Childhood Cerebral Astrocytoma

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

The cause of most childhood brain tumors is unknown.

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

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, computerized tomography, or computerized 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 removed in surgery.
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 most important factors that affect prognosis (chance of recovery) are thought to be cancer cells remaining after surgery, the type of astrocytoma, and the location. Treatment options depend on whether cancer cells remain after surgery, the location of the tumor, and the child's age.

Stages of Childhood Cerebral Astrocytoma
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 the best treatment.

The following grades are used for childhood cerebral astrocytoma:

• Low-grade cerebral astrocytoma: Tumors that are very slow-growing and rarely spread.
• High-grade or malignant cerebral astrocytoma: Tumors 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 tumor that has recurred (come back) after it has been treated. The tumor may recur many years after the first tumor. A recurrent tumor may come back in the brain or in other parts of the central nervous system.

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 Cancer.gov 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:

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

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.

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.

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, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Because radiation therapy can affect growth and brain development in young children, clinical trials are studying ways of using chemotherapy to delay or reduce the need for radiation therapy.

Other types of treatment are being tested in clinical trials.

High-dose chemotherapy with bone marrow transplantation
High-dose chemotherapy with bone marrow transplantation is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the body’s blood cells.

Low-Grade Childhood Cerebral Astrocytoma
Initial treatment for cerebral astrocytoma is usually surgery. When the tumor is completely removed by surgery, more treatment may not be needed and the child is closely observed for symptoms to appear or change. This is also called watchful waiting.

When cancer cells remain after surgery, treatment depends on the location of the remaining cancer cells, absence of seizures, and the age of the child. Treatment may include the following:

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

High-Grade Childhood Cerebral Astrocytoma
Treatment of high-grade childhood cerebral astrocytoma may include the following:

• Surgery followed by chemotherapy and radiation therapy.
• A clinical trial of 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.

Recurrent Childhood Cerebral Astrocytoma
Treatment of recurrent low-grade childhood cerebral astrocytoma may include the following:

• Surgery followed by radiation therapy.
• Surgery followed by radiation therapy and chemotherapy.
• A clinical trial of a new therapy.

Treatment of recurrent high-grade childhood cerebral astrocytoma may include the following:

• Surgery.
• A clinical trial of high-dose chemotherapy with bone marrow transplantation.
• A clinical trial of a new therapy.

Source: National Institutes of Health; National Cancer Institute