and form a lump called a tumour.
A tumour may be either benign or malignant. Benign tumours may continue to grow, but the cells do not spread from the original site. In a malignant tumour, the cells can invade and destroy surrounding tissue and may spread to other parts of the brain.
Astrocytomas are a type of glioma. Gliomas start in glial cells, which support and protect nerve cells in the brain (neurons).
Astrocytomas are the most common type of glioma and develop from a star-shaped cell called an astrocyte. They can occur in most parts of the brain and occasionally in the spinal cord.
People of any age can develop an astrocytoma. In adults they most commonly grow in the main part of the brain, the cerebrum and the chance of developing one increases as people get older. The cerebrum is made up of the frontal, parietal, temporal and occipital lobes (see diagram above). Tumours in the cerebellum are more common in children and young people.
Grading of astrocytomasBack to top
Grading is about how the tumour cells look when they are examined under a microscope. The grade gives an idea of how quickly the tumour may grow. There are four grades - grades 1 and 2 are low-grade and grades 3 and 4 are high-grade.
Low-grade astrocytomas are usually slow growing and are not likely to spread. Grade 1 astrocytic tumours can sometimes be removed with surgery and are then unlikely to come back. Grade 2 tumours can sometimes be removed but may come back after surgery.
High-grade astrocytomas are more likely to grow quickly and spread to other parts of the brain. It is common for the tumour to come back after treatment. This is known as a recurrence. Further treatment will probably be necessary.
The four grades of astrocytoma are also sometimes known by names:
Grade 1 – pilocytic astrocytoma
Grade 2 – low-grade (diffuse) astrocytoma
Grade 3 – anaplastic astrocytoma
Grade 4 – glioblastoma multiforme (GBM).
As with most brain tumours, the cause is unknown but research is going on to find out more.
Symptoms of astrocytomas can develop slowly or more quickly depending on how fast the tumour grows and where it is in the brain.
Sometimes the first symptoms are caused by increase in pressure in the brain (called raised intracranial pressure). This may be caused by a blockage in the ventricles (fluid-filled spaces of the brain), which leads to a build-up of the cerebrospinal fluid (CSF). CSF is the fluid that surrounds and protects the brain and the spinal cord. This increased pressure may also be caused by swelling around the tumour itself. Raised intracranial pressure can cause headaches, sickness (vomiting) and vision problems.
Common symptoms of astrocytomas include headaches and fits (seizures).
Other symptoms relate to the area of the brain that is affected:
- frontal lobe may cause gradual changes in mood and personality, weakness or numbness of one side of the body
- temporal lobe problems with coordination and speech, and it may affect memory
- parietal lobe may cause problems with writing and weakness or numbness of one side of the body.
Your doctors need to find out as much as possible about the type, position and size of the tumour so they can plan your treatment. You may have a number of different tests.
The doctor will examine you and do tests 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 in the brain. You will also have blood tests taken to check your general health and to see how well your kidneys are working.
A CT brain scan or MRI brain scan will be done to find the exact position and size of the tumour.
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and only takes a few minutes. CT scans use small amounts of radiation, which is very unlikely to harm you or anyone you come into contact with.
You will be given an injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it’s important to let your doctor know beforehand.
Watch our video about having a CT scan at macmillan.org.uk/testsandscans
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it’s safe for you to have an MRI scan.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy but you’ll be given earplugs or headphones.
To diagnose an astrocytoma you usually need to have a small sample of tissue removed from the tumour (biopsy). This involves an operation. A neurosurgeon makes a small hole in the skull and passes a fine needle into the tumour to remove a small sample from it. A CT scan is done at the same time to help guide the surgeon to the exact area. Your doctor will explain whether a biopsy is necessary in your case, and what the operation involves.
Your treatment will depend on a number of factors. This includes whether the tumour is slow growing (low-grade) or fast growing (high-grade), its size and position, and your general health.
A team of different specialists will plan your treatment. This will usually include doctors who specialise in treating conditions of the brain (a neurologist or neurosurgeon), a cancer doctor who specialises in treating brain tumours (oncologist) and a specialist nurse.
Your doctor will explain the aims of your treatment, its benefits and disadvantages and the risks of treatment. You and your doctor can then decide on the treatments that are right for your situation.
If you have raised intracranial pressure, it's important this is reduced before treatment begins. You may be given medicines (steroids) to reduce swelling around the tumour. If you have raised pressure due to a build-up of CSF, a tube (shunt) may be inserted into your brain to drain off the excess fluid.
Before you have any treatment, your doctor will tell you about its aims and what it involves. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.
Benefits and disadvantages of treatment
Treatment can be given for different reasons and the potential benefits will vary depending on the individual situation. If you have been offered treatment that aims to cure your cancer, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.
If you feel that you can’t make a decision about the treatment when it’s first explained to you, you can always ask for more time to decide. You are free to choose not to have the treatment and the staff can explain what may happen if you do not have it. You don’t have to give a reason for not wanting to have treatment but it can be helpful to let the staff know your concerns so that they can give you the best advice.
The following information describes the different types of treatment for an astrocytoma:
Where possible, surgery is the first type of treatment for an astrocytoma. The aim of surgery is to remove as much of the tumour as possible without damaging the surrounding brain tissue. 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.
Sometimes surgery may not be possible. This may be because the position of the tumour makes it too difficult to reach and surgery would not be safe. If surgery is not possible, your doctor will talk to you about other treatments, such as radiotherapy and chemotherapy.
- Grade 1 astrocytomas in the cerebellum can often be removed completely by surgery.
- Grade 2 astrocytomas may be treated with surgery. After surgery, you will have regular MRI scans to check for any growth of the tumour or change in the tumour.
- For grade 3 and 4 tumours, surgery is usually carried out first and then followed by radiotherapy and sometimes chemotherapy.
Radiotherapy treatment uses high energy x-rays to destroy the cancer cells. It’s often used after surgery to destroy any remaining tumour cells. It may be used alone to treat an astrocytoma, or with chemotherapy if surgery is not possible.
Your doctor and specialist nurse will talk to you about the likely side effects. Radiotherapy makes you feel very tired and this can carry on for weeks or longer after it finishes. Try to get plenty of rest. The skin on your scalp may become itchy and red or darker and you will lose the hair on the area being treated. This usually grows back again after 2- 3 months. Your nurse will give you advice on looking after the skin on your scalp and coping with hair loss.
Radiotherapy to the whole brain may cause a long term risk of some changes to your memory or thinking. Your cancer doctor and nurse will talk this over with you. Newer ways of giving radiotherapy aim to give a higher dose of radiotherapy to the tumour without damaging the surrounding normal brain.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs, which destroy cancer cells. It may be given alone to treat an astrocytoma, or with surgery and radiotherapy.
You may have chemotherapy given into a vein (intravenously) or as tablets. It 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, called Gliadel ® implants, are small wafers or discs, which contain the chemotherapy drug carmustine. The surgeon will place up to eight wafers in the space where the tumour was. As the wafers dissolve, the drug is slowly released. This method of giving chemotherapy is only suitable for some people with high grade tumours. Your doctors will let you know if it’s suitable for you.
Your doctor or specialist nurse will tell you what to expect. They can prescribe drugs to reduce some side effects and give you advice on what you can do to manage side effects. One of the main side effects is risk of infection. Chemotherapy temporarily reduces the number of white blood cells which help fight infection. Other side effects will depend on the drugs used and can include, feeling sick, sore mouth, or possible hair loss. Always let your doctor or nurse know about any side effects you have.
Steroids are drugs that are used to reduce swelling around the tumour. They improve symptoms and help you to feel better. If you have raised pressure in the brain you will be treated with steroids straightaway.
You usually have them as tablets. Some of the side effects include: indigestion, weight gain, restlessness, agitation and sleep disturbance. Let your doctor or nurse know if these are causing problems or you notice any other side effects. Taking steroids with food can help reduce indigestion. Your doctor may also prescribe medication to prevent it. It is very important to take steroids exactly as they have been prescribed.
Medicines and seizures
If you have a seizure (fit), you may be given a medicine called an anticonvulsant to help prevent them.
Some people may need support to help them to recover from their symptoms after treatment. This may be from a physiotherapist to help improve your balance, walking or strength. Occupational therapists can provide equipment and help you be more independent. Other services such as speech therapy or psychological support services are also available.
You will be monitored very closely after treatment with regular scans and check-ups at clinic.
Being diagnosed with a brain tumour may feel very frightening at times. You may have many different feelings, including anxiety, anger, fear or feeling low or depressed. Many people go through these and it’s important to get the support you need.
You may find it helpful to talk things over with family and close friends and with your doctor or nurse. You can also talk to one of our support service nurses. Sometimes people need more help to cope with difficult feelings of anxiety or depression. Your doctor can refer you to a counsellor or psychologist for more support.
You may not be allowed to drive for a period of time depending on the treatment you have had and if you have had any fits (seizures). Although this can be upsetting it’s important to follow the advice you are given. Your doctor will ask you to contact the Drivers and Vehicle Licensing Association (DVLA). It is your responsibility to contact the DVLA. Your doctor or nurse will explain what you need to do.
This information has been compiled using a number of reliable sources, including:
- Guidelines on management of low-grade gliomas: report of an EFNS–EANO* Task Force. European Journal of Neurology 2010, 17: 1124–1133
- High-Grade Malignant Glioma: ESMO Clinical Practice Guidelines 2014
- Packer and Schiff. Neuro-oncology. 1st edition. 2012. Wiley-Blackwell.
With thanks to Mr David Peterson, Consultant Neurosurgeon, who reviewed this edition.
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