Childhood Cerebral Astrocytoma

Key Points for This Section

  • Cerebral astrocytoma is a type of malignant glioma.
  • Childhood cerebral astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.
  • The cause of most childhood brain tumours is unknown.
  • The symptoms of childhood cerebral astrocytoma vary and often depend on the child’s age, where the tumour is located, and the size of the tumour.
  • Tests that examine the brain are used to detect (find) childhood cerebral astrocytoma.
  • Childhood cerebral astrocytoma is diagnosed and may be removed in surgery.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Cerebral astrocytoma is a type of malignant glioma.

Childhood cerebral astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.

Astrocytomas are tumours 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 tumours are the most common type of childhood cancer other than leukaemia and lymphoma.

This summary refers to the treatment of primary brain tumours (tumours that begin in the brain). Treatment for metastatic brain tumours, which are tumours formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. Brain tumours can occur in both children and adults; however, treatment for children may be different than treatment for adults. (Refer to the treatment summary on Adult Brain Tumours for more information.)

The cause of most childhood brain tumours is unknown.

The symptoms of childhood cerebral astrocytoma vary and often depend on the child’s age, where the tumour is located, and the size of the tumour.

These symptoms may be caused by an astrocytoma or other conditions. A doctor should be consulted if any of the following problems occur:

  • Weakness or change in feeling on one side of the body.
  • Seizures.
  • Morning headache or headache that goes away after vomiting.
  • Nausea and vomiting.
  • Unusual sleepiness or change in energy level.
  • Change in personality or behaviour.

Tests that examine the brain are used to detect (find) childhood cerebral astrocytoma.

The following tests and procedures may be used:

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerised tomography, or computerised axial tomography.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Childhood cerebral astrocytoma is diagnosed and may be removed in surgery.

If a brain tumour is suspected, a brain biopsy is done by removing part of the skull and using a needle to remove a sample of the tumour 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 tumour as safely possible during the same surgery.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on:

  • Cancer cells remaining after surgery.
  • The type of astrocytoma.
  • The location of the tumour.

Treatment options depend on:

  • Whether cancer cells remain after surgery.
  • The location of the tumour.
  • The child’s age.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Childhood Cerebral Astrocytoma

After childhood cerebral astrocytoma has been removed, tests are done to find out if there is tumour remaining. The extent or spread of cancer is usually described as stages. For childhood cerebral astrocytoma, the grade of the tumour is used instead of stages. The grade of the tumour refers to how abnormal the cancer cells look under a microscope and how quickly the tumour is likely to grow and spread. It is important to know the grade of the tumour and if there were any cancer cells remaining after surgery in order to plan treatment.

The following grades are used for childhood cerebral astrocytoma:

  • Low grade cerebral astrocytoma: Tumours that are very slow-growing and rarely spread.
  • High grade or malignant cerebral astrocytoma: Tumours that are fast-growing and may spread throughout the brain.

The following procedure may be used to determine if any cancer cells remained in the brain after surgery:

  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).

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

Recurrent childhood cerebral astrocytoma is a tumour that has recurred (come back) after it has been treated. The tumour may recur many years after the first tumour. High grade cerebral astrocytoma, however, usually recurs within 3 years after it is first diagnosed. A recurrent tumour may come back in the brain or in other parts of the central nervous system.

Treatment Option Overview

Key Points for This Section

  • There are different types of treatment for children with cerebral astrocytoma.
  • Children with cerebral astrocytoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumours.
  • Three types of standard treatment are used:
    • o Surgery
    o Radiation therapy
    o Chemotherapy
  • New types of treatment are being tested in clinical trials.
    • o High-dose chemotherapy with stem cell transplant

    There are different types of treatment for children with cerebral astrocytoma.

    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 tumours.

    Your child’s treatment will be overseen by a paediatric oncologist, a doctor who specializes in treating children with cancer. The paediatric oncologist may refer you to other paediatric doctors who have experience and expertise in treating children with brain tumours and who specialize in certain areas of medicine. These may include the following specialists:

    • Neurosurgeon.
    • Neurologist.
    • Neuropathologist.
    • Neuroradiologist.
    • Rehabilitation specialist.
    • Radiation oncologist.
    • Medical oncologist.
    • Endocrinologist.
    • Psychologist.

    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 summary on Late Effects of Treatment for Childhood Cancer for more information.

    Three types of standard treatment are used:

    Surgery

    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 tumours who are having seizures, MRI-guided surgery may be used to control both seizures and tumour growth.

    Radiation therapy

    Radiation 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 tumour. This allows doctors to give the highest possible dose of radiation to the tumour, while sparing as much normal tissue as possible.

    Chemotherapy

    Chemotherapy 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

    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.

    Treatment Options for Childhood Cerebral Astrocytoma

    Low-Grade Childhood Cerebral Astrocytoma

    Initial treatment for low grade cerebral astrocytoma depends on the location of the tumour. When the tumour 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 tumour 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:

    • Watchful waiting.
    • Another surgery to remove the tumour.
    • Radiation therapy.
    • Chemotherapy.

    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.
    High-Grade Childhood Cerebral Astrocytoma

    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:

    • A clinical trial of surgery followed by chemotherapy to delay or reduce the use of radiation therapy for children younger than 3 years of age.
    • A clinical trial of surgery followed by chemotherapy with or without radiation therapy.
    • A clinical trial of surgery followed by chemotherapy during and after radiation therapy.

    Information about these and other ongoing clinical trials is available from the NCI Web site.
    Recurrent Childhood Cerebral Astrocytoma

    Standard treatment of recurrent low grade childhood cerebral astrocytoma may include the following:

    • Combination chemotherapy.
    • Surgery followed by radiation therapy.
    • Surgery followed by radiation therapy and chemotherapy.

    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:

    • A clinical trial of high-dose chemotherapy with stem cell transplant.
    • A clinical trial of a new therapy.

© Medic8 ® All Rights Reserved.