Astrocytoma, a type of glioma, is one of the most common brain tumors. Treatment depends on the exact type of tumor and its location. The course and chances of recovery also depend to a large extent on this. A grade 1 astrocytoma has very good chances of recovery.
Below you will find further information and selected astrocytoma specialists.
Pilocytic astrocytoma (grade 1) usually occurs in children and young adults. Pilocytic astrocytoma is the most common brain tumor in children.
It mainly affects
Grade 1 brain tumors grow slowly and are clearly differentiated from the surrounding brain tissue in terms of their growth characteristics. It is benign in 99 percent of cases and can be cured if completely removed surgically.
Diffuse astrocytoma (grade 2) usually affects middle-aged people (30 to 40 years of age). In most cases, it is located in the white matter of the cerebrum, often in the area of the frontal lobe. Diffuse astrocytoma is also often found in the thalamus, midbrain and bridge. More rarely, this tumor occurs in the temporal or parietal lobe.
Grade 2 astrocytomas grow very slowly. However, it also affects healthy tissue in its vicinity ("diffuse growth"). In around 10 percent of cases per year, a malignant degeneration occurs if left untreated.
An anaplastic astrocytoma (grade 3) occurs in people between 35 and 45 years of age. The tumour enlarges faster than grade 2, is located in the cerebrum and can also develop into a glioblastoma.
Glioblastoma (grade 4) usually occurs in people after the age of 50. It is the most malignant and, with 3 new cases per 100,000 people, the most common glioma.
The tumor mainly originates from the white matter of the cerebrum. It grows infiltrating, i.e. into the healthy brain tissue.
An astrocytoma can affect different areas of the brain © bilderzwerg | AdobeStock
Basically, astrocytomas develop similar symptoms to other brain tumors. However, the exact symptoms depend primarily on the location of the tumor.
Astrocytomas located near the visual pathway impair vision. The eyeball protrudes (so-called exophthalmos).
If the tumor grows in the cerebellum, the patient suffers from
Other possible symptoms of a brain tumor are
This type of tumor develops from astrocytes. This cell type belongs to the group of supporting cells (glial cells) in the brain. Supporting cells are responsible for separating the nerve cells from the blood vessels and the surface of the brain.
Astrocytomas are caused by genetic changes that result in a disruption of the growth control of astrocytes. This leads to uninhibited cell division and the development of a tumor.
Various factors are discussed as causes for such genetic changes. It is certain that brain tumors can develop as a result of radiotherapy.
However, medical science assumes that astrocytomas are not usually hereditary. However, there are certain genetic diseases in which astrocytomas occur more frequently. These include, for example, neurofibromatosis type 1 and 2 (a rare skin disease).
The most important examination method for suspected astrocytomas is magnetic resonance imaging(MRI, also known as magnetic resonance imaging, Fig. 1). Using a contrast agent, neurologists recognize the astrocytoma as either a well-defined or diffuse area in the MRI.
In a grade 1 astrocytoma, the affected brain region is clearly illuminated as the tumor is sharply defined.
Grade 2 and 3 tumors are only visible as more or less dark areas. The glioblastoma can be seen as a ring-shaped structure.
Fig. 1: MRI image of an astrocytoma. In the tumor image, it is lighter than the normal brain. The tumor grade WHO II or WHO III and the molecular profile as an astrocytoma are not visible on the MRI. This is partially possible with special metabolic sequences or a PET examination. Only the examination of removed tissue (biopsy) provides a diagnosis of the molecular characteristics and methylation features of the tumor. [Source: Prof. Dr. Andreas Raabe; Inselspital Bern]
A biopsy is often used to confirm the diagnosis. The neurosurgeon surgically removes a tissue sample from the affected brain region. This sample is examined in the laboratory for malignant cells. The result of this histological examination is important: the doctors use it to determine the degree of malignancy of the tumor and then plan the treatment.
In selected cases, the presence of certain molecular markers is examined. Their presence or absence can have an influence on the prognosis and the treatment decision.
Another examination method is cerebrospinal fluid diagnostics. This refers to the removal and examination of fluid from the spinal cord. It plays a particular role in differentiating astrocytomas from other diseases.
When deciding on treatment, the attending physician must weigh up the risks and benefits. He takes into account
into the treatment planning.
In addition to these non-influenceable factors, there are also influenceable factors. They also determine the success of treatment. These include
In principle, the therapeutic options for astrocytoma are therefore
are available.
The modern strategy of very early surgery for astrocytoma is based on relatively recent observations. One study compared the survival times of patients from two universities with two different but consistently pursued strategies. It demonstrated a clear survival advantage for patients who underwent surgery.
On the other hand, observation over a period of years or biopsy and chemotherapy or radiotherapy alone without surgery led more frequently to malignant degeneration and the associated accelerated progression of the disease.
In the case of pilocytic astrocytoma (WHO grade 1), surgery is usually sufficient. If the tumor is located in the cerebellum, it can be completely removed in most cases. This results in a very good prognosis and the symptoms improve quickly.
Pilocytic astrocytomas
are removed using microsurgical methods. However, complete removal is often not possible, so radiotherapy usually follows.
Smaller diffuse astrocytomas (WHO grade 2) in particular can be surgically removed. Depending on the results of the histologic examination
The aim of an operation is usually to completely remove the tumor tissue. However, the tumor also grows into healthy brain tissue. There is therefore a risk of neurological deficits if healthy brain tissue is also removed along with the tumor tissue. For this reason, larger tumors cannot usually be completely removed.
In these cases, radiotherapy is important.
Chemotherapy is only used in the case of very extensive tumors and if the tumor grows again after radiotherapy.
Anaplastic astrocytoma (WHO grade 3) also grows into healthy tissue. Therefore, complete surgical removal is not possible as with other gliomas.
Instead, the aim of the operation is to reduce the size of the tumor. This increases the chances of success of subsequent radiotherapy or chemotherapy.
Once an astrocytoma has been diagnosed, it is usually monitored by MRI for the rest of the patient's life. However, the imaging interval is adjusted individually. The following intervals are currently considered standard:
According to the Bernese OPTIMISST protocol, most patients should be able to resume their activities quickly on the day after surgery.
Patients with larger tumors or complicated locations should allow about one to two months for recovery after surgery. Here it is important to create optimal and stress-free conditions for the operation within the family and with the employer.
Deficits are to be expected with particularly difficult operations. In 95% of cases, however, these deficits are temporary. Concentrated neurorehabilitation should then be planned. The tissue diagnosis is also available no later than one week after the operation. The molecular diagnosis follows after a further week. The doctors then plan the next steps in the tumor board.
The determined grade of the tumor has a major influence on the further course of life and the disease.
Grade 1 astrocytomas have a favorable prognosis. Five years after the tumor was diagnosed, 9 out of 10 patients were still alive. Most patients are also considered "cured" after surgery if the tumor can be completely removed.
Patients with grade 2 tumors often require further surgery after 2-8 years. In the case of small tumors and favorable tumor characteristics, surgery can remove more than 99.99% of the tumor cells. Only a few cells then remain, and not all of these cells grow again afterwards.
For this reason, there are patients in whom the tumor does not develop again for decades and during their lifetime. It is therefore correct to speak of "long-term control" rather than cure.
In grade 3, the tumor tissue grows back more quickly, but depending on the exact cell characteristics, it is also possible to be tumor-free for several years. The life expectancy of patients with grade 3 astrocytoma is much lower than that of patients with grade 1 astrocytoma.
However, grade 4 astrocytoma ("glioblastoma") has the most unfavorable prognosis: Five years after diagnosis, only 5 out of 100 patients were still alive. However, survival times can be extended with the help of modern chemotherapy, especially in younger patients.
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