National Cancer Institute

Astrocytomas are tumors that start in star-shaped brain cells called astrocytes. An astrocyte is a type of glial cell. Glial cells hold nerve cells in place and help them work the way they should. There are several types of astrocytomas. They can form anywhere in the central nervous system (brain and spinal cord). Brain tumors are the third most common type of cancer in children.

The tumors may be benign (not cancer) or malignant (cancer). Benign brain tumors grow and press on nearby areas of the brain. They rarely spread into other tissues. Malignant brain tumors are likely to grow quickly and spread into other brain tissue. When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors can cause symptoms and need treatment.

This summary is about the treatment of primary brain tumors that begin in the glial cells in the brain. Information is included about the following tumors that form from glial cells:

Treatment of metastatic brain tumors is not discussed in this summary. Metastatic brain tumors are formed by cancer cells that begin in other parts of the body and spread to the brain.

Brain tumors can occur in both children and adults. However, treatment for children may be different than treatment for adults. (See the PDQ treatment summary on Adult Brain Tumors ¹ for more information.)

The central nervous system controls many important body functions.

Astrocytomas most commonly form in these parts of the central nervous system (CNS):

Cerebrum: The largest part of the brain, at the top of the head. The cerebrum controls thinking, learning, problem-solving, speech, emotions, reading, writing, and voluntary movement.
Cerebellum: The lower, back part of the brain (near the middle of the back of the head). The cerebellum controls movement, balance, and posture.
Brain stem: The part that connects the brain to the spinal cord, in the lowest part of the brain (just above the back of the neck). The brain stem controls breathing, heart rate, and the nerves and muscles used in seeing, hearing, walking, talking, and eating.
Hypothalamus: The area in the middle of the base of the brain that controls body temperature, hunger, and thirst.
Visual pathway: The group of nerves that connect the eye with the brain.
Spinal cord: The column of nerve tissue that runs from the brain stem down the center of the back. It is covered by three thin layers of tissue called membranes. The spinal cord and membranes are surrounded by the vertebrae (back bones). Spinal cord nerves carry messages between the brain and the rest of the body, such as a signal from the brain to cause muscles to move or from the skin to the brain for the sense of touch.

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Enlarge ³ ³	Enlarge ⁴ ⁴
Anatomy of the brain, showing the cerebrum, cerebellum, brain stem, and other parts of the brain.	Anatomy of the inside of the brain, showing the pineal and pituitary glands, optic nerve, ventricles (with cerebrospinal fluid shown in blue), and other parts of the brain.

The cause of most childhood brain tumors is not known.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Parents who think their child may be at risk should discuss this with their child's doctor. Possible risk factors for astrocytoma include:

Past radiation therapy to the brain.
Having certain genetic disorders, such as neurofibromatosis type 1 (NF1).

Having NF1 may increase a child's risk of a type of tumor called visual pathway glioma. These tumors usually do not cause symptoms. Children with NF1 who develop visual pathway gliomas may not need treatment for the tumor unless symptoms, such as vision problems, appear or the tumor grows.

The symptoms of astrocytomas are not the same in every child.

Symptoms are different depending on the following:

Where the tumor forms in the brain or spinal cord.
The size of the tumor.
How fast the tumor grows.
The child's age and development.

Some tumors do not cause symptoms. Other conditions may cause the same symptoms as those caused by childhood astrocytomas. Check with your child's doctor if any of the following problems occur:

Morning headache or headache that goes away after vomiting.
Nausea and vomiting.
Vision, hearing, and speech problems.
Loss of balance and trouble walking.
Worsening handwriting or slow speech.
Weakness or change in feeling on one side of the body.
Unusual sleepiness or change in energy level.
Change in personality or behavior.
Seizures.
Weight loss or weight gain for no known reason.
Increase in the size of the head (in infants).

Tests that examine the brain and spinal cord are used to detect (find) childhood astrocytomas.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health. This includes checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). Sometimes magnetic resonance spectroscopy (MRS) is done during the same MRI scan to look at the chemical makeup of the brain tissue.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Childhood astrocytomas are diagnosed and removed in surgery.

If doctors think there may be an astrocytoma, a biopsy may be done to remove a sample of tissue. For tumors in the brain, the biopsy is done by removing part of the skull and using a needle to remove tissue. Sometimes, the needle is guided by a computer. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor may remove as much tumor as safely possible during the same surgery. Because it can be hard to tell the difference between types of brain tumors, you may want to have your child's tissue sample checked by a pathologist who has experience in diagnosing brain tumors.

The following tests may be done on the tissue that was removed:

Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer. An MIB-1 test is a type of immunohistochemistry study that checks tumor tissue for an antigen called MIB-1. This may show how fast a tumor is growing.
Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.

A biopsy may not be needed for children who have NF1.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

Where the astrocytoma has formed in the CNS and if it has spread.
Whether there are cancer cells left after surgery.
The type and grade of astrocytoma.
Whether the child has NF1.
Whether there are certain changes in the genes.
The child’s age.
Whether the astrocytoma has just been diagnosed or has recurred (come back).

For recurrent astrocytoma, prognosis and treatment depend on how long it was from the time treatment ended to the time the astrocytoma recurred.

Stages of Childhood Astrocytomas

Key Points for This Section

The grade of the tumor is used in place of a staging system to plan cancer treatment.
- Low-grade astrocytomas
- High-grade astrocytomas
Tests are done to find out how much tumor remains after surgery and to plan further treatment.
There are three ways that cancer spreads in the body.

The grade of the tumor is used in place of a staging system to plan cancer treatment.

Staging is the process used to find out how much cancer there is and if cancer has spread. It is important to know the stage in order to plan treatment.

There is no standard staging system for childhood astrocytoma. Treatment is based on the grade of the tumor and whether it is untreated or recurrent (has come back after treatment). The grade of the tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread.

The following grades are used:

Low-grade astrocytomas

Low-grade astrocytomas are slow-growing and rarely spread to other parts of the brain and spinal cord or other parts of the body. These include grade I (pilocytic, which form like a cyst and look almost like normal cells) and grade II (fibrillary, with cells that look long or slender like fibers) astrocytomas.

High-grade astrocytomas

High-grade astrocytomas are fast-growing and often spread within the brain and spinal cord. These include grade III (anaplastic or malignant) and grade IV (glioblastoma, which spreads the fastest) astrocytomas.

Childhood astrocytomas may form at more than one place in the brain, but they do not usually spread to other parts of the body. Children who have neurofibromatosis type 1 are more likely to have tumors in more than one place.

Tests are done to find out how much tumor remains after surgery and to plan further treatment.

Some of the tests used to detect astrocytomas are repeated after the tumor is removed. (See the General Information ⁵ section.) This is to find out how much tumor remains after surgery and to plan further treatment. An MRI (magnetic resonance imaging) is done in the first 2 days after the surgery to see if there is any tumor left.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

Through tissue. Cancer invades the surrounding normal tissue.
Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Recurrent Childhood Astrocytomas

A recurrent childhood astrocytoma is an astrocytoma that has recurred (come back) after it has been treated. The cancer may come back in the same place as the first tumor or in other parts of the body. High-grade astrocytomas often recur within 3 years.

Treatment Option Overview

Key Points for This Section

There are different types of treatment for patients with childhood astrocytoma.
Children with astrocytomas should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.
Childhood brain tumors may cause symptoms that begin before diagnosis and continue for months or years.
Some cancer treatments cause side effects months or years after treatment has ended.
Six types of standard treatment are used:
New types of treatment are being tested in clinical trials.
- Targeted therapy
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.

There are different types of treatment for patients with childhood astrocytoma.

Different types of treatment are available for children with astrocytomas. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with astrocytomas should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other healthcare providers who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

Childhood brain tumors may cause symptoms that begin before diagnosis and continue for months or years.

Symptoms caused by the tumor may begin before diagnosis. These symptoms may continue for months or years. It is important to talk with your child's doctors about symptoms caused by the tumor that may continue after treatment.

Some cancer treatments cause side effects months or years after treatment has ended.

Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:

Physical problems.
Changes in mood, feelings, thinking, learning, or memory.
Second cancers (new types of cancer).

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer ⁶ for more information).

Six types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood astrocytoma as discussed in the General Information ⁷ section of this summary. If cancer cells remain after surgery, further treatment depends on:

Where the remaining cancer cells are.
The grade of the tumor.
Age of the child.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Cerebrospinal fluid diversion

Cerebrospinal fluid diversion is a method used to drain fluid that has built up around the brain and spinal cord. A shunt (long, thin tube) is placed in a ventricle (fluid-filled space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries excess fluid away from the brain so it may be absorbed elsewhere in the body.

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Cerebrospinal fluid (CSF) diversion; drawing shows extra CSF flowing through a tube (shunt) from a ventricle in the brain into the abdomen. The shunt goes from the ventricle, under the skin in the neck and chest, and into the abdomen. Also shown is a valve that controls the flow of CSF.

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Cerebrospinal fluid (CSF) diversion. Extra CSF is removed from a ventricle in the brain through a shunt (tube) and is emptied into the abdomen. A valve controls the flow of CSF.

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. Watchful waiting is often used for patients who have neurofibromatosis type1 or a tumor that is not growing and spreading.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and location of cancer being treated.

Radiation therapy to the brain can affect growth and development in young children. Certain ways of giving radiation therapy can lessen the damage to healthy brain tissue:

Conformal radiation therapy is a type of external radiation therapy. It uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to normal tissue around the tumor.
Stereotactic radiation therapy uses a rigid head frame attached to the skull to aim radiation directly to a tumor, causing less damage to normal tissue around the tumor. The total dose of radiation is divided into several smaller doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.

For children younger than 3 years, chemotherapy may be given instead, to delay or reduce the need for radiation therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and location of the cancer being treated.

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site ⁹.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. One type of targeted therapy under study for childhood astrocytomas is monoclonal antibody therapy.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. (See the General Information ⁵ section for a list of tests.) Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the astrocytoma has recurred (come back). If the tumor recurs in the brain, a biopsy may also be done to find out if it is made up of dead tumor cells or if new cancer cells are growing. These tests are sometimes called follow-up tests or check-ups. MRIs may be done regularly as follow-up to see if the tumor is growing back.

Treatment Options for Childhood Astrocytomas

Childhood Low-Grade Astrocytomas

When the tumor is first diagnosed, treatment for childhood low-grade astrocytoma depends on the location of the tumor and is usually surgery. An MRI is done after surgery to see if there is tumor remaining.

If the tumor was completely removed by surgery, more treatment may not be needed and the child is closely watched to see if symptoms appear or change. This is also called watchful waiting.

If there is tumor remaining after surgery, treatment may include the following:

Watchful waiting.
More surgery to remove the tumor.
Cerebrospinal fluid diversion.
Radiation therapy, which may include conformal radiation therapy or stereotactic radiation therapy.
Combination chemotherapy with or without radiation therapy.
A clinical trial of a new treatment.

In some cases, children who have a visual pathway glioma will be treated by watchful waiting. In other cases, treatment may include surgery or radiation therapy. A goal of treatment is to save as much vision as possible. The effect of tumor growth on the child's vision will be closely followed during treatment.

Children with neurofibromatosis type 1 (NF1) may not need treatment unless the tumor grows or symptoms, such as vision problems, appear.

Children with tuberous sclerosis may develop benign (not cancer) tumors in the brain called subependymal giant cell astrocytomas (SEGAs). These tumors may be treated with drugs to shrink them instead of surgery.

Recurrent Childhood Low-Grade Astrocytomas

Before more cancer treatment is given, imaging tests, biopsy, or surgery are done to be sure cancer is present and find out how much cancer there is.

Treatment of recurrent childhood low-grade astrocytoma may include the following:

More surgery to remove the tumor.
Radiation therapy to the tumor only, if radiation therapy was not used when the tumor was first diagnosed. Conformal radiation therapy may be given.
Surgery, chemotherapy, and/or radiation therapy, if the patient had only surgery when the tumor was first diagnosed.
Chemotherapy if the tumor recurred after treatment with radiation therapy.
Chemotherapy if the tumor recurred where it cannot be removed by surgery and the patient had radiation therapy when the tumor was first diagnosed.
A clinical trial of a new treatment.

Childhood High-Grade Astrocytomas

Treatment of childhood high-grade astrocytoma may include the following:

Surgery, chemotherapy, and radiation therapy to the tumor.
A clinical trial of chemotherapy with or without radiation therapy.
A clinical trial of targeted therapy with a monoclonal antibody or chemotherapy given at the same time as radiation therapy to the tumor, followed by more treatment with targeted therapy and chemotherapy.

Recurrent Childhood High-Grade Astrocytomas

Treatment of recurrent childhood high-grade astrocytoma may include the following:

Surgery.
High-dose chemotherapy with stem cell transplant.
A clinical trial of a new treatment.

Current Clinical Trials

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood astrocytoma ¹⁰. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ¹¹.

To Learn More About Childhood Astrocytomas

For more information from the National Cancer Institute about childhood astrocytomas, see the following:

What You Need to Know About™ Brain Tumors ¹²
Targeted Cancer Therapies ¹³
Understanding Cancer Series: Targeted Therapies ¹⁴ (Advances in Targeted Therapies)
Pediatric Brain Tumor Consortium (PBTC) ¹⁵

For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:

Changes to This Summary (05/17/2012)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

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About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ²⁹. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ¹¹. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

The PDQ database contains listings of groups specializing in clinical trials.

The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site ²⁹ or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Glossary Terms

antibody (AN-tee-BAH-dee)

A protein made by plasma cells (a type of white blood cell) in response to an antigen (a substance that causes the body to make a specific immune response). Each antibody can bind to only one specific antigen. The purpose of this binding is to help destroy the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen.

antigen (AN-tih-jen)

Any substance that causes the body to make a specific immune response.

astrocyte (AS-troh-site)

A large, star-shaped cell that holds nerve cells in place and helps them develop and work the way they should. An astrocyte is a type of glial cell.

astrocytoma (AS-troh-sy-TOH-muh)

A tumor that begins in the brain or spinal cord in small, star-shaped cells called astrocytes.

benign (beh-NINE)

Not cancerous. Benign tumors may grow larger but do not spread to other parts of the body. Also called nonmalignant.

biopsy (BY-op-see)

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

brain stem (brayn stem)

The part of the brain that is connected to the spinal cord.

brain tumor (brayn TOO-mer)

The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancer).

cancer (KAN-ser)

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

cell (sel)

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

central nervous system (SEN-trul NER-vus SIS-tem)

The brain and spinal cord. Also called CNS.

cerebellum (SAYR-eh-BEH-lum)

The portion of the brain in the back of the head between the cerebrum and the brain stem. The cerebellum controls balance for walking and standing, and other complex motor functions.

cerebrum (seh-REE-brum)

The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. Areas within the cerebrum control muscle functions and also control speech, thought, emotions, reading, writing, and learning.

chemical (KEH-mih-kul)

A substance made up of elements, such as hydrogen or sodium.

chromosome (KROH-muh-some)

Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes.

condition (kun-DIH-shun)

In medicine, a health problem with certain characteristics or symptoms.

contrast material (KON-trast muh-TEER-ee-ul)

A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.

CT scan (… skan)

A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.

cytogenetics (SY-toh-jeh-NEH-tix)

The study of chromosomes and chromosomal abnormalities.

diagnosis (DY-ug-NOH-sis)

The process of identifying a disease, such as cancer, from its signs and symptoms.

disorder (dis-OR-der)

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

electron microscope (ee-LEK-tron MY-kroh-SKOPE)

A microscope (device used to magnify small objects) that uses electrons (instead of light) to produce an enlarged image. An electron microscope shows tiny details better than any other type of microscope.

gadolinium (GA-duh-LIH-nee-um)

A metal element that is used in magnetic resonance imaging (MRI) and other imaging methods. It is a contrast agent, which helps show abnormal tissue in the body during imaging with a special machine.

gene (jeen)

The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.

genetic (jeh-NEH-tik)

Inherited; having to do with information that is passed from parents to offspring through genes in sperm and egg cells.

glial cell (GLEE-ul sel)

Any of the cells that hold nerve cells in place and help them work the way they should. The types of glial cells include oligodendrocytes, astrocytes, microglia, and ependymal cells. Also called neuroglia.

glioblastoma (GLEE-oh-blas-TOH-muh)

A fast-growing type of central nervous system tumor that forms from glial (supportive) tissue of the brain and spinal cord and has cells that look very different from normal cells. Glioblastoma usually occurs in adults and affects the brain more often than the spinal cord. Also called GBM, glioblastoma multiforme, and grade IV astrocytoma.

grade (grayd)

A description of a tumor based on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.

immunohistochemistry (IH-myoo-noh-HIS-toh-KEH-mih-stree)

A technique used to identify specific molecules in different kinds of tissue. The tissue is treated with antibodies that bind the specific molecule. These are made visible under a microscope by using a color reaction, a radioisotope, colloidal gold, or a fluorescent dye. Immunohistochemistry is used to help diagnose diseases, such as cancer, and to detect the presence of microorganisms. It is also used in basic research to understand how cells grow and differentiate (become more specialized).

injection (in-JEK-shun)

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

laboratory test (LA-bruh-tor-ee...)

A medical procedure that involves testing a sample of blood, urine, or other substance from the body. Tests can help determine a diagnosis, plan treatment, check to see if treatment is working, or monitor the disease over time.

light microscope (lite MY-kroh-SKOPE)

A microscope (device to magnify small objects) in which objects are lit directly by white light.

magnetic resonance spectroscopic imaging (mag-NEH-tik REH-zuh-nunts SPEK-troh-SKAH-pik IH-muh-jing)

A noninvasive imaging method that provides information about cellular activity (metabolic information). It is used along with magnetic resonance imaging (MRI) which provides information about the shape and size of the tumor (spatial information). Also called 1H-nuclear magnetic resonance spectroscopic imaging, MRSI, and proton magnetic resonance spectroscopic imaging.

malignant (muh-LIG-nunt)

Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.

medical history (MEH-dih-kul HIH-stuh-ree)

A record of information about a person’s health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise. A family medical history includes health information about a person’s close family members (parents, grandparents, children, brothers, and sisters). This includes their current and past illnesses. A family medical history may show a pattern of certain diseases in a family.

membrane (MEM-brayn)

A very thin layer of tissue that covers a surface.

metastatic (meh-tuh-STA-tik)

Having to do with metastasis, which is the spread of cancer from the primary site (place where it started) to other places in the body.

microscope (MY-kroh-SKOPE)

An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.

MRI

A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.

National Cancer Institute (NA-shuh-nul KAN-ser IN-stih-TOOT)

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

nausea (NAW-zee-uh)

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

nerve (nerv)

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

nerve cell (nerv sel)

A type of cell that receives and sends messages from the body to the brain and back to the body. The messages are sent by a weak electrical current. Also called neuron.

neurofibromatosis type 1 (NOOR-oh-FY-broh-muh-TOH-sis ...)

A rare genetic condition that causes brown spots and tumors on the skin, freckling in skin areas not exposed to the sun, tumors on the nerves, and developmental changes in the nervous system, muscles, bone, and skin. Also called NF1.

neurological exam (NOOR-oh-LAH-jih-kul eg-ZAM)

A series of questions and tests to check brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, ability to walk, and how well the muscles, sensory systems, and deep tendon reflexes work.

oligoastrocytoma (AH-lih-goh-AS-troh-sy-TOH-muh)

A brain tumor that forms from both oligodendrocytes and astrocytes, which are types of glial cells (cells that cover and protect nerve cells in the brain and spinal cord and help them work the way they should). An oligoastrocytoma is a type of mixed glioma.

oligodendroglioma (AH-lih-goh-DEN-droh-glee-OH-muh)

A rare, slow-growing tumor that begins in oligodendrocytes (cells that cover and protect nerve cells in the brain and spinal cord). Also called oligodendroglial tumor.

organ (OR-gun)

A part of the body that performs a specific function. For example, the heart is an organ.

pathologist (puh-THAH-loh-jist)

A doctor who identifies diseases by studying cells and tissues under a microscope.

PDQ

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)

An exam of the body to check for general signs of disease.

primary tumor (PRY-mayr-ee TOO-mer)

The original tumor.

prognosis (prog-NO-sis)

The likely outcome or course of a disease; the chance of recovery or recurrence.

radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

radioisotope (RAY-dee-oh-I-suh-tope)

An unstable form of a chemical element that releases radiation as it breaks down and becomes more stable. Radioisotopes may occur in nature or be made in a laboratory. In medicine, they are used in imaging tests and in treatment. Also called radionuclide.

recover (ree-KUH-ver)

To become well and healthy again.

recur (ree-KER)

To come back or to return.

recurrent cancer (ree-KER-ent KAN-ser)

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrence.

risk factor (... FAK-ter)

Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.

seizure (SEE-zher)

Sudden, uncontrolled body movements and changes in behavior that occur because of abnormal electrical activity in the brain. Symptoms include loss of awareness, changes in emotion, loss of muscle control, and shaking. Seizures may be caused by drugs, high fevers, head injuries, and certain diseases, such as epilepsy.

spinal cord (SPY-nul kord)

A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.

surgery (SER-juh-ree)

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

symptom (SIMP-tum)

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

tissue (TIH-shoo)

A group or layer of cells that work together to perform a specific function.

tumor (TOO-mer)

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

vein (vayn)

A blood vessel that carries blood to the heart from tissues and organs in the body.

visual pathway glioma (VIH-zhoo-ul ... glee-OH-muh)

A rare, slow-growing tumor that usually forms in the optic nerve, optic chiasm, or optic tract. These are parts of the nervous system that carry messages from the eye to the brain. Also called optic pathway glioma.

vomit (VAH-mit)

To eject some or all of the contents of the stomach through the mouth.

x-ray (EX-ray)

A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.

Table of Links
¹	http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/Patient
²	http://www.cancer.gov/cancertopics/pdq/treatment/child-astrocytomas/patient/Tab le1
³	http://www.cancer.gov/PublishedContent/MediaLinks/305864.html
⁴	http://www.cancer.gov/PublishedContent/MediaLinks/305865.html
⁵	http://www.cancer.gov/cancertopics/pdq/treatment/child-astrocytomas/patient/#Se ction_16
⁶	http://www.cancer.gov/cancertopics/pdq/treatment/lateeffects/Patient
⁷	http://www.cancer.gov/cancertopics/pdq/treatment/child-astrocytomas/patient/#Se ction_94
⁸	http://www.cancer.gov/PublishedContent/MediaLinks/305866.html
⁹	http://cancer.gov/clinicaltrials
¹⁰	http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?Diagnosis=659536&tt=1& amp;format=1&cn=1
¹¹	http://www.cancer.gov/clinicaltrials
¹²	http://www.cancer.gov/cancertopics/wyntk/brain
¹³	http://www.cancer.gov/cancertopics/factsheet/Therapy/targeted
¹⁴	http://www.cancer.gov/cancertopics/understandingcancer/targetedtherapies
¹⁵	http://www.pbtc.org/public/gen_info.htm
¹⁶	http://www.cancer.gov/cancertopics/wyntk/overview
¹⁷	http://www.cancer.gov/cancertopics/types/childhoodcancers
¹⁸	http://www.curesearch.org
¹⁹	http://www.cancer.gov/cancertopics/aya
²⁰	http://www.cancer.gov/cancertopics/youngpeople
²¹	http://www.cancer.gov/cancertopics/factsheet/NCI/children-adolescents
²²	http://www.cancer.gov/cancertopics/understandingcancer/cancer
²³	http://www.cancer.gov/cancertopics/factsheet/Detection/staging
²⁴	http://www.cancer.gov/cancertopics/coping
²⁵	http://www.cancer.gov/cancertopics/cancerlibrary/questions
²⁶	http://www.cancer.gov/cancertopics/literature
²⁷	http://dccps.nci.nih.gov/ocs/resources.html
²⁸	https://livehelp.cancer.gov
²⁹	http://cancer.gov
³⁰	https://pubs.cancer.gov/ncipl