Astrocytoma: types, grades, symptoms and treatment

The NHS describes a brain tumour as a growth of cells in the brain that multiplies in an abnormal, uncontrollable way, graded by how fast it grows and how likely it is to grow back after treatment. Cancer Research UK explains that astrocytomas develop from astrocytes, which support the nerve cells of the brain, and are a type of glioma.

The Brain Tumour Charity says astrocytomas are primary brain tumours, which means they form in the brain rather than spreading there, and can occur in many areas because astrocytes are found throughout the brain. They affect adults and children.

Cancer Research UK says doctors have changed how they group astrocytomas, using the World Health Organization 2021 classification. Doctors look for changes (mutations) in a gene called IDH. If there are changes the diagnosis is astrocytoma, IDH mutant; if there are not, it is glioblastoma, IDH wildtype.

Grade depends on how the cells look and on genes and proteins in the tumour cells. Cancer Research UK says there are 3 grades of IDH mutated astrocytoma (2, 3 and 4), while some astrocytomas, such as pilocytic astrocytoma, are grade 1. It also says some are circumscribed (a clear border from normal brain, more common in children) and others diffuse (no clear boundary).

Cancer Research UK says the symptoms depend on where the tumour is in the brain and can include headaches, seizures, weakness or numbness in the arms and legs, eyesight problems such as blurred vision, changes in personality and problems with balance and movement. The Brain Tumour Charity adds difficulty speaking and cognitive difficulties such as trouble thinking or remembering.

The NHS says to see a GP if you have these types of symptoms, particularly a headache that feels different from the type you usually get or headaches that are getting worse. You may not have a brain tumour, but the symptoms should be checked. The NHS also lists persistent sickness and drowsiness, and says sometimes there are no symptoms to begin with.

Cancer Research UK says the tests may include an MRI or CT scan, a neurological examination and a biopsy, and that your doctor checks the size and location of the tumour to plan treatment. The Brain Tumour Charity says detecting gene mutations with biomarker testing is now essential for diagnosis and for deciding which treatments to use.

The NHS says that if a GP cannot identify a more likely cause of your symptoms, they may refer you to a neurologist for further assessment and tests such as a brain scan.

Treatment depends on grade, size, location and gene changes. The Brain Tumour Charity says generally the first treatment is neurosurgery to remove as much of the tumour as possible, which may be followed by radiotherapy and sometimes chemotherapy, and that children may be given chemotherapy rather than surgery or radiotherapy. For pilocytic astrocytomas, active monitoring may be used before surgery.

Cancer Research UK says treatment can control the tumour for some time but it can start to grow again, and that your doctor will talk through options which depend on what treatment you had before, your symptoms and where the tumour is. You might have more surgery, more radiotherapy or more chemotherapy, such as temozolomide, the PCV combination or lomustine on its own.

Cancer Research UK says that after treatment you have regular appointments, and might have an MRI scan every 3 to 6 months for two years, then every 6 months or every year, depending on your situation.

It also says a brain tumour can affect your ability to drive, that you may not be allowed to drive for some time after diagnosis or treatment, and that you should ask your doctor or specialist nurse about your right to drive.

The Brain Tumour Charity says it is impossible to answer for certain how long someone can live with an astrocytoma: averages exist but everybody is different, depending on tumour grade, size and location, general health and response to treatment. Cancer Research UK says that even when some grade 2 tumour is left behind after surgery, it may take years to cause symptoms again.

Ask your specialist team about what the figures mean for you, and whether you can speak to a clinical nurse specialist.

The Brain Tumour Charity says we are not entirely sure what causes these tumours, and that some genetic conditions, such as neurofibromatosis type 1, make people more likely to develop brain tumours. The NHS lists risk factors for brain tumours generally including age, radiation exposure and family history or genetic conditions such as tuberous sclerosis, neurofibromatosis and Turner syndrome.

On the NHS, a GP refers you to a neurologist or neurosurgical team, and treatment is decided at a specialist multidisciplinary team meeting. The Brain Tumour Charity offers information on getting a second opinion. Whichever route you use, ask for your biomarker results to be explained and for the plan to be shared with your GP.