Astrocytoma

An astrocytoma is a type of brain tumour. Astrocytoma belongs to a group of tumours called gliomas. Astrocytomas are the most common type of glioma. 

A glioma is made up of cells that look similar to glial cells. Glial cells are the supporting cells in the brain or spinal cord. There are different types of glial cells.

An astrocytoma is made up of cells that look like glial cell called astrocytes. This type of tumour can develop in most parts of the brain and sometimes in the spinal cord. Astrocytomas can affect people of any age.

This information is about astrocytoma in adults. The Children’s Cancer and Leukaemia Group has more information on caring for children with cancer, including brain tumours. The The Brain Tumour Charity also has information about brain tumours in children.

The causes of astrocytomas are unknown, but research is being done to find out more.

We have more information about risk factors and causes of brain tumours.

A doctor who specialises in examining brain tissue samples called a neuro-pathologist looks at the brain tumour sample under a microscope. This is to find out how fast the tumour is likely to grow (its grade). Tests called molecular tests are also done on the sample to look for genetic changes (mutations) in the tumour cells. Molecular markers may also be called biomarkers.

Your doctor will use information from both the grade and the molecular tests to understand how quickly a tumour might grow and to help them decide on treatment. For example, an astrocytoma that looks low-grade may have genetic changes that mean it behaves more like a high-grade glioma.

Treatments used for an astrocytoma include surgery, radiotherapy and chemotherapy.  You may have a combination of treatments. Your treatment may depend on the:

• the size and position of the tumour
• the grade of the tumour
• molecular marker results
• symptoms you have.

A team of specialists will plan your treatment. Your specialist doctor and specialist nurse will explain the aims of your treatment and what it involves. They will talk to you about the benefits and risks of different treatment types. They will also explain the side effects.

You may be given a choice of treatment options. You will have time to talk about this with your family, friends and hospital team before you make any treatment decisions.

You will need to give permission (consent) for the hospital staff to give you the treatment. Tell your doctor if you need more information or more time to decide on a treatment.

If you need treatment, you usually have surgery to remove the tumour. If you have a low-grade tumour, this may be the only treatment you need.

The surgeon will remove as much of the tumour as possible. Depending on the size and position of the tumour, it may not be possible to remove all the tumour. Your surgeon will discuss this with you and whether you might need further treatment after surgery.

If surgery is not possible, your doctor will talk to you about other treatments.

After surgery, the MDT (multidisciplinary team) will discuss whether further treatment might be recommended. This may be radiotherapy, chemotherapy, or both. You may be referred to a doctor who specialises in cancer treatment called an oncologist. They will talk to you about the benefits and possible side effects of the treatment.

Further treatment after surgery will depend on:

• how much of the tumour it was possible to remove
• the grade and molecular markers
• your symptoms
• your general health.

The aim of further treatment is to delay or reduce the risk of the astrocytoma coming back after surgery. It also aims to delay or reduce the risk of a low-grade tumour developing into a higher-grade tumour (malignant or cancerous transformation).

If diagnostic brain scans suggest the tumour is low-grade and not causing you problems, your doctor may suggest active monitoring. This is also called active surveillance or watch and wait. Active monitoring means regularly checking the tumour with follow-up MRI brain scans to find out if it is growing or changing. Your doctor will also monitor your symptoms carefully.

Some people may have active monitoring before they have any treatment. This means you have active monitoring instead of having treatment straight away.

If you have not had a biopsy, your doctor may also suggest having a biopsy to confirm the diagnosis. A biopsy is an operation to remove a small piece of the tumour.

If you have surgery, your doctor may also suggest active monitoring after surgery, instead of having immediate further treatment. This means delaying treatment until it is needed.

Delaying treatment might be beneficial in some situations because treatment can cause side effects. Some of these side effects may be permanent. Instead of starting treatment straight away, you may see your specialist doctor regularly to discuss the results of your scans. The scan results help your doctor know if and when to recommend treatment.

High-grade tumours grow more quickly and usually need to be treated straight away.

You may be offered active monitoring after surgery. This will depend on the grade of the tumour and how much was removed with surgery.

You have regular scans to check if the tumour is growing again and delay having further treatment until it is needed. This might be if you have a low-grade astrocytoma. It will also depend on the molecular markers and your age.

You may find it difficult to cope with the uncertainty of active monitoring and not having treatment. Your specialist nurse can give you support and advice on coping. You might find it helpful to talk about how you feel with family and friends. Or you may want to talk to people who are in a similar situation. You could try joining a support group or online forum.

Radiotherapy uses high-energy X-rays to control or destroy the tumour cells that could not be removed at the time of surgery. Chemotherapy uses anti-cancer drugs to destroy tumour cells.

If you have a low-grade astrocytoma, you may have radiotherapy followed by chemotherapy. Or you may have radiotherapy alone. Occasionally you may have chemotherapy alone.

If you have a high-grade astrocytoma, you will usually have both radiotherapy and chemotherapy, or both. Chemotherapy may be given at the same time as radiotherapy, after radiotherapy, or on its own.

If you have chemotherapy, you may have 1 of the following treatments:

• temozolomide
• PCV – this is a combination of procarbazine CCNU (lomustine) and vincristine.

The chemotherapy used will depend on the molecular markers found and your response to treatment. Sometimes you will change chemotherapy depending on how well it is working.

If surgery to remove most or all of the tumour is not possible, you may have radiotherapy, chemotherapy or both. Your doctor will talk to you about your treatment options.

Other types of drug treatments including immunotherapy and targeted treatments are not routinely used for brain tumours. Currently they have not shown to be effective enough. Depending on your situation, there may be a clinical trial you could join. If you have questions about this, talk to your doctor.

Your specialist doctor or specialist nurse will explain your treatment and possible side effects. Most side effects are short-term and will improve gradually when the treatment is over. Some treatments can cause side effects that can continue and may not get better. These are called long-term effects. You may also get side effects that start months or years later. These are called late effects.

We have more information about coping:

• before and after surgery
• with side effects of radiotherapy
• with side effects of chemotherapy

When chemotherapy is given at the same time as radiotherapy, it can cause more side effects than either of the treatments alone.

You may need treatment for the symptoms of an astrocytoma before you have any treatment for the tumour. You may also need your symptoms managed during your main treatment or after it has finished.

You may have 1 of the following treatments:

• Drugs called anti-convulsants, also called anti-epileptic drugs (AEDs), to reduce the risk of having seizures.
• Steroids to reduce swelling around the tumour.
• Surgery to drain fluid from the brain to another area of the body to reduce pressure inside the skull. This might be with an operation called endoscopic third ventriculostomy (ETV). It involves putting a thin tube called an endoscope into the brain. This helps create a new channel to bypass the blockage of the cerebrospinal fluid (CSF).

Sometimes a brain tumour cannot be removed or may stop responding to treatment. If this happens, you can still have treatment for any symptoms. You will have supportive care (sometimes called palliative care) from a specialist doctor or nurse who is an expert at managing symptoms and giving emotional support.

We have more information about coping with advanced cancer.

Clinical trials are a type of medical research involving people. They are important because they show which treatments are most effective and safe. This helps healthcare teams plan the best treatment for the people they care for.

Trials may test how effective a new treatment is compared to the current treatment used. Or they may get information about the safety and side effects of treatments.

They will give you information about the clinical trial so that you understand what it means to take part. If you decide not to take part in a trial, your specialist doctor and nurse will respect your decision. You do not have to give a reason for not taking part. Your decision will not change your care. Your doctor will give you the standard treatment for the type of tumour you have.

Clinical trials also research other areas. These include diagnosis and managing side effects or symptoms. As these tumours are rare, there may not always be a relevant clinical trial happening. If there is, your doctor or nurse may ask you to think about taking part.

We have more information about clinical trials.