Astrocytoma in Children

An astrocytoma is a type of brain tumor. A brain tumor is an abnormal growth of tissue in the brain.

The brain is part of the central nervous system (CNS). The CNS also includes the spinal cord. The main parts of the brain are:

• Cerebrum. This is the front of the brain. The cerebrum has two sides, the right and left hemispheres. It controls thoughts, emotions, speech, and movement. It also helps with understanding information from the senses. This includes seeing, hearing, smelling, touching, and feeling pain.
• Cerebellum. This is the back of the brain. It organizes muscle movement and helps to maintain posture, balance, and equilibrium.
• Brainstem. This is the base of the brain. It includes the midbrain, the pons, and the medulla. It is the part of the brain that connects to the spinal cord. It plays a part in controlling muscles and sensations from the body. Part of the brainstem helps control breathing and the heartbeat. Many of the cranial nerves start in the brainstem. The spinal cord carries messages to and from different parts of the body to the brain.

Brain tumors start in the cells of the brain. They can be either of the following:

• Noncancer (benign). This kind of tumor doesn’t contain cancer cells. In most cases, once a benign tumor is removed, it often doesn’t grow back. Most benign brain tumors don’t grow into nearby tissue. These tumors can cause symptoms depending on their size and location in the brain.
• Cancer (malignant). This kind of tumor does contain cancer cells. Malignant brain tumors usually grow fast, and grow into nearby tissue. Malignant brain tumors don’t usually spread to other areas of the body. They may grow back after treatment.

Brain tumors can occur at any age. Brain tumors that occur in infants and children are very different from adult brain tumors.

Astrocytomas

The most common type of brain tumor is a glioma. Gliomas begin from glial cells, which make up the supportive tissue of the brain (brainstem). Astrocytoma is a type of glioma. It forms in small, star-shaped cells called astrocytes, a type of glial cell. It is the most common type of brain tumor in children. In a child, an astrocytoma is usually found at the base of the brain. It is usually low grade, which means slow growing. A low-grade astrocytoma may not need treatment right away. But it should be watched carefully. This is because it could turn into a faster-growing tumor. Often, a biopsy or surgery is needed to confirm the diagnosis.

Most brain tumors are caused by abnormal genes or chromosomes. Researchers don’t know what causes them to be abnormal. Some chemicals may play a part in gene changes. Research is ongoing.

An astrocytoma can cause symptoms if it begins to grow into or press on an area of the brain. The most common symptoms of an astrocytoma are:

• Loss of balance
• Trouble walking
• Morning headache or a headache that goes away after vomiting
• Seizures
• Slow speech
• Handwriting skills get worse
• Changes in energy level or excessive sleepiness
• Vision, hearing, or speech problems

The symptoms of an astrocytoma can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

The healthcare provider will ask about your child's health history and symptoms. They will examine your child. This will include a neurological exam. The exam tests 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 have tests, such as:

• CT scan. A CT scan uses a series of X-rays and a computer to make detailed pictures of the body.
• 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 the healthcare provider see cancer cells more clearly.
• Magnetic resonance spectroscopy (MRS). An MRS scan can see the metabolites inside the tumor. Sometimes this test is used to find out if a growth is an active tumor or a mass of radiation damage (necrosis).
• Lumbar puncture. The healthcare provider puts a special needle into the lower back, into the spinal canal, a fluid-filled space for the spinal cord, and nerve roots. This is done to check the brain and spinal cord for cancer cells. The provider removes a small amount of cerebrospinal fluid (CSF) and sends it for testing. CSF is the fluid around the brain and spinal cord.
• PET scan. For this test, the healthcare provider injects a radioactive sugar into the bloodstream. Cancer cells use more sugar than normal cells, so the sugar will collect in cancer cells. The provider uses a special camera to see where the radioactive sugar is in your child’s body. A PET scan can sometimes spot cancer cells in different areas of the body, even when they can’t be seen by other tests. This test is often used along with a CT scan. This is called a PET/CT scan.
• Biopsy. The healthcare provider removes tumor cells and sends them to a lab for testing. This is done to find out the type of tumor and how quickly it is likely to grow.
• Blood tests. These may be done to check for substances that are released by some tumors. These are called tumor markers.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. If your child has been diagnosed with a brain tumor, you may want to talk with a second oncologist before treatment. Your health insurer may require this.

Treatment may include one or more of the below:

• Surgery. Surgery is usually the first step in treating brain tumors. The goal is to remove as much of the tumor as possible while keeping brain function.
• Chemotherapy. These are medicines that kill tumor cells or stop them from growing. They may be given into the vein (IV), injected into tissue, or taken by mouth.
• Targeted therapy. These are medicines that kill tumor cells but don’t harm healthy cells.
• Radiation therapy. These are high-energy X-rays or other types of radiation. They are used to kill tumor cells or stop them from growing.
• High-dose chemotherapy with a stem cell transplant. The healthcare provider takes young blood cells (stem cells) from your child or from someone else. Your child then gets a large amount of chemotherapy medicine. This damages the bone marrow. After the chemotherapy, the stem cells are replaced.

Other treatments may include:

• Corticosteroids. These treat and prevent swelling in the brain.
• Antiseizure medicine. These treat and prevent seizures (epilepsy).
• Ventriculoperitoneal (VP) shunt. The healthcare provider may put a long tube called a shunt in the brain to remove extra fluid. This helps control pressure in the skull.
• Supportive care. Treatment can cause side effects. Medicines and other treatments can be used for pain, fever, infection, and nausea and vomiting.
• Antibiotics. These treat and prevent infections.
• Hormones. Medicines can replace hormones if a tumor affects natural hormone production.

With any cancer, how well a child is expected to recover (prognosis) varies. Keep in mind:

• Getting medical treatment right away is important for the best prognosis.
• Your child will need ongoing follow-up care during and after treatment.
• New treatments are being tested to better stop the cancer and to ease side effects.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

A child may have complications from the tumor or from treatment. These include:

• Damage to the brain or nervous system that causes problems with coordination, muscle strength, speech, or eyesight
• Seizures
• Problems after surgery, such as infection or bleeding, and problems with general anesthesia
• Infection and bleeding from chemotherapy
• Delayed growth and development
• Learning problems
• Problems having children in the future (infertility)
• Return of the cancer
• Growth of other cancers

A child with a brain tumor needs ongoing care. Your child will be seen by oncologists and other healthcare providers. These providers will treat any late effects of treatment. They will also watch for symptoms of the tumor returning. Your child will be checked with imaging tests and other tests. And your child may see other healthcare providers for problems from the tumor or from treatment. For example, your child may see an eye care provider (ophthalmologist) for vision problems.

Your child may need therapy to help with movement and muscle strength. This may be done by physical and occupational therapists. If your child's speech is affected, they may need help from a speech therapist. Your child may also need the help of other therapists for learning or emotional problems.

You can help your child manage their treatment in many ways. For example:

• Your child may have trouble eating. A dietitian may be able to help.
• Your child may be very tired. They will need to balance rest and activity. Encourage your child to get some exercise. This is good for overall health. And it may help to lessen tiredness.
• If your child smokes, help them quit. If your child doesn’t smoke, make sure they know the danger of smoking.
• Get emotional support for your child and your family. Find a counselor or child support group for help.
• Be aware of the stress your child's diagnosis has on your other children. Seek emotional support for them as appropriate.
• Reach out to your child's school for educational support, including homeschooling if needed.
• Make sure your child attends all follow-up appointments.

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms
• Side effects from treatment

• An astrocytoma is the most common type of brain tumor in children.
• In a child, it is usually found at the base of the brain.
• It is usually low grade, which means slow growing. A low-grade astrocytoma may not need treatment right away. But it should be watched carefully. It could turn into a faster-growing tumor.
• This type of tumor can cause symptoms if it begins to grow into or press on an area of the brain. The most common symptoms are loss of balance, trouble walking, headache, and nausea.
• Treatment may include surgery, radiation, chemotherapy, and medicines.
• A child may have complications from the tumor or from treatment.
• Emotional support for the child and other family members may be helpful in dealing with the impact of the diagnosis and treatment options.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.