Astrocytoma

Astrocytomas are the most common type of brain and spinal cord tumour in children. They are a type of brain tumour called a glioma. Over 4 out of 10 (over 40%) of brain and spinal cord tumours in children are astrocytomas.

Children can develop an astrocytoma at any age. Boys and girls are affected equally.

Where do astrocytomas start?

Astrocytomas develop from the cells called astrocytes. Astrocytes are star shaped cells. They support the nerve cells (neurones) in the brain. 

 Diagram of an astrocyte - type of glial cell

Some astrocytomas are very localised (focal). This means it is easy to see the border between the tumour and normal brain tissue on a scan or during an operation. These types of tumours are more common in children than in adults.

Other astrocytomas are called diffuse. They don’t have a clear boundary between the tumour and normal brain tissue.

Astrocytomas in children can start anywhere in the brain and spinal cord including the:

  • cerebrum (forebrain)
  • cerebellum (hindbrain)
  • brain stem
  • eyesight nerve pathways (optic nerves)
Diagram showing some of the main parts of the brain

Risks and causes

We don’t know what causes, or how to prevent most childhood cancers, including astrocytoma. 

We know that there is an increased risk of low grade gliomas (including low grade astrocytoma) with an inherited syndrome called neurofibromatosis 1 (NF1). Around 15 to 20 out of 100 (around 15-20%) of all low grade gliomas are linked to NF1.

Because of this, children with NF1 have regular eye checks. This is to check for any sight problems in the eyesight nerve pathway which a tumour could cause.

Signs and symptoms

Your child might have symptoms for a few weeks or months before they are diagnosed with an astrocytoma. This is especially true if they have a low grade, slow growing astrocytoma.

Many of the symptoms are general and non specific. Some are similar to less serious childhood illnesses. Symptoms include:

  • headaches in the morning
  • feeling or being sick – being sick often makes the headaches feel better
  • double vision
  • seizures (fits)

Other symptoms depend on where the astrocytoma is in the brain.

Young infants might have an increasing head circumference. This is measured by a health professional during their well baby check ups. Or the soft spot on top of the skull (fontanelle) might be swollen. 

Take your child to the GP to get it checked out if you are worried your child has a symptom of a brain tumour.

Tests

The first tests your child might have are a:

  • CT scan
  • MRI scan

Your child might have a sample of the tumour taken for testing in the laboratory. The test is called a biopsy. Your child’s surgeon takes the sample using a needle during an operation.

Your child’s team decide if a biopsy is a safe test depending on the results of scans. It’s not always possible to take a biopsy before treatment. This might be due to the position of the tumour in the brain.

For some types of test, your child might need sedation or a general anaesthetic. This is to help them lie still.

Getting diagnosed

We have information for parents whose child has just been diagnosed with cancer. It has information about what to expect when your child is first diagnosed.

Even if you have been told that a brain tumour is a possibility, hearing this confirmed by a doctor can be shocking. 

Types

There are 4 main types of astrocytomas. These are:

Low grade

  • pilocytic astrocytoma (grade 1)
  • diffuse (fibrillary) astrocytoma (grade 2)

High grade

  • anaplastic astrocytoma (grade 3)
  • glioblastoma multiforme (grade 4)

Almost 8 out of 10 (almost 80%) astrocytomas are low grade. This means the tumour cells look similar to normal cells, the tumours grow fairly slowly and are less likely to spread.

Less than 2 out of 10 astrocytomas (less than 20%) are high grade. These tumours tend to grow more quickly and are more likely to spread to other areas of the body. 

Decisions about treatment

Your child’s specialist team decides on the best treatment options for your child. Both you and your child will be involved in decisions about treatment decisions and care. 

Treatment for astrocytoma in children depends on:

  • the grade of the tumour – if it is fast or slow growing
  • where in the brain the tumour is
  • if it is possible to remove the tumour with surgery
  • how old your child is

Treatment

The main treatments for astrocytomas are:

  • surgery
  • radiotherapy
  • chemotherapy

Your child might have steroids to help reduce any swelling in the brain. This is usually a steroid drug called dexamethoasone.

Treatment for low grade tumours

Surgery is the main treatment. Sometimes surgery is not possible. Or, the surgeon might not be able to remove all of the tumour during the operation.

In this case, your doctors will talk with you about the other treatment options for your child.

The main treatment for most childhood astrocytomas is surgery to remove as much of the tumour as possible. But it isn't always possible to fully remove tumours in some areas of the brain.

For example, surgery to remove tumours in the brain stem can cause too much damage to the surrounding normal brain tissue.

Low grade tumours are generally easier to remove than high grade tumours because they are less invasive. Low grade tumours don't spread out into the surrounding brain tissue in the way that some high grade tumours do.

Surgery might be the only treatment your child needs.

Hearing your child needs brain surgery can feel very frightening. A paediatric neurosurgeon does the operation. They are highly specialised and skilled professionals in looking after children with brain tumours.

Sometimes surgery is not possible. Or, the surgeon might not be able to remove all of the tumour during the operation. In this case, your doctors will talk with you about the other treatment options for your child.

If most of the tumour was removed, your child will be closely monitored and might have regular scans but no further treatment at this stage.

Radiotherapy treatment uses high energy x-rays to destroy the cancer cells. Your child’s team might suggest that your child has radiotherapy. This treatment is usually for children 8 years and older.

Doctors try to avoid giving radiotherapy treatment to children:

  • under the age of 3
  • with NF1

This is because they are more at risk of severe side effects during and after treatment.

Proton beam therapy is a type of radiotherapy. It uses protons rather than high-energy x-rays to kill cancer cells. Protons are tiny parts of atoms. They work differently from x-rays in that they produce a sudden burst of energy when they stop, which stays inside the tumour. So, there is less damage to healthy cells around the tumour.

Photo of a child having proton beam therapy

Research shows that proton beam therapy can work well for some types of children’s brain tumours. This includes some, but not all, children with low grade astrocytoma.

Your child’s specialist will talk with you if they think proton therapy might be beneficial for your child.

In 2009, the UK government made the decision to set up a National NHS Proton Beam Therapy Service. One therapy centre is open at The Christie hospital in Manchester. The other will be at University College London hospital. At the moment, some children needing this service will need to travel abroad for it.

Chemotherapy is the use of anti cancer drugs to destroy cancer cells. Your child’s specialist might recommend chemotherapy instead of radiotherapy. Or your child might have chemotherapy and radiotherapy together.

Your child will have most of their chemotherapy into a vein (intravenous).

Chemotherapy can work very well for some types of astrocytoma in babies and young children. The exact combination of drugs and the timing varies. But generally chemotherapy is given every 2 to 6 weeks. Children under 2 years of age when they are diagnosed usually have chemotherapy for about 2 years. After that, your child might have a course of radiotherapy to help stop the astrocytoma from coming back.

Generally, chemotherapy treatment for low grade glioma can last up to a year to 18 months. But your child has most of their treatment on outpatient or daycare ward and can go home after. Many children return to school while having this type of chemotherapy treatment.

It’s difficult for doctors to predict how well chemotherapy will work. Chemotherapy works best at killing cells that are growing and dividing quickly. Low grade tumours are slow growing, so it might take some time to see them shrink.

Treatment for high grade astrocytoma

Your child might have:

Your child might have surgery to:

  • remove all or as much of the tumour as possible
  • take a piece of the tumour to look at under the microscope, to find out for certain what type of tumour it is (biopsy)

Fluid build up

Some tumours cause fluid to build up in the brain. This is called hydrocephalus. Treatment to reduce this is an operation. Your child’s surgeon might either:

  • make a hole to drain fluid into another area of the brain, where it is absorbed, this is called a ventriculostomy
  • put a small tube called a shunt in your child’s brain, so that the fluid drains to another part of the body usually the tummy, where the body gets rid of it

Hearing your child needs brain surgery can feel very frightening. A paediatric neurosurgeon does the operation. They are highly specialised and skilled professionals in looking after children with brain tumours.

After surgery your child might have radiotherapy. They are likely to start treatment quickly after their surgery. Especially if they have lots of symptoms. Radiotherapy treatment uses high energy x-rays to destroy any remaining cancer cells.

Doctors try to avoid giving radiotherapy treatment to children:

  • under the age of 3
  • with NF1

This is because they are at higher risk of severe side effects during and after treatment. Doctors might reduce the dose of radiotherapy or delay it until your child is a bit older to try and prevent these side effects.

Research has shown that chemotherapy can help children with high grade astrocytoma. Children under 2 years of age when they are diagnosed usually have chemotherapy for about 12-18 months. After that, your child might have a course of radiotherapy. But we still need more research to find out what the best drugs are and how long treatment should last. Because of this, many children who have chemotherapy have it as part of a clinical trial.

Chemotherapy implants

Wafer implants are a way of giving chemotherapy for brain tumours into the area of the tumour. The wafer is made of gel that contains the chemotherapy carmustine. During brain surgery to remove some or all of the tumour, the surgeon puts up to 8 wafers in the space where the tumour was. Over the next few days, the wafers slowly release the chemotherapy drug carmustine into the area.

This is not a common treatment for children.

Targeted cancer drugs work by ‘targeting’ those differences that help a cancer cell to survive and grow.

Researchers are interested in using a targeted cancer drug called bevacizumab to treat astrocytomas in children. Bevacizumab targets a cancer cell protein called vascular endothelial growth factor (VEGF). This protein helps cancers to grow blood vessels, so they can get food and oxygen from the blood. Bevacizumab blocks this protein and stops the cancer from growing blood vessels, so it is starved and can't grow.

Doctors can already use bevacizumab to treat different types of adult cancers. Researchers are looking into whether adding bevacizumab to radiotherapy and chemotherapy works better than just radiotherapy and chemotherapy in children with high grade astrocytoma.

Astrocytoma that has come back

An astrocytoma can come back some time after treatment. The treatment for a brain tumour that has come back depends on the treatment that your child had first time round.

Your child's surgeon may be able to operate again. If your child didn't have radiotherapy before, then your specialist may suggest it now. If your child has had radiotherapy, they may still be able to have it again. Or their doctor may suggest chemotherapy instead.

Side effects

The side effects of treatment are different for each child. Some side effects of chemotherapy and radiotherapy happen during treatment and stop once treatment finishes. Other side effects, known as late effects or long term effects, happen months or years after treatment. These can be mild or more challenging. Not all children have challenging long term side effects.

To help your child with any long term side effects a team of specialists will closely monitor them after treatment finishes.

The possible side effects of treatment might lead to problems at school or with your child meeting their developmental milestones. Many children have hormonal problems because of where the tumour was located. Your child might have some physical disabilities or seizures after treatment.

We have detailed information on follow up and late effects of children’s brain tumour treatment, what treatments can help and where to get support. There is long term support available from a brain tumour late effects service.

Clinical trials

Researchers are interested in finding new and kinder ways to treat astrocytomas. And ways to reduce the side effects of treatment. Many children have their treatment for a brain tumour as part of a clinical trial.

Coping when your child has a brain tumour

We have information about where to get help and support when your child has a brain tumour.

Last reviewed: 
13 Mar 2019
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    A Crellin

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    Volume 30

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