Astrocytoma - Childhood

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What is Astrocytoma - Childhood?

The brain and spinal column make up the central nervous system (CNS), where all vital functions of the body, including thought, speech, and strength, are controlled.

Astrocytoma is a type of CNS tumor that forms in cells called astrocytes. Normal astrocytes provide the connecting network of the brain and spinal cord and form scar tissue when the CNS is damaged. Astrocytoma begins when normal astrocytes change and grow uncontrollably, forming a mass called a tumor.

Astrocytoma can occur throughout the CNS, including in the following places:

Cerebellum (the back part of the brain responsible for coordination and balance)

Cerebrum (the top part of the brain that controls motor activities and talking)

Diencephalon or central part of the brain (controls vision, hormone production, and arm and leg movement)

Brain stem (controls eye and facial movements, arm and leg movement, and breathing)

Spinal cord (controls sensation and arm and leg motor function)

A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Astrocytoma is more commonly referred to by its grade (a measure of how much the tumor cells appear like normal cells), as either high grade or low grade, depending on the number and shape of the tumor cells and how quickly they grow and spread. A low-grade tumor is less likely to grow quickly or spread. Once a tumor is found in the CNS, the doctor will usually perform a biopsy  to see if the tumor is an astrocytoma and to determine the grade of the tumor. A biopsy is the removal of a small amount of tissue for examination under a microscope.

Symptoms & Signs

Children with astrocytoma may experience the following symptoms or signs. Sometimes, children with astrocytoma do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a tumor. If you are concerned about a symptom or sign on this list, please talk with your child’s doctor.

Headaches

Lethargy (feeling tired and listless)

Seizures not related to a high fever

Eyesight problems, such as double vision

Changed growth or development

In a baby, the only symptom may be that the head is growing too fast. An infant’s skull can expand to make room for a growing tumor in the brain, so a baby with astrocytoma may have a larger than normal head.

Your child’s doctor will ask you questions about the symptoms your child is experiencing to help find out the cause of the problem, called a diagnosis. This may include how long your child has been experiencing the symptom(s) and how often.

If a tumor is diagnosed, relieving symptoms and side effects remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with the health care team about symptoms your child experiences, including any new symptoms or a change in symptoms.

Risk Factors

A risk factor is anything that increases a person’s chance of developing a tumor. Although risk factors often influence the development of a tumor, most do not directly cause a tumor. Some people with several risk factors never develop a tumor, while others with no known risk factors do.

Doctors and researchers don’t know what causes most childhood tumors. There is some evidence that genetic factors may play a role in a small percentage of children with cerebral astrocytoma. For example, children who have neurofibromatosis may have an increased risk of developing astrocytoma. Neurofibromatosis is an inherited disorder that causes neurofibromas (a type of noncancerous tumor) to form on peripheral nerves in the body, brown spots on the skin, and tissue and bone deformities. Neurofibromatosis is also called Recklinghausen’s disease or von Recklinghausen’s disease. Other, less common genetic conditions associated with a higher risk of CNS tumors include Li-Fraumeni syndrome, tuberous sclerosis, nevoid basal cell carcinoma syndrome, and Turcot syndrome.

Diagnosis

Doctors use many tests to diagnose a tumor and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of tumors, a biopsy is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the tumor has spread. This list describes options for diagnosing astrocytoma, and not all tests listed will be used for every person. Your child’s doctor may consider these factors when choosing a diagnostic test:

Age and medical condition

Type of tumor suspected

Signs and symptoms

Previous test results

In addition to a physical examination, the following tests may be used to diagnose astrocytoma:

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a contrast medium (a special dye) is injected into a vein or given orally (by mouth) to provide better detail.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein or given orally to create a clearer picture.

Biopsy. Other tests can suggest that a tumor is present, but only a biopsy can make a definite diagnosis. For astrocytoma, a biopsy is done to determine the type and grade of the tumor. A neurosurgeon (a doctor who specializes in treating a CNS tumor using surgery) will remove a small piece of tissue from the tumor. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

After these diagnostic tests are done, your child’s doctor will review all of the results with you. If the diagnosis is astrocytoma, these results also help the doctor describe the tumor; this is called staging and grading.

Stages and Grades

Staging is a way of describing where a tumor is located, if or where it has spread, and whether it is affecting other parts of the body. Several types of childhood CNS tumors can spread through the spinal fluid that surrounds the brain and the spine. This information helps the doctor plan the treatment and determine the child’s prognosis (chance of recovery). In addition to staging, tumor grade strongly affects prognosis, with a low-grade tumor having a better prognosis than a higher-grade tumor. The grades of astrocytoma are:

Low-grade tumor. A low-grade tumor has cells that look similar to normal CNS cells under a microscope. The tumor usually does not grow quickly or spread to other parts of the CNS, although both rapid growth and spread can sometimes occur. Tumors may appear in more than one spot in the brain, especially when they are associated with neurofibromatosis. One of the more common low-grade tumors occurring almost only in children is called juvenile pilocytic astrocytoma, or JPA.

High-grade tumor. A high-grade tumor has cells that do not look similar to normal astrocytes. This type of tumor grows quickly and can spread throughout other parts of the CNS.

Recurrent astrocytoma. Recurrent astrocytoma is a tumor that has come back after treatment. Astrocytoma usually recurs near where it first started. If there is a recurrence, the tumor may need to be graded again using the system above.

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