Astrocytoma (aka Glioma)

What Causes Astrocytoma in a Child?

Children with neurofibromatosis type 1, an inherited genetic disease, have a higher risk of developing low-grade astrocytomas/gliomas in the optic pathway and rest of the brain. However, there is no known cause for most cases of astrocytomas. They are usually not hereditary, and there is no evidence that any environmental factors cause this type of tumor. Researchers believe that something is absent during normal development. Specifically, cells of the brain and spinal cord grow and separate as the body develops. During this cell division process, cells need to replicate their genetic material. Errors can take place during this process, leading to mutations, a change in structure of the gene, which may allow cells to grow into tumors. These errors generally occur randomly and cannot be prevented.

Some diseases, however, can give your child a higher risk of developing astrocytomas, such as neurofibromatosis type 1 and 2. Neurofibromatosis type 1 and 2 are genetic conditions that affect how cells grow, divide and die.

What Are the Signs and Symptoms?

Your child’s symptoms can vary depending on the location and size of the tumor. Some of the more common symptoms that your child might experience include problems with vision, hearing, communication and balance. Headaches are also common due to the increased pressure from the tumor, and they tend to be more painful in the morning. Headaches may also be associated with nausea and vomiting.

Other symptoms include:

• one-sided weakness
• seizures
• unexplained weight loss or gain
• changes in behavior or personality
• increase in head size (in infants)

How Is an Astrocytoma Tumor Diagnosed?

Your child's health care provider will ask about your child's health history and symptoms. The provider will do a physical exam and a neurological exam, testing reflexes, muscle strength, eye and mouth movement and coordination. Your child's healthcare provider may refer your child to a cancer specialist (oncologist). Your child may need tests such as:

• CT Scan - A CT scan uses a series of X-rays and a computer to take pictures of the head or body. CT scans are very quick imaging, usually no more than a few minutes of scanning (though preparation may take longer).
• MRI - An MRI uses large magnets, radio waves and a computer to make detailed pictures of the body. Contrast dye may be injected into your child's vein. It helps tumors show clearly on the images. MRIs are very detailed imaging, providing much more information about the tumor, so take longer to perform (often 1-2 hours).
• Biopsy - Tumor cells are removed during surgery and sent to a lab for testing. This is done to find out the type of tumor to diagnosis the tumor and determine how best to treat it.

How Is an Astrocytoma Treated?

Treatment for astrocytoma will be individualized for your child based on the tumors size, location and grade. Your child’s treatment may include some or all of the following:

• Surgery - This is done to remove part or all of the tumor. More surgery may be needed over time if the tumor grows back. Surgery may be followed by chemotherapy or radiation therapy.
• Chemotherapy - These are medicines that kill cancer cells. One or more medicines may be given. Medicines may be oral or given through an IV or central line.
• Targeted Therapy - These are medicines (usually oral) used to target specific genetic alterations in the cancer cells and kill them.
• Radiation Therapy - These are high-energy X-rays or other types of radiation. They are used to kill cancer cells or stop them from growing. 
• Clinical Trials - A clinical trial is a way to test new treatments for cancer. Ask your child's healthcare provider if there are any treatments being tested that may work well for your child. Many new treatments are only available in clinical trials.
• Supportive Care - Medicines and other treatments can be used for pain, fever, infection, nausea and vomiting.

A child may have short- and long-term complications from the tumor or treatment. They may include things such as:

• Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech or eyesight
• Problems after surgery, such as infection, bleeding and problems with general anesthesia
• Increased risk of infection and bleeding from chemotherapy
• Delayed growth and development
• Learning problems
• Problems with reproduction (infertility)
• Return of the cancer (recurrence)
• Increased risk for other cancers later in life

Talk with the doctor about what you should watch for and what can be done to help prevent complications.

Survivorship – Outcomes and Life After Astrocytoma Treatment

Improving the quality of life for survivors of brain and spine tumors is an area of much ongoing research and continued progress. Some patients have little to no long-term problems from their tumor or treatment, whereas other patients experience more significant side effects. All patients will continue to be followed by our oncology team after finishing treatment to ensure they are doing well and to offer appropriate resources, therapies, and subspecialty team services as needed. Patients will also continue to get surveillance imaging (MRIs) to ensure their tumor do not grow back; as the time from end of treatment increases, these scans will be spaced further apart.

Why Choose Nationwide Children’s Hospital?

The Neuro-Oncology Program at Nationwide Children’s Hospital offers clinical excellence in treating children, teens, and young adults with brain and spine tumors. Patients and their families will be supported by a multi-disciplinary team of providers, all dedicated to ensuring that the patient has the best possible outcomes. Depending on the specific tumor diagnosis and treatment plan, the patient and their family will be cared for by oncologists, neurosurgeons, radiation oncologists, clinical psychologists, rehabilitation medicine doctors, neurologists, endocrinologists, ophthalmologists, therapists (physical, occupational, speech, art, music), social workers, dieticians, and/or pharmacists. These team-members all work closely together with one another and the family to provide the best care for the patient.

Cancer Clinical Research

Nationwide Children’s Hospital is also a national leader in oncology research and clinical trials. There are many ongoing research studies aimed at improving outcomes for children and young adults with brain/spine tumors—understanding why these tumors develop and how to appropriately target them. We are members of all major pediatric brain tumor clinical trial consortia including Pediatric Brain Tumor Consortium (PBTC), Collaborative Network of Neuro-oncology Clinical Trials (CONNECT), Pacific Neuro-oncology Consortium (PNOC) and the Children’s Oncology Group (COG). We have many open clinical trials testing new drugs in difficult-to-treat tumors.

Clinical Research and Trials

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