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Astrocytoma

Last updated: March 7, 2021

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Astrocytomas are neuroepithelial tumors (gliomas) that arise from the supportive tissue of the brain. These tumors are classified by the WHO into four separate grades depending on the extent of abnormality. Astrocytomas initially present with general symptoms including headaches and/or epileptic seizures, which are rapidly replaced by focal symptoms such as progressive paralysis or aphasia. Low-grade astrocytomas are usually localized, slow-growing, and occur predominantly in younger populations (children and adults aged between 20 and 40). Grade IV astrocytomas, on the other hand, are rapidly growing glioblastomas, which are the most common malignant primary brain tumors in adults aged 60–70. Diagnosis is established based on the patient's clinical history and MRI findings. The treatment for astrocytomas is surgical resection, which may need to be combined with radiotherapy and/or chemotherapy in higher-grade tumors. The prognosis is usually poor for higher-grade tumors regardless of whether they receive treatment, with a life expectancy of several months (maximum of 2 years). However, low-grade astrocytomas can often be completely cured with effective surgical resection.

Overview of astrocytomas
WHO grade I II III IV Variable
Type Pilocytic astrocytoma [1][2][3][4] Optic glioma [5] Diffuse astrocytoma Anaplastic astrocytoma [6][7] Glioblastoma [8][9][10] Brainstem glioma
[11]
Epidemiology
  • Children and young adults (< 20 years)
  • Most frequently children (< 10 years)
  • 20–40 years of age
  • 30–50 years of age
  • 60–70 years of age
  • Most common malignant primary nervous system cancer
  • Associated with EGFR mutations (e.g., amplification)
  • 3–10 years of age
  • Comprise 15% of all childhood brain tumors
Location
  • Cerebral hemisphere
Symptoms
  • Sporadic episodes of vision impairment
  • Bulging of eyeball
  • Impaired eye movements
Diagnostics
Treatment
  • Surgical resection
  • No treatment in asymptomatic patients with no signs of tumor growth
  • Surgical resection
  • Radiotherapy
    • Unresectable tumors
    • Adjuvant
  • Complete surgical resection often not possible ; resection until definable margins can be attempted
  • Percutaneous radiotherapy for very diffuse, unresectable tumors
  • Surgical resection is often difficult
Prognosis
  • Good: completely curable with complete surgical resection
  • Median survival: > 10 years
  • Good
  • Many patients have significant long-term visual impairment.
  • 5-year survival rate: ∼ 23%
  • Unfavorable
  • Median survival of 15 months

Astrocytomas nearly always stain positive for glial fibrillary acidic protein (GFAP).

  1. Low grade infiltrative astrocytoma. https://radiopaedia.org/articles/low-grade-infiltrative-astrocytoma. Updated: January 1, 2017. Accessed: February 19, 2017.
  2. Astrocytoma. http://www.mdguidelines.com/astrocytoma. Updated: January 1, 2017. Accessed: February 19, 2017.
  3. Collins VP, Jones DTW, Giannini C. Pilocytic astrocytoma: pathology, molecular mechanisms and markers. Acta Neuropathol. 2015; 129 (6): p.775-788. doi: 10.1007/s00401-015-1410-7 . | Open in Read by QxMD
  4. Pilocytic Astrocytoma. https://radiopaedia.org/articles/pilocytic-astrocytoma. Updated: January 1, 2018. Accessed: November 12, 2018.
  5. Optic Nerve Glioma. http://eyewiki.aao.org/Optic_Nerve_Glioma. Updated: September 27, 2016. Accessed: February 19, 2017.
  6. Smoll NR, Hamilton B. Incidence and relative survival of anaplastic astrocytomas. Neuro Oncol. 2014; 16 (10): p.1400-1407. doi: 10.1093/neuonc/nou053 . | Open in Read by QxMD
  7. Anaplastic Astrocytoma. https://radiopaedia.org/articles/anaplastic-astrocytoma. Updated: April 1, 2018. Accessed: June 28, 2018.
  8. Glioblastoma. https://radiopaedia.org/articles/glioblastoma. Updated: January 1, 2017. Accessed: February 19, 2017.
  9. Nizamutdinov D, Stock EM, Dandashi JA, et al. Prognostication of survival outcomes in patients diagnosed with glioblastoma. World Neurosurg. 2018; 109 : p.e67-e74. doi: 10.1016/j.wneu.2017.09.104 . | Open in Read by QxMD
  10. Westphal M, Maire CL, Lamszus K. EGFR as a Target for Glioblastoma Treatment: An Unfulfilled Promise. CNS Drugs. 2017; 31 (9): p.723-735. doi: 10.1007/s40263-017-0456-6 . | Open in Read by QxMD
  11. Hu J, Western S, Kesari S. Brainstem glioma in adults. Front Oncol. 2016; 6 . doi: 10.3389/fonc.2016.00180 . | Open in Read by QxMD