Overview

Astrocytoma is a type of brain tumor or spinal cord tumor. It starts in cells called astrocytes. These star-shaped cells help keep nerve cells healthy and working as they should.

Astrocytoma symptoms depend on where the tumor grows. A brain astrocytoma can cause headaches, seizures, nausea, or changes in mood or behavior. A spinal cord astrocytoma may cause weakness or trouble moving the arms or legs.

Astrocytomas can behave in different ways. Some are slower growing and considered less aggressive, while others grow and spread more quickly. Doctors often test the tumor's genes or molecular features to help choose the best treatment.

Astrocytoma is part of a larger group of brain tumors called gliomas. These tumors start in cells that help support nerve cells. Astrocytomas are graded 1 to 4 based on how fast they grow. Grade 4 astrocytoma, also called glioblastoma, grows the fastest and is the most aggressive. Lower grade astrocytomas, grades 1 to 3, usually grow more slowly. They often have a better outlook than glioblastoma. Treatment and prognosis depend on the tumor's grade, size, location and molecular features.

Symptoms

Astrocytoma symptoms often start out as mild. Symptoms depend on where the tumor is in the brain or spinal cord. These brain tumor symptoms can change as the tumor grows. Early symptoms come from local irritation of the nearby brain tissue. Later symptoms happen as the brain tumor grows and pressure builds in the brain or spinal canal.

Low-grade astrocytomas can grow larger before causing symptoms, while high-grade brain tumors tend to cause symptoms sooner.

Early symptoms of astrocytoma

  • New seizures, which are often the first sign in slow-growing tumors.
  • Subtle changes in thinking, mood or memory.
  • Mild headaches.
  • Difficulty finding the right words to say.
  • Changes in vision.
  • Clumsiness on one side of the body.
  • Pain in the neck or back that begins slowly.
  • Tingling or numbness that travels into an arm or leg.

Later symptoms of astrocytoma as the tumor grows

  • Headaches that get worse, especially in the morning or with coughing or straining.
  • Nausea and vomiting, which can happen as a result of increased pressure.
  • Increasing weakness.
  • Speech or vision troubles.
  • Changes in memory, thinking or concentration, called cognitive decline.
  • Worsening balance.
  • Bowel or bladder changes.

Astrocytoma symptoms by tumor location

An astrocytoma may start in the brain or the spinal cord. The signs and symptoms often look different depending on the location of the tumor.

Back and lower part of brain

  • Trouble with balance and coordination such as stumbling or shaky movements.
  • Headache, nausea and vomiting from pressure in the brain.

Brainstem

  • Double vision or other eye movement issues.
  • Facial weakness or lack of feeling in the face.
  • Difficulty speaking or swallowing.
  • Difficulty with walking and balance.
  • Weakness.

Spinal cord

  • Back or neck pain that slowly gets worse.
  • Pain that spreads into an arm or leg.
  • Numbness and tingling.
  • Weakness.
  • Poor balance, falls and unsteadiness when walking.
  • Bowel or bladder changes that may occur later.

These symptoms aren't necessarily specific to astrocytoma but can happen with many types of brain tumors. New symptoms or symptoms that get worse should be checked by your healthcare professional. These symptoms include a first-time seizure, vision changes, speech trouble, one-sided weakness or headaches that are worse in the morning.

Can swelling, called edema, around the tumor worsen symptoms?

Yes. Swelling of brain tissue around the tumor is called peritumoral edema. It can make symptoms worse or cause new symptoms to appear. These symptoms may include headaches, weakness, speech trouble or vision changes. The swelling increases pressure inside the skull and can stretch or irritate nearby brain pathways. This may worsen common symptoms. Short courses of steroid medicines may be used to reduce swelling and relieve symptoms.

Edema is more common in high-grade astrocytomas and contributes to symptoms even when the tumor itself is not very large.

How do children's symptoms of pilocytic astrocytoma differ from adult symptoms?

Pilocytic astrocytomas are a type of astrocytoma that are more common in children and teens. Adults can have these tumors, but it is rare. Because pilocytic astrocytomas grow slowly, symptoms often develop gradually over weeks or months.

Children may have:

  • Headaches, especially in the morning.
  • Balance problems or clumsiness if the tumor is in the cerebellum.
  • Nausea, vomiting or irritability from pressure in the brain.
  • Vision problems if the tumor affects the optic pathway.

In very young children, parents may notice changes in coordination, school performance or behavior.

In adults, astrocytomas are more likely to develop in a different part of the brain. They may cause new seizures, speech issues, or changes in thinking or personality as early symptoms.

Astrocytoma grading system

Astrocytomas are sorted into grades depending on how their cells appear and act under a microscope. The World Health Organization (WHO) created this grading system to help predict how quickly the tumor might grow or spread and to guide treatment decisions.

Grade Name How it behaves Notes
1 Pilocytic astrocytoma Least aggressive. Grows slowly and usually has clear edges. Often treated successfully with surgery alone. It's considered nonmalignant (benign). Most people are cured with surgery and live a typical lifespan.
2 Diffuse astrocytoma Slow growing but often grows into nearby brain tissue, which can make complete removal difficult. Cells look only slightly different from typical under the microscope. Treatment usually involves surgery to remove as much of the tumor as safely possible followed by radiation or chemotherapy or both. Median survival is between 7 and 8 years.
3 Anaplastic astrocytoma High-grade. Grows faster than grade 2 and is more serious. Requires more aggressive treatment. Treatment usually involves surgery to remove as much tumor as safely possible, followed by radiation therapy and chemotherapy. Overall median survival is about 5 years or longer depending on the tumor type.
4 Glioblastoma Most aggressive. Can arise from a lower grade tumor or appear suddenly as high-grade disease. Most common in adults. Treatment is usually surgery followed by radiation and chemotherapy. Median survival is around 15 months.

Circumscribed versus diffuse tumors

Some astrocytomas are called circumscribed, and others are called diffuse. Circumscribed means the tumor is well defined and localized. Diffuse astrocytomas spread into nearby brain tissue. Circumscribed defines the growth pattern and the category of the tumor, but not the grade. Pilocytic and pleomorphic xanthoastrocytoma (PXA) are circumscribed tumors. These are grouped separately from diffuse astrocytomas.

IDH tumors

IDH is a gene found in cells. There are two: IDH1 and IDH2. When a tumor is IDH wild type, it means the IDH gene looks healthy and there's no change to the IDH gene in the tumor cells. Glioblastoma is an IDH wild-type tumor.

When a tumor is IDH mutant, there is a change in the IDH1 or IDH2 gene. In the current WHO system, if lab tests show an IDH change, the tumor is named astrocytoma, IDH mutant. After naming the type, a grade is assigned — 2, 3 or 4 — based on how fast it's likely to grow. IDH testing helps the healthcare team classify the tumor and predict how it may behave.

When to see a doctor

Make an appointment with a healthcare professional if you have ongoing symptoms that worry you.

Causes

The exact cause of astrocytoma, a type of brain or spinal cord tumor, often isn't known. It starts when brain or spinal cord cells called astrocytes begin to grow and divide in an unusual and uncontrolled way. Astrocytes usually support and protect cells in the brain and spinal cord.

Astrocytoma happens when astrocytes develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time.

In tumor cells, the changes in the DNA give different instructions. These gene changes are called mutations. They likely cause astrocytoma by affecting how cells control growth and repair damage. The changed genes make the cells divide when they shouldn't and live longer than they should. This causes too many cells to group together and form a tumor.

As the tumor grows, it can press on nearby areas of the brain or spinal cord. Sometimes the DNA changes turn the tumor cells into cancer cells. Cancer cells can invade and destroy healthy body tissue.

Scientists have found that certain gene changes inside the tumor drive this unhealthy growth of astrocytoma cells:

  • IDH1 and IDH2 gene changes affect how tumor cells make and use energy. They are common in many low-grade astrocytomas.
  • TP53 and ATRX gene changes affect how cells repair DNA and manage cell growth.
  • MGMT gene silencing affects how tumor cells repair DNA damage and can affect how well treatment works.
  • In children, BRAF gene changes are often seen in slow-growing brain tumors called pilocytic astrocytomas. These gene changes develop inside the tumor and are not usually passed down in families.

Pilocytic astrocytoma tumors happen when a growth signal in the cell gets stuck "on." This causes the cells to grow slowly in one spot. High-grade astrocytomas develop after many harmful DNA changes build up. This makes the cells grow quickly and spread into nearby brain tissue.

Risk factors

Astrocytoma risk factors include:

  • History of high-dose ionizing radiation therapy to the head or neck. If you had high-dose radiation for another cancer, your risk may be higher. This is especially true if the radiation was near the head or neck and especially during childhood.
  • Age. Astrocytomas can occur in both children and adults. Children more often have low-grade tumors, which tend to grow slowly. Adults more often have high-grade tumors, which grow more quickly and act more aggressively. Most high-grade astrocytomas are diagnosed after age 40.
  • Inherited conditions. Certain rare conditions that run in families, such as neurofibromatosis type 1 (NF1), Lynch syndrome, Turcot syndrome and tuberous sclerosis may increase risk.

Could lifestyle or the environment cause astrocytoma?

There's no proven link between lifestyle factors, such as diet, exercise or smoking, and astrocytoma. Other suspected environmental risks, such as chemical exposures or cellphone use, have not been shown to cause astrocytoma. Most cases appear by chance, without a clear outside trigger.

There is no known way to prevent astrocytoma.

Complications

Astrocytomas can cause complications as the tumor grows or as a result of treatment. Possible astrocytoma complications include:

  • Neurological issues. The tumor may press on parts of the brain or spinal cord. This can lead to headaches, seizures, trouble speaking, weakness or difficulty walking.
  • Tumor recurrence. Even after treatment, astrocytomas may come back, especially if they are high grade or could not be fully removed.
  • Treatment risks and side effects. Surgery, radiation and chemotherapy sometimes can cause side effects such as trouble with memory or thinking, seizures, headaches, nausea, or fatigue. In some cases, treatment may damage healthy brain tissue.

Your care team works with you to help manage these issues and support your quality of life.

By Mayo Clinic Staff