Astrocytoma in Children and Teens

What is astrocytoma?

Astrocytomas are tumors of the brain and spinal cord. They grow from cells called astrocytes. Astrocytoma is a type of glioma.

Astrocytoma is the most common type of childhood brain tumor. About half of brain and spinal cord tumors in children are astrocytomas.

Places for astrocytomas to develop include the:

• Cerebellum
• Cerebrum
• Brain stem
• Hypothalamus
• Visual pathway—also see Optic Pathway Tumor
• Spinal cord

Doctors may refer to an astrocytoma as a low-grade glioma or high-grade glioma. An astrocytoma is classified as low-grade or high-grade based on how it looks under a microscope.

Treatment for astrocytoma usually includes surgery to remove the tumor. Patients may also have chemotherapy or radiation therapy. Other treatments such as targeted therapy or immunotherapy may be used based on the type of tumor.

The survival rate for pediatric astrocytoma depends on the tumor’s type and location and whether it can be removed by surgery. Your child’s care team is the best source of information about your child’s case.

Symptoms of astrocytoma

Some tumors do not cause any symptoms until they become large. Symptoms may be gradual and hard to notice. Other times, symptoms may be severe and develop quickly.

Symptoms of astrocytoma depend on factors such as the child’s age, the tumor’s location and size, and how fast the tumor grows.

Astrocytoma symptoms in children may include:

• Headache, often worse in the morning or improves after vomiting
• Nausea and vomiting
• Vision, hearing, and speech problems
• Loss of balance or problems walking
• Changes in personality or behavior
• Seizures
• Fatigue or sleepiness
• Confusion
• Unexplained weight gain or loss
• Early puberty
• Increase in head size (in infants)

As the tumor grows, it often blocks the normal flow of cerebrospinal fluid (CSF). This causes a buildup of fluid within the brain known as hydrocephalus. The fluid increases pressure in the brain. Hydrocephalus may cause some astrocytoma symptoms.

Risk factors for astrocytoma

For most children, there is no known cause of astrocytoma.

But certain inherited conditions may increase risk. These include:

• Neurofibromatosis type 1 (NF1)
• Tuberous sclerosis
• Li-Fraumeni syndrome

Past radiation therapy to the brain also increases risk.

Diagnosis of astrocytoma

The doctor will do a physical exam and health history. This is to learn about symptoms, general health, past illness, and risk factors.

The doctor will order certain tests.

Tests to diagnose astrocytoma are:

• A neurological exam to measure brain function. This includes memory, vision, hearing, muscle strength, balance, coordination, and reflexes.
• An eye exam to look at eye health and vision
• Imaging tests to help identify the tumor, its size and location
  • Magnetic resonance imaging (MRI) is the main imaging test. An MRI is also done after surgery to see if any tumor remains.
  • Computed tomography (CT scan) may also be used.
• A biopsy, in which surgeons remove a small tumor sample. A pathologist looks at it under a microscope to identify the type and grade of astrocytoma.

Types of childhood astrocytomas and gliomas

Grading and staging of astrocytoma

Astrocytoma tumors are classified by how they look under the microscope. Tumor grades are grades 1–4. The more abnormal the cells look, the higher the grade.

Grade 1 and 2 tumors are low-grade. The cells tend to grow slowly. The prognosis for low-grade astrocytoma is good, especially in children.

Grade 3 and 4 tumors are high-grade. They are aggressive and grow more quickly. The prognosis for high-grade tumors is much worse than for low-grade tumors. But this can depend on the treatments that are available.

Most astrocytomas in children are low-grade.

Classification of astrocytoma by tumor grade

What is pilocytic astrocytoma?

Pilocytic astrocytoma (or juvenile pilocytic astrocytoma) is the most common pediatric brain tumor. It is a low-grade tumor. It rarely becomes a higher-grade tumor.

Pilocytic astrocytoma is a slow-growing tumor. It seems to grow in phases. In children, these tumors are often in the cerebellum and optic pathway. Surgery is the main treatment for pilocytic astrocytoma. Due to the risk of injuring nearby brain structures during surgery, not all tumors (such as optic pathway gliomas) can be completely removed.

Pilocytic astrocytoma has a 90% survival rate at 10 years in the United States. But infants tend to have a worse prognosis than older children.

Treatment of astrocytoma

Treatment depends on the type of tumor, its location, and whether it has spread or has come back. Aggressive tumors need more intensive treatment.

Doctors also consider the patient’s age. Doctors avoid radiation therapy in very young children. That is because the risk of severe side effects is higher.

Steroid and anti-seizure medicines may help manage symptoms. Some children with hydrocephalus due to astrocytoma may have a shunt placed in the brain to prevent cerebrospinal fluid from building up. A shunt is a small tube that drains fluid from the brain.

Read more about shunts:

Prognosis for astrocytoma

The chance of cure depends on the type of tumor and its location. Some low-grade astrocytomas have a survival rate of 95% or higher in the United States. But certain high-grade astrocytomas have a survival rate of 10–30%. Clinical trials may be an option.

Factors that influence chance of cure include:

• Type and grade of the tumor: Low-grade astrocytomas grow more slowly. They are less likely to come back. High-grade astrocytomas can be harder to treat and often come back.
• Location of the tumor: Tumors in the cerebrum or cerebellum have a greater chance of cure. Tumors in the middle of the brain or brainstem have a lower chance because they are hard to remove with surgery.
• If surgery can completely remove the tumor: Children who have no visible tumor after surgery have the best chance of cure.
• Age at diagnosis: Children with low-grade astrocytoma who are older than age 3 at diagnosis tend to have a better outcome compared to younger children. In high-grade astrocytoma, patients diagnosed at a young age tend to do better.
• Whether the cancer has spread: Cancer that has spread to other parts of the brain or spine is harder to treat.
• Whether the child has NF1: Patients with low-grade astrocytoma who have neurofibromatosis type 1 (NF1) tend to do better than patients who do not have NF1.
• If the cancer is new or if it has come back: Disease that has come back (recurrent) is harder to treat.
• Molecular features of the tumor: Certain changes in genes and cell features of the tumor can make the disease easier to treat. This could include targeted therapy.

Support for patients with astrocytoma

Recovery and long-term effects of astrocytoma in children depend on the type of tumor and treatments received. Rehabilitation therapy may be needed. Patients should have regular follow-up care, lab tests, and imaging tests.

Pediatric low-grade astrocytoma as a long-term disease

Low-grade astrocytoma or glioma is often a chronic or long-term disease. Overall survival from low-grade glioma is high. But the tumor often comes back or gets worse over time. Patients may need more treatments. This means the patient is at risk for more complications from the tumor or its treatment.

Sometimes a tumor may show growth on a scan, but the care team recommends observation (watchful waiting) instead of treatment. Good communication and trust among the patient, family, and care team help aid decision making and disease management.

Regular checkups and screenings are important to watch for health problems that can develop years after therapy.

Life after brain tumors

Questions to ask your care team

• What type of tumor does my child have?
• What are the treatments? Should I consider a clinical trial?
• Where are treatment centers? Will my child need to be treated in another city?
• What are the side effects of treatment?
• Will my child attend school during treatment? How will my child’s disease and treatment affect their learning and daily living?
• What are the long-term effects?