Astrocytoma

Astrocytomas are a common type of brain tumours in both adults and children. They belong to a group of brain tumours called gliomas.

The main treatments for astrocytomas are surgery, radiotherapy and chemotherapy.

The information on this page is about astrocytomas in adults. We also have information about astrocytomas in children.

What are astrocytomas?

Astrocytomas develop from a type of glial cells called astrocytes. Astrocytes are star shaped cells. They support the nerve cells (neurones) in the brain.

 Diagram of an astrocyte - type of glial cell

Doctors use a system to group (classify) brain tumours into different groups (categories) and types. The World Health Organisation (WHO) regularly update this system. The information in this page is based on the latest WHO classification of 2021.

Astrocytomas are a type of brain tumour that belongs to a group of brain tumours called gliomas.

Doctors have changed the way they group and describe astrocytomas. All astrocytomas are now called:

  • astrocytoma, IDH mutant

What does IDH mutant mean?

Your doctor looks to see if there are certain gene changes in the brain tumour cells. These tests are also called biomarker or molecular studies. Your doctor uses these test results to decide what type of glioma you have. 

IDH (isocitrate dehydrogenase) is a gene. Your doctor looks for permanent changes (mutations) in the IDH gene.

Your doctor diagnoses:

  • astrocytoma, IDH mutant - if you have changes (mutations) in the IDH gene
  • glioblastoma, IDH wildtype - if you don’t have changes in the IDH gene (the term ‘wildtype’ describes an unchanged gene)

This page is about astrocytoma, IDH mutant.

Diffuse and circumscribed astrocytomas

Some astrocytomas are very localised (focal). This means it is easy to see the border between the tumour and the normal brain tissue on a scan or during surgery. Doctors call these circumscribed astrocytomas. These are more common in children.

Other astrocytomas are called diffuse astrocytomas. They don’t have a clear boundary between the tumour and the normal brain tissue. Most grade 2 astrocytomas are diffuse.

Grades of astrocytomas

Astrocytomas are put into groups according to how quickly they are likely to grow. These are called grades. 

The grade depends on how the cells look.  Generally, the more normal the cells look, the lower the grade. The more abnormal the cells look, the higher the grade. Grade also depends on genes and proteins in the tumour cells. 

There are 3 grades of IDH mutated astrocytomas:

  • grade 2 (diffuse
  • grade 3 (anaplastic)
  • grade 4

How common it is

Around 9 out of every 100 brain tumours (around 9%) diagnosed in England between 1995 and 2017 were astrocytomas. This doesn’t include glioblastomas.

What tests will I have?

You have tests to diagnose an astrocytoma. Your doctor checks the size of the tumour and its location. This helps your doctor plan your treatment. The tests you might have include:

  • MRI scan or CT scan
  • a test of your neurological system (neurological examination)
  • a biopsy

Treatment

The main treatments for astrocytoma are:

  • surgery
  • radiotherapy, which uses high energy x-rays to destroy cancer cells
  • chemotherapy, which uses cytotoxic drugs to destroy cancer cells

Your treatment depends on the grade of your astrocytoma. It also depends on whether you have changes (mutations) in certain genes.

Surgery is the main treatment for grade 2 astrocytoma.

It isn’t always possible to completely remove the tumour in some parts of the brain. But even when some tumour if left behind, grade 2 tumours may take years to cause symptoms again. 

Your doctor might recommend that you have radiotherapy after surgery if you:

  • are over 40 years old
  • have a lot of tumour left behind after surgery

You might have chemotherapy after surgery and radiotherapy. You usually have a combination of chemotherapy drugs called PCV. It includes the drugs:

  • procarbazine
  • lomustine (CCNU)
  • vincristine

Surgery is the main treatment for grade 3 and 4 astrocytomas.

You usually have radiotherapy after surgery.

You might take a chemotherapy drug called temozolomide if you are well and able to care for yourself. You usually have temozolomide for several months. You have it in stages known as cycles. You might have temozolomide:

  • after surgery and radiotherapy if you have a grade 3 astrocytoma
  • after surgery and at the same time as radiotherapy (chemoradiotherapy) if you have a grade 4 astrocytoma

Treatment for astrocytoma can control the tumour for some time. But the tumour can start to grow again. If this happens, your treatment depends on several factors including:

  • what treatment you had before, and when you had it
  • your symptoms
  • where the tumour is

If your astrocytoma comes back, you might have:

  • more surgery
  • more radiotherapy (a boost)
  • more chemotherapy – you might have temozolomide again or PCV

Follow up

You have regular appointments with your doctor or nurse after treatment finishes. Your doctor examines you at each appointment. They ask how you are feeling, whether you have had any symptoms or side effects, and if you are worried about anything. You might also have MRI scans on some visits.

How often you have check ups depend on your individual situation.

You might have an MRI scan every 3 to 6 months, for two years. You then have an MRI scan every 6 months or every year.

Coping with astrocytoma

Coping with a diagnosis of a brain tumour can be difficult, both practically and emotionally. It can be especially difficult when you have a high grade tumour. Being well informed about the type of tumour you have, and its treatment can make it easier to cope.  

Research and clinical trials

Doctors are always trying to improve the diagnosis and treatment of brain tumours. As part of your treatment, your doctor might ask you to take part in a clinical trial. This might be to test a new treatment or look at different combinations of existing treatments.

  • Cancer: Principles and Practice of Oncology (12th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Wolters Kluwer, 2023

  • Brain tumours (primary) and brain metastases in adults
    The National Institute for Health and Care Excellence (NICE), July 2018

  • The incidence of major subtypes of primary brain tumors in adults in England 1995-2017
    H Wanis and others
    Neuro Oncology, 2021 Volume 23, issue 8, pages 1371-1382

  • The 2021 WHO Classification of Tumors of the Central Nervous System: a summary.
    D Louis and others
    Neuro Oncology, 2021 Volume 23, Issue 8, Pages 1231-1251

  • EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood
    M Weller and others
    Nature Reviews Clinical Oncology, 2021. Volume 18, Pages 170 – 186

  • Classification and pathologic diagnosis of gliomas, glioneuronal tumors, and neuronal tumors
    D Louis and others
    UpToDate, accessed February 2023

  • Classification of adult-type diffuse gliomas: Impact of the World Health Organization 2021 update
    B Whitfield and Jason Huse
    Brain Pathology. 2022, issue 32, e13062.

Last reviewed: 
07 Jun 2023
Next review due: 
07 Jun 2026

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