Childhood astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.
Astrocytomas are tumors that start in star-shaped brain cells called astrocytes. An astrocyte is a type of glial cell. Glial cells hold nerve cells in place and help them work the way they should. There are several types of astrocytomas. They can form anywhere in the central nervous system (brain and spinal cord). Brain tumors are the third most common type of cancer in children.
The tumors may be benign (not cancer) or malignant (cancer). Benign brain tumors grow and press on nearby areas of the brain. They rarely spread into other tissues. Malignant brain tumors are likely to grow quickly and spread into other brain tissue. When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors can cause symptoms and need treatment.
This summary is about the treatment of primary brain tumors that begin in the glial cells in the brain. Information is included about the following tumors that form from glial cells:
Treatment of metastatic brain tumors is not discussed in this summary. Metastatic brain tumors are formed by cancer cells that begin in other parts of the body and spread to the brain.
Brain tumors can occur in both children and adults. However, treatment for children may be different than treatment for adults. (See the PDQ treatment summary on Adult Brain Tumors for more information.)
The central nervous system controls many important body functions.
Astrocytomas most commonly form in these parts of the central nervous system (CNS):
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The cause of most childhood brain tumors is not known.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Parents who think their child may be at risk should discuss this with their child's doctor. Possible risk factors for astrocytoma include:
Having NF1 may increase a child's risk of a type of tumor called visual pathway glioma. These tumors usually do not cause symptoms. Children with NF1 who develop visual pathway gliomas may not need treatment for the tumor unless symptoms, such as vision problems, appear or the tumor grows.
The symptoms of astrocytomas are not the same in every child.
Symptoms are different depending on the following:
Some tumors do not cause symptoms. Other conditions may cause the same symptoms as those caused by childhood astrocytomas. Check with your child's doctor if any of the following problems occur:
Tests that examine the brain and spinal cord are used to detect (find) childhood astrocytomas.
The following tests and procedures may be used:
Childhood astrocytomas are diagnosed and removed in surgery.
If doctors think there may be an astrocytoma, a biopsy may be done to remove a sample of tissue. For tumors in the brain, the biopsy is done by removing part of the skull and using a needle to remove tissue. Sometimes, the needle is guided by a computer. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor may remove as much tumor as safely possible during the same surgery. Because it can be hard to tell the difference between types of brain tumors, you may want to have your child's tissue sample checked by a pathologist who has experience in diagnosing brain tumors.
The following tests may be done on the tissue that was removed:
A biopsy may not be needed for children who have NF1.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
For recurrent astrocytoma, prognosis and treatment depend on how long it was from the time treatment ended to the time the astrocytoma recurred.
The grade of the tumor is used in place of a staging system to plan cancer treatment.
Staging is the process used to find out how much cancer there is and if cancer has spread. It is important to know the stage in order to plan treatment.
There is no standard staging system for childhood astrocytoma. Treatment is based on the grade of the tumor and whether it is untreated or recurrent (has come back after treatment). The grade of the tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread.
The following grades are used:
Low-grade astrocytomas
Low-grade astrocytomas are slow-growing and rarely spread to other parts of the brain and spinal cord or other parts of the body. These include grade I (pilocytic, which form like a cyst and look almost like normal cells) and grade II (fibrillary, with cells that look long or slender like fibers) astrocytomas.
High-grade astrocytomas
High-grade astrocytomas are fast-growing and often spread within the brain and spinal cord. These include grade III (anaplastic or malignant) and grade IV (glioblastoma, which spreads the fastest) astrocytomas.
Childhood astrocytomas may form at more than one place in the brain, but they do not usually spread to other parts of the body. Children who have neurofibromatosis type 1 are more likely to have tumors in more than one place.
Tests are done to find out how much tumor remains after surgery and to plan further treatment.
Some of the tests used to detect astrocytomas are repeated after the tumor is removed. (See the General Information section.) This is to find out how much tumor remains after surgery and to plan further treatment. An MRI (magnetic resonance imaging) is done in the first 2 days after the surgery to see if there is any tumor left.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
A recurrent childhood astrocytoma is an astrocytoma that has recurred (come back) after it has been treated. The cancer may come back in the same place as the first tumor or in other parts of the body. High-grade astrocytomas often recur within 3 years.
There are different types of treatment for patients with childhood astrocytoma.
Different types of treatment are available for children with astrocytomas. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with astrocytomas should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other healthcare providers who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:
Childhood brain tumors may cause symptoms that begin before diagnosis and continue for months or years.
Symptoms caused by the tumor may begin before diagnosis. These symptoms may continue for months or years. It is important to talk with your child's doctors about symptoms caused by the tumor, that may continue after treatment.
Some cancer treatments cause side effects months or years after treatment has ended.
Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).
Six types of standard treatment are used:
Surgery
Surgery is used to diagnose and treat childhood astrocytoma as discussed in the General Information section of this summary. If cancer cells remain after surgery, further treatment depends on:
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Cerebrospinal fluid diversion
Cerebrospinal fluid diversion is a method used to drain fluid that has built up around the brain and spinal cord. A shunt (long, thin tube) is placed in a ventricle (fluid-filled space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries excess fluid away from the brain so it may be absorbed elsewhere in the body.
Watchful waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. Watchful waiting is often used for patients who have neurofibromatosis type1 or a tumor that is not growing and spreading.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and location of cancer being treated.
Radiation therapy to the brain can affect growth and development in young children. Certain ways of giving radiation therapy can lessen the damage to healthy brain tissue:
For children younger than 3 years, chemotherapy may be given instead, to delay or reduce the need for radiation therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and location of the cancer being treated.
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. (See the General Information section for a list of tests.) Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the astrocytoma has recurred (come back). If the tumor recurs in the brain, a biopsy may also be done to find out if it is made up of dead tumor cells or if new cancer cells are growing. These tests are sometimes called follow-up tests or check-ups. MRIs may be done regularly as follow-up to see if the tumor is growing back.
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Untreated low-grade astrocytoma
When the tumor is first diagnosed, treatment for low-grade childhood astrocytoma depends on the location of the tumor and is usually surgery. An MRI is done after surgery to see if there is tumor remaining.
If the tumor was completely removed by surgery, more treatment may not be needed and the child is closely watched to see if symptoms appear or change. This is also called watchful waiting.
If there is tumor remaining after surgery, treatment may include the following:
In some cases, children who have a visual pathway glioma will be treated by watchful waiting. In other cases, treatment may include surgery or radiation therapy. A goal of treatment is to save as much vision as possible. The effect of tumor growth on the child's vision will be closely followed during treatment.
Children with neurofibromatosis type 1 (NF1) may not need treatment unless the tumor grows or symptoms, such as vision problems, appear.
Untreated high-grade astrocytoma
Treatment of untreated high-grade childhood astrocytoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with untreated childhood cerebellar astrocytoma, untreated childhood cerebral astrocytoma, untreated childhood brain stem glioma, untreated childhood visual pathway and hypothalamic glioma and untreated childhood subependymal giant cell astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Before more cancer treatment is given, imaging tests, biopsy, or surgery are done to be sure cancer is present and find out how much cancer there is.
Recurrent low-grade astrocytoma
Treatment of recurrent low-grade childhood astrocytoma may include the following:
Recurrent high-grade astrocytoma
Treatment of recurrent high-grade childhood astrocytoma may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma, recurrent childhood brain stem glioma, recurrent childhood visual pathway and hypothalamic glioma and recurrent childhood subependymal giant cell astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
For more information from the National Cancer Institute about Childhood Astrocytomas, see the following:
For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:
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The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
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2010-02-05 Last Modified: 2011-01-06