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Astrocytoma: types, symptoms, causes and treatment

Astrocytoma: types, symptoms, causes and treatment

July 23, 2024

"You have a tumor." It is probably one of the phrases that we are most afraid to hear when we go to the doctor to do a checkup or we are tested for a problem that we do not know the cause of. And is that cancer is one of the most feared diseases worldwide, being one of the best known and leading causes of death worldwide and one of the main challenges of medicine along with AIDS and dementia.

Among the multiple locations in which it can appear, the brain is one of the most dangerous, since even a noncancerous benign tumor can cause serious effects and even death. Within the different types of existing brain tumors, one of the most common are astrocytomas , of which we are going to talk about in this article.


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What are astrocytomas?

We call astrocytoma a all that neoplasm or tumor formed mainly by astrocytes , one of the main types of glial cells that feed and support neurons. This tumor is therefore a mass of astrocytes that occurs before an anomalous, pathological and uncontrolled growth and proliferation of one of the types of glial tissue present in the nervous system, being one of the main types of brain tumor.

Astrocytomas are tumors whose symptoms can vary greatly depending on the location or locations in which they appear, if they compress other brain areas, their proliferative capacity or if they infiltrate other tissues or self-limiting. However, at a general level it is usual to find the existence of headaches, nausea and vomiting, sonolence and fatigue, altered consciousness and confusion. It is also relatively frequent that alterations of personality and behavior appear. Fever and dizziness are also common, as well as weight changes without reasons for this, problems of perception and language and loss of sensitivity and mobility, and even convulsions. It is also possible, especially when they occur in children, that malformations are generated and that the intracranial and extracranial craniofacial anatomy be altered .


This type of tumor can occur, as it happens with other tumors, in a circumscribed way to a specific region or structure or in a diffuse way, the former having a much better prognosis than the latter. In general, they do not usually metastasize to other areas of the body beyond the nervous system, although they do expand within that system.

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Diagnosis

The diagnosis of these tumors is complex, being necessary to perform various procedures. First of all it is necessary to perform a tumor biopsy , which will allow us to take a sample of the brain tumor, being currently performed by stereotaxis. Later it will be necessary to carry out a phenotypic and histological analysis to check the type of tissue we are talking about, as well as its behavior. Finally, it will be necessary to assess the proliferative capacity, in order to be able to finish determining its degree and infiltration capacity.


Causes

As with all other brain tumors, the causes of astrocytomas are mostly unknown. However, some inherited disorders can facilitate their appearance, such as neurofibromatosis. Also the infection with the Epstein-Barr virus or the previous application of radiotherapy due to another tumor seem to be risk factors to develop them.

Classification according to grades

The term astrocytoma, as we have already indicated, groups together the group of tumors or neuplasias constituted mainly by astrocytes. But Within the astrocytomas we can find different classifications and divisions , depending on other criteria of its degree of malignancy and proliferation. In this sense, we can observe the existence of four degrees of severity

Grade I

Astrocytomas of grade one are considered all those tumors whose main characteristic is their benignity. Weight to it can generate serious problems and even be deadly or generate disability depending on whether they grow and cause the crushing of parts of the brain against the skull. These are rare tumors, predominantly infantile, that they have the advantage of having a very high degree of survival and be relatively easy to treat. In many cases, surgical resection is sufficient. An example of tumors of this grade is found in pilocytic astrocytoma.

Grade II

In contrast to grade I astrocytomas, grade II astrocytomas are cancer itself, being malignant tumors.The aggressive grade two astrocytomas, much more complex to treat and considered malignant and expansive. They usually generate epileptic seizures , observing diffuse lesions. Diffuse astrocytomas are usually included in this group, among which fibrillar, gemistocytic, and protoplasmic astrocytomas are the most common. They are the most common type of low-grade astrocytoma.

Grade III

The grade three astrocytomas result a type of malignant tumor that has a high capacity for proliferation and infiltration towards other structures. The best known is anaplastic astrocytoma. It is frequent that it is the evolution of one of the previous tumors and even that it evolves towards a grade four tumor.

Grade IV

Astrocytomas that are more invasive, aggressive and infiltrating are considered grade four, rapidly expanding to other areas of the brain. The most typical and well-known astrocytoma with this degree of malignancy is glioblastoma multiforme, being in fact the most frequent type of cerebral neoplasia. The prognosis is usually fatal and the life expectancy is greatly reduced.

The two most frequent

Below are some of the most frequent characteristics of some of the two most common and well-known types of astrocytoma.

Glioblastoma multiforme

The most frequent of all astrocytomas and one of the most frequent brain tumors (around a quarter of the brain tumors diagnosed are glioblastomas) is also the most aggressive and with the worst prognosis. It is a tumor in which the cells are poorly differentiated, which reproduces at high speed and proliferates at the vascular level generating death and degeneration of other structures by necrosis . Life expectancy does not usually exceed one year and three months. It can be primary, appearing by itself, but it is usually an evolution of some of the tumors with the lowest degree of malignancy.

Anaplastic astrocytoma

The second of the most known and malignant types, we are facing a grade III astrocytoma that tends to infiltrate the surrounding tissue without destroying it, appearing a thickening of these. It usually generates edema around the affected area, although it does not usually generate necrosis. Survival is greater than in glioblastoma, although only about 20% survive more than five years. It has been discussed if there is a hereditary genetic predisposition in some subjects because some hereditary syndromes predispose their appearance.

Treatments

The treatment of a brain tumor such as astrocytomas is something that must be planned carefully, considering that we are facing an intervention that can generate alterations in different brain regions beyond that directly affected by the tumor. However, even if secondary alterations occur, the priority must be integrity

Surgery in order to perform tumor resection is one of the main treatment modalities for astrocytomas, with the initial treatment to be applied in practically all things and after which other therapies that eliminate the remains of the tumor will be applied. or prevent its expansion. But nevertheless, sometimes complete resection will not be possible , as it happens in the cases in which the tumor is located in the brainstem (since its resection could cause the death of the subject when controlling this area vital functions).

This resection is carried out in both low-grade and high-grade tumors, although recurrences and infiltrations in other brain areas frequently occur in the latter. This is because even in these cases the resection can improve the mental capacities of the patient that were diminished by the pressure of the tumor. Once the maximum possible amount of tumor has been eliminated, they are usually used radiotherapy and chemotherapy to fight the remains of cancer cells .

In the case of radiotherapy, we are facing the application of high doses of radiation on cancerous tissues in order to destroy the cells and reduce or eliminate tumors, and it has been very effective in tumors with a high degree of malignancy. The need to focus the radiation only on the cancerous area must be taken into account, since if used in a generalized manner, a large number of healthy cells would be excessively destroyed.

Chemotherapy is the application of powerful chemical substances and drugs used to fight the tumor, generally through the inhibition of tumor proliferation when applying substances that prevent cell division and DNA repair . Among these substances we can find temozolomide, ifosfamide, etoposide, carboplatin or lomustine.

At the psychological level, intervention is also recommended, especially when there are symptoms and alterations of anxiety and mood. Psychoeducation is fundamental, especially in those cases in which the only possible treatment is only palliative and / or are in the terminal phase.It is also essential to have a safe and reliable space in which to solve doubts and express feelings and fears without fear of being judged, something common in this type of disease. Also, there are therapies such as adjuvant psychological therapy, creative innovation therapy or visualization therapy that can be applied in order to help the subject to have greater perception of control over their disease.

Bibliographic references:

  • Buckner, J.C .; Brown, P.D .; O'Neill, B.P .; Meyer, F.B .; Wetmore, C.J. & Uhm, J.H. (2007). Central Nervous System Tumors. Mayo Clinic Proceedings, 82: 1271-86.
  • Kleihues, P .; Burger, P.C. & Scheithauer, B.W. (1993). The new WHO classification of brain tumours. Brain Pathol 3 (3): 255-68.
  • Michaud, D.S. (2016). Epidemiology of brain tumors. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SK, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier.
  • Pérez, L .; Galarraga, J .; Gómez, H. & Tamayo, J.D. (2000). Classification of astrocytic gliomas. Brief considerations. Rev. Neurol., 31: 1180-1183.

Brain Tumors: Frequently Asked Questions | Jon Weingart, M.D. (July 2024).


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