Brain astrocytoma: causes, symptoms, diagnosis and treatment

Astrocytoma is one of the most common brain tumors. The inside of the tumor often contains cysts, which can grow to large sizes and cause compression of the brain matter.

Benign astrocytomas, located in an accessible location, give a better prognosis for life expectancy than high-grade astrocytomas or benign astrocytomas, located in a location inaccessible to the surgeon and having a large tumor size. The earlier a tumor is detected, the better the prognosis for its treatment.

At the Yusupov Hospital they deal with the diagnosis and treatment of astrocytes. The hospital is equipped with innovative diagnostic equipment that allows you to receive all diagnostic services.

Brain astrocytoma: what is it?

An astrocytoma is a glial brain tumor that develops from astrocytes, neuroglial cells that look like stars or spiders. Astrocytes support the structural component of the nervous system of the brain - neurons. Astrocytes influence the movement of substances from the wall of a blood vessel to the plasma membrane of a neuron, participate in the growth of nerve cells, regulate the composition of intercellular fluid, and much more. Astrocytes in the white matter of the brain are called fibrous or fibrous. Protoplasmic astrocytes predominate in the gray matter of the brain. Astrocytes perform the function of protecting brain neurons from chemicals and injuries, providing nutrition to neurons, and participating in regulating brain blood flow.

Brain tumors cannot be called cancer, since cancer does not develop from epithelial cells, but from cells of more complex structures. A malignant brain tumor practically does not metastasize beyond the brain, but the brain can be affected by metastases from tumors located in other organs and tissues of the body. A malignant brain tumor may be no different from a benign tumor. A brain tumor does not have a clear boundary, so its complete removal is almost impossible. The difficulty of treating such tumors is that the brain has a blood-brain barrier, through which many antitumor drugs do not pass; the brain has its own immunity. A brain tumor can affect the entire brain - the tumor itself can develop in one part of the brain, and its cells can be located in different places in the brain.

Polyclonal brain tumors are a tumor within a tumor. These include primary brain tumors. The difficulty is that such a combination of tumors should be treated with different groups of drugs - one of the tumors is insensitive to drugs for treating another type of tumor. A major role in the effectiveness of treatment of a brain tumor is played not by the determination of the histological type of the tumor, but by the location and size of the tumor.

Complications

With the growth of astrocytoma, we can already talk about a threat to the health and life of the patient, and the degree of malignancy and class of the tumor do not matter.

Consequences are also possible during the process of therapeutic measures. During surgery, for example, the possibility of damage to the cerebral cortex cannot be ruled out. Depending on which lobe is affected, hemianesthesia and impairment of verbal and cognitive functions may develop.

Gamma therapy in children can lead to:

hormonal imbalances ;
decreased mental abilities;
developmental and growth retardation;
disorders ;
development of secondary tumors and radiation necrosis of white matter.

Chemotherapy has negative effects on the liver, kidneys and lungs. Cytostatics combined with radiation therapy increase the risk of necrotizing leukoencephalopathy.

Causes

There is currently no data on the reasons for the development of tumors from astrocyte cells. There is an opinion that some negative factors can serve as a trigger for tumor development:

radioactive exposure. Radiation often causes the development of malignant brain tumors in patients. The risk of developing astrocytoma increases in patients who have undergone radiotherapy;
long-term exposure to toxic chemicals. Working in hazardous work can cause the development of brain tumors.
oncogenic viruses;
hereditary predisposition;
injuries;
patient's age. Some types of tumors primarily affect children, others are more common in young people between 20 and 30 years of age, and a third type of tumor affects older people more.

When studying the causes of astrocytomas, two types of damaged genes were identified.

Causes and risk factors

The exact cause of anaplastic astrocytoma is unknown. Researchers suggest that genetic and immunological disorders, environmental factors (eg, exposure to ultraviolet rays, certain chemicals, ionizing radiation), diet, stress and/or other factors may play a determining role in the occurrence of certain types of cancer.

Scientists are conducting ongoing basic research to find out more about the many factors that can lead to cancer.

Astrocytomas occur with greater frequency in certain genetic disorders, including neurofibromatosis type I, Li-Fraumeni syndrome, and tuberous sclerosis. With the exception of these rare diseases, the vast majority of astrocytomas are not passed on to offspring at a higher rate.

Researchers believe that some people may have a genetic predisposition to developing astrocytoma. A person who is genetically predisposed to a disorder carries the gene (or genes) for the disease, but it may not be expressed unless it is caused or "activated" under certain circumstances, such as due to certain environmental factors.

Symptoms of astrocytoma development

Symptoms of tumor development depend on its location and size. Depending on its location, it can impair coordination of movement (tumor in the cerebellum) and cause disturbances in speech, vision, and memory. Tumor growth in the left hemisphere can cause paralysis on the right side of the body. A patient with a brain tumor suffers from a headache, sensitivity is impaired, weakness appears, blood pressure surges, and tachycardia. When the hypothalamus or pituitary gland is damaged, endocrine disorders develop. Symptoms of the disease depend on the location of the tumor in a specific part of the brain responsible for certain functions.

Primary

When astrocytoma is localized in the frontal lobe of the brain, patients experience the appearance of psychopathological symptoms: a feeling of euphoria, decreased criticism of their illness, aggressiveness, emotional indifference, the psyche can completely collapse. If the corpus callosum or the medial surface of the frontal lobes is damaged, patients experience memory and thinking impairment. When Broca's area is damaged in the frontal lobe of the dominant hemisphere, motor speech disorders develop. Patients with tumors in the posterior regions develop paresis and paralysis in the upper and lower extremities.

In case of damage to the temporal lobe, patients may experience the appearance of hallucinations: auditory, gustatory, visual, which over time are replaced by generalized epileptic seizures. Often the development of auditory agnosia - a person does not recognize previously known sounds, voices, melodies. An astrocytoma located in the temporal region threatens to dislocate and herniate into the foramen magnum, resulting in almost inevitable death. When the tumor is localized in the temporal and frontal lobes, patients often experience epileptic seizures.

When a tumor affects the parietal lobe of the brain, sensory disturbances, astereognosis, and apraxia in the opposite limb occur (with apraxia, purposeful actions are impaired in a person). Patients experience the development of focal epileptic seizures. If the lower parts of the left parietal lobe are damaged, right-handers experience impairment in speech, counting, and writing.

The least commonly diagnosed astrocytomas are those in the occipital lobe of the brain. Patients with these tumors develop visual hallucinations, photopsia, and hemianopsia (loss of half the visual field of each eye).

Secondary

One of the main signs of cerebral astrocytoma is the presence of paroxysmal or aching diffuse pain in the head. The headache has no clear localization and is caused by intracranial hypertension. In the early stages of the disease, the pain is paroxysmal and aching, but over time it becomes constant, which is associated with the progression of the tumor.

In patients with cerebral astrocytoma, intracranial pressure increases as a result of compression of the cerebrospinal fluid ducts and venous vessels. Headaches, vomiting, persistent hiccups appear, cognitive functions and visual acuity decrease. Severe cases are accompanied by a person falling into a coma.

Can astrocytoma be cured?

The fibrillary type of astrocytoma, if the pathology is detected in a timely manner, responds well to therapy.

If the pathology progresses slowly, the doctor may recommend a wait-and-see approach. The patient in this case must undergo periodic examinations to assess the rate of progression of the disease. In this case, the patient should lead a healthy lifestyle, use folk remedies and medications and eat right.

If the location of the tumor is unfavorable or its rapid growth, surgery cannot be avoided. With an integrated approach to the treatment of this type of glial tumor, its complete cure can be achieved.

Surgical direction of tumor treatment

If tumor cells grow diffusely, it is not possible to completely eliminate them. Neoplasms that have a dense structure are more amenable to classical surgery. Before the intervention, the patient is given a special drug that will make the tumor cells more pronounced.

During the operation, the neurosurgeon must use a microscope to remove as much tumor cells as possible without damaging healthy brain tissue. After surgical removal of the tumor, the patient requires long-term rehabilitation.

Radiosurgery

For diffuse tumors, radiosurgery is most often used. Using a special apparatus, tumor tissues are irradiated with ionizing radiation. At the same time, healthy tissues are preserved. This type of surgery is performed under tomography guidance.

Often, tumor elimination is carried out in several stages. Neurological complications are rarely observed after such an intervention.

Chemotherapy

The use of chemotherapy is justified when a tumor is detected at an early stage. However, tumors do not always respond to such treatment. Only in 30% of cases is it possible to achieve remission. If a positive effect is not observed, the patient subsequently requires surgical removal of the tumor.

Radiation therapy

Radiation therapy is used for astrocytomas whose size does not exceed 2 cm. During treatment, 5 to 30 courses of such treatment are prescribed. In some cases, it is possible to achieve complete regression of the tumor using this method. The advantage of radiation therapy is that there is no need to open the skull.

Traditional treatment recipes

No folk remedies can eliminate tumors in the brain. These methods can be used exclusively as an adjunct to surgical therapy.

If you have frequent mood swings and depression, you can use herbs that have a calming effect. A decoction of chamomile and mint helps a lot To prepare this herbal tea, you should take ½ tsp. each plant. The resulting composition should be poured with boiling water and left for at least 10 minutes. You need to add 1 tsp to the finished product. honey You need to drink the product in small sips.

Often, for this pathological condition, herbalists recommend hornbeam decoction . To prepare this product you need 2 tbsp. l. pour 500 ml of boiling water over the flowers. The resulting mixture must be left to simmer in a water bath for 30 minutes. The product should be allowed to cool and strain. You need to take it ½ cup for 3 months.

In addition, a decoction of chestnut flowers . To prepare this product you need to pour 2 tbsp. crushed flowers 200 ml boiling water. The composition must be brought to a boil and set aside for 8 hours. The finished product should be strained and taken one sip at a time throughout the day.

Any folk remedies can be used only after consultation with your doctor. Self-medication may cause the condition to worsen.

Diagnosis: types of tumor

The structure of malignant cells divides astrocytomas into two groups:

fibrillar, gemistocytic, protoplasmic.
piloid (pilocytic), subepidemic (glomerular), cerebellar microcystic.

Astrocytoma has several degrees of malignancy:

first degree of malignancy - this type of benign tumor grows slowly, is small in size, is limited to healthy areas of the brain by a kind of capsule, and rarely affects the development of neurological deficits. The tumor is represented by normal astrocyte cells, which develop in the form of a nodule. A representative of such a tumor is piloid astrocytoma, pilocytic. Affects children and adolescents more often;
second degree of malignancy - the tumor grows slowly, the cells begin to differ from normal brain cells, more common in young people aged 20 to 30 years. A representative of this degree of malignancy is fibrillar (diffuse) astrocytoma;
third degree of malignancy - anaplastic astrocytoma. Grows rapidly, tumor cells are very different from normal brain cells, the tumor has a high level of malignancy;
fourth degree - malignant glioblastoma, the cells do not look like normal brain cells. It affects important centers of the brain, grows quickly, and often it is impossible to remove such a tumor. It affects the cerebellum, the cerebral hemispheres, and the area of the brain responsible for the redistribution of information from the sensory organs - the thalamus.

Over time, tumor cells of the first and second degrees degenerate and turn into cells of the third and fourth degrees of malignancy. Transformation of a tumor from a benign to a malignant neoplasm most often occurs in adults. Benign brain tumors can be as life-threatening as malignant tumors. It all depends on the size of the formation and the location of the tumor.

Treatment of astrocytoma

Treatment tactics for brain tumors depend on the location of the tumor, its size, and the type of tumor. A favorable prognosis in the treatment of diffuse astrocytoma exists for young patients, provided that the brain tumor is completely removed. Anaplastic astrocytoma is treated using a combined approach - surgery, radiation therapy, and polychemotherapy. The average life expectancy is about three years after surgery. The prognosis is favorable for young people who were in good health before surgery, provided that the tumor was completely removed.

Pilocytic (piloid) astrocytoma develops in children, has limited growth, characteristic localization, and morphological features. Treatment of the tumor has a favorable prognosis due to its slow growth and low malignancy. Treatment is carried out by surgery and complete removal of the tumor, which in some cases is not possible due to the location of the tumor in the hypothalamus or brain stem. Some types of piloidal astrocytomas (hypothalamic) have the ability to metastasize.

Similar disorders

Symptoms of the following disorders may be similar to those of anaplastic astrocytoma. Comparisons may be useful for differential diagnosis.

Other brain tumors must be distinguished from anaplastic astrocytomas. Such tumors include metastatic tumors, lymphomas, hemangioblastomas, craniopharyngiomas, teratomas, ependymomas, and medulloblastomas.

Additional conditions that may resemble anaplastic astrocytoma include inflammation of the meninges surrounding the brain and spinal cord (meningitis) and pseudotumor cerebri (benign intracranial hypertension).

Brain astrocytoma: consequences after surgery

The consequences after surgery for astrocytoma depend on the size of the tumor and its location. Benign astrocytomas, located in an accessible location, give a better prognosis for life expectancy than high-grade astrocytomas or benign astrocytomas, located in a location inaccessible to the surgeon and having a large tumor size. After removal of an astrocytoma, tumor recurrence often occurs, which occurs within two years after surgery. The earlier a tumor is detected, the better the prognosis for its treatment.

Prevention and prognosis

Since experts cannot name an unambiguous reason for the appearance of astrocytomas in people, measures to prevent the appearance of a neoplasm will be general:

maintaining a healthy lifestyle;
rejection of bad habits;
proper nutrition;
sound daily sleep;
taking vitamin complexes;
absence of stressful situations;
timely treatment of infectious pathologies, especially of the brain.

The prognosis for early detection of a fibrillary tumor is as follows: the five-year survival rate of patients reaches 55-75%. Whereas, when seeking medical help late and specialized antitumor treatment is unavailable, death in the first 1-3 years is observed in 85–90% of patients.

There is a high risk of transformation of astrocytoma into its malignant, rapidly progressing form - glioblastoma. The chances of recovery in this case are practically non-existent.

However, if a person pays close attention to his health and undergoes regular medical examinations, including brain examinations, astrocytomas can be quickly diagnosed. The disease is completely treatable, and the person gets a chance to continue living a full life.

Forecast

After surgical removal of nodular forms of astrocytoma, long-term remission (more than ten years) can occur. Diffuse astrocytomas are characterized by frequent relapses, even after combined treatment.

With glioblastoma, the average life expectancy of a patient is one year, with anaplastic astrocytoma of the brain - about five years.

With other types of astrocytomas, the average life expectancy is much longer; after adequate treatment, they return to a full life and normal work activity.

Radiation therapy for astrocytomas

To suppress the growth and development of cancer cells in the brain, both at the preoperative and postoperative stages of managing a patient with fibrillary astrocytoma, doctors recommend courses of radiation therapy. This method allows you to keep healthy tissue intact, which improves the prognosis of recovery and keeps the brain as active as possible.

Such therapy usually involves the use of one of two methods:

internal irradiation - special radioactive materials are introduced into the cancer site, which lead to the death of astrocytoma cells;
External irradiation – the source of radiation is located outside the patient’s body.

The method of radiosurgery is being recognized as increasingly popular and effective, when, after careful calculations and computer modeling, precise rays are directed directly to the fibrillary focus. At the same time, the risk of irradiation of healthy cells is minimal.

It is the prerogative of the doctor to determine the number of courses of radiation therapy, their duration and evaluate the results of treatment. To maintain the patient’s immune barriers and strength, and reduce the negative consequences of such procedures, experts recommend courses of vitamin therapy, adaptogens, and hepatoprotectors.

Spreading

Hemostocytic neoplastic astrocytes exhibit a significantly lower proliferation rate than the scrambled small cell component. However, microdissection revealed identical TP53 mutations in both hemocytes and non-hemistocytic tumor cells.

Immunophenotype

The cytoplasm of neoplastic gemistocytes is filled with GFAP, causing the nuclei to shift to the periphery of the cell body. Expression of p53 protein is also frequently observed in hemocytes.

Genetic profile

Gemistocytic astrocytoma is a variant of diffuse astrocytoma associated with IDH mutants. Reports have noted that gemistocytic astrocytomas are characterized by a particularly high frequency of TP53 mutations, which are present in >80% of all cases and probably in almost all cases of IDH-mutated gemistocytic astrocytomas. The fact that TP53 mutations are present in both hemocytes and non-hemistocytic tumor cells indicates that hemocytes are neoplastic and non-reactive. This interpretation is also supported by immunoreactivity to the mutant IDH1 protein.

Temporal lobe

When an astrocytoma is localized in this area, the patient begins to suffer from hallucinations, both visual and auditory. In the future, this problem can develop into the occurrence of epileptic seizures. If the tumor affects the temporal lobe of the dominant hemisphere, the patient may no longer understand oral and written speech, and his speech will consist of a set of arbitrary words. A symptom that often appears is auditory agnosia - this is the failure to recognize voices, melodies and sounds that the patient previously knew. Very often, with astrocytoma of the temporal region, a person dies without even starting treatment.

Most often, epileptic seizures occur with astrocytomas, which are localized in the frontal and temporal lobe:

Uncontrollable turns of the head may occur, as well as periodic spasms in the limbs;
The patient complains of a feeling of “crawling goosebumps” on the skin, and objects may begin to change their color;
Increased nausea and cardiac dysfunction;
Sometimes cramps begin in one part of the body and gradually spread to another part;
Severe partial seizures may occur when the patient’s consciousness is disrupted, he stops making any contact with others, begins to repeat the same sounds and even sing;
A person may “freeze” for a few seconds, after which he returns to normal activities.

Occipital lobe

In this area, astrocytomas are the least common. Usually accompanied by visual hallucinations, and one half of the picture may fall out of each eye.

Secondary symptoms of this disease include the following:

Headache. Astrocytoma begins to resemble itself precisely with headaches and epileptic seizures. Headache is associated with intracranial hypertension, and is characterized by unclear localization of the source of pain. Initially, the pain may be periodic and aching. As the tumor grows, the pain may become constant. Most often occurs when changing body position. Suspicion of its formation should arise if the headache appears after sleep and decreases slightly in the evening, and may be accompanied by an increased gag reflex, which is not associated with food intake;
Brain swelling. The tumor, which as it grows begins to compress the cerebrospinal fluid pathways and other parts of the brain, causes increased intracranial pressure.

It manifests itself as severe headaches, nausea, vomiting, frequent hiccups, impaired memory and thought processes, decreased vision, etc.

In severe cases, the person may fall into a coma. Most often, cerebral edema occurs, and intracranial hypertension occurs when localized in the frontal lobe.