星形细胞瘤

概述

星形细胞瘤是一种始于脑或脊髓的细胞生长物。生长物被称为肿瘤，始于星形胶质细胞。星形胶质细胞支持和连接脑和脊髓中的神经细胞。

星形细胞瘤的症状取决于肿瘤的位置。脑部星形细胞瘤可引起人格改变、癫痫发作、头痛和恶心。脊髓星形细胞瘤可导致肿瘤生长受累区域变得虚弱并丧失功能。

一些星形细胞瘤生长缓慢。它们未被视为癌症。这些非癌性肿瘤有时被称为良性星形细胞瘤。大多数星形细胞瘤生长迅速，被认为是脑癌。这些有时被称为恶性星形细胞瘤。您的肿瘤是良性还是恶性是医疗护理团队在制定治疗计划时需考虑的一个因素。

症状

星形细胞瘤的体征和症状可能因肿瘤的起始部位而异。这种肿瘤可能发生在脑或脊髓。

脑部星形细胞瘤的症状包括：

• 癫痫发作，可能会导致意识丧失或行为改变，例如盯着虚空发呆。
• 头痛。
• 恶心和呕吐。
• 人格改变。
• 说话问题。
• 感觉非常疲倦或无力。

脊髓星形细胞瘤的症状包括：

• 受累区域疼痛。
• 夜间疼痛加重。
• 手臂或腿部无力并逐渐加重。
• 行走困难。

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.

何时就医

如果您因持续存在的症状而担忧，请与医生或其他医务人员约诊。

病因

星形细胞瘤的病因通常不明。这种肿瘤最开始是脑或脊髓中的细胞生长物，在称为星形胶质细胞的细胞中形成。星形胶质细胞支持和连接脑和脊髓中的神经细胞。

星形胶质细胞中的 DNA 发生变化时，可能发生星形细胞瘤。细胞 DNA 含有指示细胞活动的指令。在正常细胞中，DNA 指令让细胞按设定速度生长和增殖。这些指令会指示细胞在设定的时间死亡。在肿瘤细胞中，发生变化的 DNA 给出了不同的指令。这些变化指示肿瘤细胞迅速生长和增殖。正常细胞应该死亡时，肿瘤细胞还能继续存活。这会导致细胞过多。

肿瘤细胞会形成一个生长物，随着体积变大，可能压迫附近的脑或脊髓。有时，DNA 变化会将肿瘤细胞转变为癌细胞。癌细胞可以侵入并破坏健康的身体组织。

风险因素

星形细胞瘤的风险因素包括：

• 放射疗法史。 如果您接受了其他癌症类型的放疗，尤其是头部或颈部附近的放疗，您可能面临更大的风险。
• 中年。 星形细胞瘤可能在任何年龄发生，但在 30 至 55 岁成人中最为常见。
• 遗传性综合征。 患有某些家族遗传性疾病的人更有可能患星形细胞瘤。示例包括 1 型神经纤维瘤病、林奇综合征和利-弗劳梅尼综合征。

目前尚无预防星形细胞瘤的方法。

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.

并发症

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.

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