General Information About Childhood Cerebellar Astrocytoma
Stages of Childhood Cerebellar Astrocytoma
Recurrent Childhood Cerebellar Astrocytoma
Treatment Option Overview
Treatment Options for Childhood Cerebellar Astrocytoma

Untreated Childhood Cerebellar Astrocytoma Recurrent Childhood Cerebellar Astrocytoma

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Changes to This Summary (08/17/2004)
About PDQ

General Information About Childhood Cerebellar Astrocytoma

Key Points for This Section

Childhood cerebellar astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain. The cause of most childhood brain tumors is unknown. The symptoms of childhood cerebellar astrocytoma vary and often depend on the child’s age and where the tumor is located. Tests that examine the brain and spinal cord are used to detect (find) childhood cerebellar astrocytoma. Childhood cerebellar astrocytoma is diagnosed and removed in surgery. Certain factors affect prognosis (chance of recovery) and treatment options.

Childhood cerebellar astrocytoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.

Astrocytomas are tumors that develop from brain cells called astrocytes. Cerebellar astrocytomas start in the cerebellum, which is located at the lower back of the brain. The cerebellum is the part of the brain that controls movement, balance, and posture.

About 15-25% of all childhood brain tumors are cerebellar astrocytomas. Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma.

This summary refers to the treatment of primary brain tumors (tumors that begin in the brain). Treatment for metastatic brain tumors, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary.

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

The cause of most childhood brain tumors is unknown.

The symptoms of childhood cerebellar astrocytoma vary and often depend on the child’s age and where the tumor is located.

These symptoms may be caused by an astrocytoma or other conditions. A doctor should be consulted if any of the following problems occur:

• Loss of balance, difficulty walking, worsening handwriting, or slow speech.
• Morning headache or headache that goes away after vomiting.
• Nausea and vomiting.
• Unusual sleepiness or change in energy level.
• Change in personality or behavior.
• Unexplained weight loss or weight gain.

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

The following tests and procedures may be used:

• 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.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through 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).

Childhood cerebellar astrocytoma is diagnosed and removed in surgery.

If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the brain tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.

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

The prognosis (chance of recovery) depends on:

• The type of astrocytoma.
• Whether cancer cells remain after surgery.

Treatment options depend on:

• Whether cancer cells remain after surgery or have spread to other parts of the brain.
• The location of the tumor.
• The child’s age.

Stages of Childhood Cerebellar Astrocytoma

After the childhood cerebellar astrocytoma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages. For childhood cerebellar astrocytoma, the grade of the tumor is used instead of stages. The grade of the tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment.

There are two grades for childhood cerebellar astrocytoma:

• Grade I pilocytic tumors are very slow-growing and rarely spread. These tumors form inside cysts.
• Grade II diffuse or fibrillary tumors spread slowly within the brain.

The following procedure may be used to determine if any cancer cells remain in the brain after surgery:

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through 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).

Cerebellar astrocytomas do not usually spread from the cerebellum to other parts of the brain or body.

Recurrent Childhood Cerebellar Astrocytoma

Recurrent childhood cerebellar astrocytoma is a tumor that has recurred (come back) after it has been treated. Childhood cerebellar astrocytoma may recur many years after initial treatment. The tumor may recur at the same place in the brain or in other parts of the central nervous system (brain and spinal cord), especially if the original tumor was a diffuse or fibrillary tumor.

Treatment Option Overview

Key Points for This Section

There are different types of treatment for children with cerebellar astrocytoma. Children with cerebellar astrocytoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors. Three types of standard treatment are used: Surgery Radiation therapy Chemotherapy Other types of treatment are being tested in clinical trials.

There are different types of treatment for children with cerebellar astrocytoma.

Different types of treatment are available for children with cerebellar astrocytoma. 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. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site ². Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with cerebellar astrocytoma should have their treatment planned by a team of doctors with expertise in treating childhood brain tumors.

Your child’s treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other pediatric doctors who have experience and expertise in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

• Neurosurgeon.
• Neurologist.
• Neuropathologist.
• Neuroradiologist.
• Rehabilitation specialist.
• Radiation oncologist.
• Medical oncologist.
• Endocrinologist.
• Psychologist.

Three types of standard treatment are used:

Surgery

Surgery is used to diagnose and treat childhood cerebellar astrocytoma as discussed in the General Information ³ section of this summary.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. 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 stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells 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 in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials.

Information about ongoing clinical trials is available from the NCI Cancer.gov Web site ².

Treatment Options for Childhood Cerebellar Astrocytoma

Untreated Childhood Cerebellar Astrocytoma

Untreated childhood cerebellar astrocytoma is a tumor for which no treatment has been given. The child may have received drugs or treatment to relieve symptoms caused by the tumor.

Initial treatment for childhood cerebellar astrocytoma is usually surgery. When the tumor is completely removed by surgery, more treatment may not be needed and the child is closely observed for symptoms to appear or change. This is also called watchful waiting.

If cancer cells remain after surgery, treatment depends on the location of the remaining cancer cells and the age of the child. Standard treatment may include the following:

• Watchful waiting.
• Another surgery to remove the tumor.
• Radiation therapy.
• Chemotherapy.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with untreated childhood cerebellar astrocytoma ⁴.

Standard treatment of recurrent childhood cerebellar astrocytoma may include the following:

• Surgery.
• Radiation therapy.
• Chemotherapy.

Some of the treatments being studied in clinical trials for recurrent childhood cerebellar astrocytoma include the following:

• A clinical trial of new anticancer drugs.

Information about this and other ongoing clinical trials is available from the NCI Cancer.gov Web site ².

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood cerebellar astrocytoma ⁵.

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Changes to This Summary (08/17/2004)

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.

Editorial changes were made to this summary.

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 ⁷. 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 ⁹. 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), TTY at 1-800-332-8615.

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 ⁷ or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

The PDQ database contains listings of cancer health professionals and hospitals with cancer programs.

Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

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

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.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is 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.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

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

CNS. The brain and spinal cord. Also called CNS.

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.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

Computed tomography scan. 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 computed tomography scan, computerized tomography, computerized axial tomography scan, and CAT scan.

A sac or capsule in the body. It may be filled with fluid or other material.

A doctor who specializes in diagnosing and treating hormone disorders.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

The grade of a tumor depends 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.

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, radiation brachytherapy, and implant radiation therapy.

Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.

Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.

A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

Cancer that has spread from the place in which it started to other parts of the body.

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, nuclear magnetic resonance imaging, and NMRI.

A doctor who specializes in the diagnosis and treatment of disorders of the nervous system.

A doctor who specializes in surgery on the brain, spine, and other parts of the nervous system.

A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.

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

Having to do with children.

The original tumor.

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

A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.

Energy released in the form of particles or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, and medical x-rays.

A doctor who specializes in using radiation to treat cancer.

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 radiotherapy and irradiation.

Giving off radiation.

A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.

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.

A healthcare professional who helps people recover from an illness or injury and return to daily life. Examples of rehabilitation specialists are physical therapists and occupational therapists.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called standard of care or best practice.

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

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

Treatment with anticancer drugs that travel through the blood to cells all over the body.

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

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 cancerous), or malignant (cancerous). Also called neoplasm.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called observation.

A type of high-energy radiation. 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.