Astrocytoma
Astrocytomas are a common type of brain tumours in both adults and children. They belong to a group of brain tumours called gliomas.
The main treatments for astrocytomas are surgery, radiotherapy and chemotherapy.
The information on this page is about astrocytomas in adults. We also have information about astrocytomas in children.
What are astrocytomas?
Astrocytomas develop from a type of glial cells called astrocytes. Astrocytes are star shaped cells. They support the nerve cells (neurones) in the brain.
Doctors use a system to group (classify) brain tumours into different groups (categories) and types. The World Health Organisation (WHO) regularly update this system. The information in this page is based on the latest WHO classification of 2021.
Astrocytomas are a type of brain tumour that belongs to a group of brain tumours called gliomas.
Doctors have changed the way they group and describe astrocytomas. All astrocytomas are now called:
- astrocytoma, IDH mutant
What does IDH mutant mean?
Your doctor looks to see if there are certain gene changes in the brain tumour cells. These tests are also called biomarker or molecular studies. Your doctor uses these test results to decide what type of glioma you have.
IDH (isocitrate dehydrogenase) is a gene. Your doctor looks for permanent changes (mutations) in the IDH gene.
Your doctor diagnoses:
- astrocytoma, IDH mutant - if you have changes (mutations) in the IDH gene
- glioblastoma, IDH wildtype - if you don’t have changes in the IDH gene (the term ‘wildtype’ describes an unchanged gene)
This page is about astrocytoma, IDH mutant.
Diffuse and circumscribed astrocytomas
Some astrocytomas are very localised (focal). This means it is easy to see the border between the tumour and the normal brain tissue on a scan or during surgery. Doctors call these circumscribed astrocytomas. These are more common in children.
Other astrocytomas are called diffuse astrocytomas. They don’t have a clear boundary between the tumour and the normal brain tissue. Most grade 2 astrocytomas are diffuse.
Grades of astrocytomas
Astrocytomas are put into groups according to how quickly they are likely to grow. These are called grades.
The grade depends on how the cells look. Generally, the more normal the cells look, the lower the grade. The more abnormal the cells look, the higher the grade. Grade also depends on genes and proteins in the tumour cells.
There are 3 grades of IDH mutated astrocytomas:
- grade 2 (diffuse
- grade 3 (anaplastic)
- grade 4
How common it is
Around 9 out of every 100 brain tumours (around 9%) diagnosed in England between 1995 and 2017 were astrocytomas. This doesn’t include glioblastomas.
What tests will I have?
You have tests to diagnose an astrocytoma. Your doctor checks the size of the tumour and its location. This helps your doctor plan your treatment. The tests you might have include:
- MRI scan or CT scan
- a test of your neurological system (neurological examination)
- a biopsy
Treatment
The main treatments for astrocytoma are:
- surgery
- radiotherapy, which uses high energy x-rays to destroy cancer cells
- chemotherapy, which uses cytotoxic drugs to destroy cancer cells
Your treatment depends on the grade of your astrocytoma. It also depends on whether you have changes (mutations) in certain genes.
Surgery is the main treatment for grade 2 astrocytoma.
It isn’t always possible to completely remove the tumour in some parts of the brain. But even when some tumour if left behind, grade 2 tumours may take years to cause symptoms again.
Your doctor might recommend that you have radiotherapy after surgery if you:
- are over 40 years old
- have a lot of tumour left behind after surgery
You might have chemotherapy after surgery and radiotherapy. You usually have a combination of chemotherapy drugs called PCV. It includes the drugs:
- procarbazine
- lomustine (CCNU)
- vincristine
Surgery is the main treatment for grade 3 and 4 astrocytomas.
You usually have radiotherapy after surgery.
You might take a chemotherapy drug called temozolomide if you are well and able to care for yourself. You usually have temozolomide for several months. You have it in stages known as cycles. You might have temozolomide:
- after surgery and radiotherapy if you have a grade 3 astrocytoma
- after surgery and at the same time as radiotherapy (chemoradiotherapy) if you have a grade 4 astrocytoma
Treatment for astrocytoma can control the tumour for some time. But the tumour can start to grow again. If this happens, your treatment depends on several factors including:
- what treatment you had before, and when you had it
- your symptoms
- where the tumour is
If your astrocytoma comes back, you might have:
- more surgery
- more radiotherapy (a boost)
- more chemotherapy – you might have temozolomide again or PCV
Follow up
You have regular appointments with your doctor or nurse after treatment finishes. Your doctor examines you at each appointment. They ask how you are feeling, whether you have had any symptoms or side effects, and if you are worried about anything. You might also have MRI scans on some visits.
How often you have check ups depend on your individual situation.
You might have an MRI scan every 3 to 6 months, for two years. You then have an MRI scan every 6 months or every year.
Coping with astrocytoma
Coping with a diagnosis of a brain tumour can be difficult, both practically and emotionally. It can be especially difficult when you have a high grade tumour. Being well informed about the type of tumour you have, and its treatment can make it easier to cope.
Research and clinical trials
Doctors are always trying to improve the diagnosis and treatment of brain tumours. As part of your treatment, your doctor might ask you to take part in a clinical trial. This might be to test a new treatment or look at different combinations of existing treatments.
