Astrocytomas are tumors that start in brain cells called astrocytes. Cerebral astrocytomas form in the area of the brain called the cerebrum. The cerebrum, which is at the top of the head, is the largest part of the brain. The cerebrum controls thinking, learning, problem-solving, speech, emotions, reading, writing, and voluntary movement.
Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.
This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the PDQ treatment summary on Adult Brain Tumors for more information.)
The cause of most childhood brain tumors is unknown.These symptoms may be caused by an astrocytoma or other conditions. A doctor should be consulted if any of the following problems occur:
The following tests and procedures may be used:
If a brain tumor is suspected, a brain biopsy is done by removing part of the skull and using a needle to remove a sample of the tumor tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.
Certain factors affect prognosis (chance of recovery) and treatment options.The prognosis (chance of recovery) depends on:
Treatment options depend on:
After childhood cerebral astrocytoma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood cerebral astrocytoma, the grade of the tumor is used instead of stages. The grade of the tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment.
The following grades are used for childhood cerebral astrocytoma:
The following procedure may be used to determine if any cancer cells remained in the brain after surgery:
Cerebral astrocytomas may form at more than one place in the brain and do not usually spread to other parts of the body.
Recurrent childhood cerebral astrocytoma is a tumor that has recurred (come back) after it has been treated. The tumor may recur many years after the first tumor. High grade cerebral astrocytoma, however, usually recurs within 3 years after it is first diagnosed. A recurrent tumor may come back in the brain or in other parts of the central nervous system.
Different types of treatment are available for children with cerebral astrocytoma. 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. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Children with cerebral astrocytoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:
Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.
Three types of standard treatment are used:Surgery is used to diagnose and treat childhood cerebral astrocytoma as discussed in the General Information section of this summary. For patients with slow-growing tumors who are having seizures, MRI-guided surgery may be used to control both seizures and tumor growth.
Radiation therapyRadiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells. 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 stage of the cancer being treated. Radiation therapy may be used in addition to chemotherapy.
Because radiation therapy can affect growth and brain development in young children, it is often used only when the cancer has started to spread. Newer ways of giving radiation are being studied that may have fewer side effects than standard methods. Conformal radiation therapy uses a computer to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing as much normal tissue as possible.
ChemotherapyChemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells 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 in the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.
New types of treatment are being tested in clinical trials.High-dose chemotherapy with stem cell transplant is a method 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.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Initial treatment for low grade cerebral astrocytoma depends on the location of the tumor. When the tumor is completely removed by surgery, more treatment may not be needed. The child is then closely observed for symptoms to appear or change. This is called watchful waiting. When the tumor is located deep inside the brain, surgery may not be possible. Biopsy followed by chemotherapy or radiation therapy may be used instead.
When cancer cells remain after surgery, treatment depends on the location of the remaining cancer cells and the age of the child. Treatment may include the following:
One of the treatments being studied in clinical trials for low grade childhood cerebral astrocytoma is combination chemotherapy.
Information about this and other ongoing clinical trials is available from the NCI Web site.
Standard treatment of high grade childhood cerebral astrocytoma may include surgery followed by chemotherapy and radiation therapy.
Some of the treatments being studied in clinical trials for high grade childhood cerebral astrocytoma include the following:
Information about these and other ongoing clinical trials is available from the NCI Web site.
Standard treatment of recurrent low grade childhood cerebral astrocytoma may include the following:
Some of the treatments being studied in clinical trials for recurrent low grade childhood cerebral astrocytoma include new ways of giving radiation.
Standard treatment of recurrent high grade childhood cerebral astrocytoma may include biopsy or surgery.
Some of the treatments being studied in clinical trials for recurrent high grade childhood cerebral astrocytoma include the following:
Information about these and other ongoing clinical trials is available from the NCI Web site.