Astrocytoma- a tumor that develops in the brain and spinal cord

Astrocytoma is a type of glioma tumor that develops in the brain and spinal cord. It starts from a particular type of glial cells that are star-shaped brain cells in the cerebellum called astrocytes. Most often, this tumor doesn’t spread to other parts of the body and Is localized in the brain and occasionally in the spinal cord. 

Types: 

The different types of astrocytomas seen in patients are:

• Anaplastic astrocytoma – They possess tentacle-like fingers that proliferate and spread to nearby brain tissues. Due to this, they are relatively hard to treat.
• Glioblastomas are the most aggressive, malignant, and common type of astrocytoma. Over 50% of astrocytomas are glioblastomas characterized by pronounced brain invasion, destruction, and speedy progression.
• Diffuse astrocytoma is an invasive tumor that slowly grows into nearby tissues. Although these are considered low-grade tumors, they may convert into high-grade ones over time.
• Anaplastic astrocytomas – It has a higher pace of growth and is slightly more aggressive than diffuse astrocytomas. Chemotherapy and radiation therapy are the main therapeutic options for this tumor.
• Pineal astrocytic tumors – These tumors occur in the pineal gland and can be of any grade.
• Pilocytic astrocytomas and subependymal giant cell astrocytomas are grade I tumors that are commonly seen in children. Surgical resection is the curative treatment for these tumors, as they do not invade the surrounding brain tissues.

Astrocytoma Causes

In a vast majority of cases, astrocytomas happen by chance. However, most often, the exact cause of astrocytomas is not known. Several factors that contribute to the development of astrocytomas are as follows:

· Hereditary syndromes – Diseases caused by inherited DNA mutations are more likely to increase the chances of developing astrocytomas. This includes –

• § Li-Fraumeni syndrome
• § Turcot
• § Neurofibromatosis-1
• § Tuberous sclerosis

· Environmental factors – Exposure to ionizing radiations and warfare chemicals increases the risk factor. Patients receiving radiotherapy to the head and neck regions are associated with delayed onset of astrocytomas.

Astrocytoma Symptoms

The clinical symptoms observed in astrocytoma patients depend on the tumor’s location in the brain rather than its biological characteristics. Some brain regions, like the forehead, can accommodate large tumors before becoming symptomatic. However, other brain regions manifest symptoms early on, even when small tumors develop. Low-grade tumors are often more prominent and more symptomatic as they produce less brain swelling and tend to displace the brain. High-grade tumors, however, are more aggressive and most often destroy the brain. The common signs and symptoms of astrocytomas are:

• · Persistent headaches
• · Headaches that are worse in the morning or cause sleep disturbance
• · Double or blurred vision
• · Speech problems
• · Decreased cognitive abilities
• · New seizures
• · Grasp or limb weakness
• · Changes in mental status
• · Nausea and vomiting
• · Motor impairments
• · Abnormal reflexes or weakness on one side of the body.

Screening tests

Diagnosing astrocytomas is generally difficult as its symptoms are very similar to other neurological disorders. The diagnostic tests commonly performed in patients with suspected astrocytomas are:

• Ø Neurological exam – The doctor questions the signs and symptoms experienced by the patient and conducts a physical exam. Any problems in vision, hearing, balance, coordination, strength, and reflex may provide clues about the part of the brain affected by the tumor.
• Ø Imaging tests: By using imaging studies like MRI scans, MRI spectroscopy, functional MRI, and perfusion MRI, the doctor determines the location and size of the tumor in the brain.
• Ø Biopsy: In a biopsy, a section of the tumor cells or tissues is removed by a fine needle and observed under a microscope by a pathologist. This is done to remove the astrocytoma before or during the surgery and to determine the tumor cells’ aggressiveness level.

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Astrocytoma Treatment

Surgery is the first step in treating astrocytomas, although it depends on various factors. The decision to perform surgery is generally taken post-biopsy. Still, in patients with other medical conditions, it is not recommended. Besides, surgery aims to remove the tumor from the brain tissues. Still, it is tricky to perform surgeries when it is located near sensitive brain tissues. In such cases, other treatment options used for treatment are:

· Chemotherapy – Drugs are administered to the patients to facilitate the death of the tumor cells or to stop them from dividing. The commonly used chemotherapeutic agents are –

• § Temozolomide
• § Bevacizumab
• § Antiseizure drugs – Levetiracetam
• § Steroids – Dexamethasone

· Radiation therapy – High-powered beams such as x-rays or protons are used to kill the cancer cells or prevent their metastasis.