Brain and spinal tumours

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Astrocytoma

Astrocytomas are a type of glioma that starts in glial cells called astrocytes. Astrocytes surround, support and protect neurons. The majority of gliomas are astrocytomas.

Most astrocytomas spread throughout the brain and blend with normal tissue, which can make it difficult to remove the tumour with surgery. They can spread throughout the cerebrospinal fluid but rarely spread outside the brain and spinal cord.

Based on the World Health Organization (WHO) grading system, astrocytomas are classified as low to high grade (grades 1–4).

Low-grade astrocytomas

Low-grade astrocytomas include both grade 1 and grade 2 tumours. A low-grade astrocytoma may turn into an anaplastic astrocytoma.

Pilocytic astrocytoma

Pilocytic astrocytomas (also called juvenile pilocytic astrocytomas) are grade 1 tumours. They tend to grow slowly and often contain cysts. They are most common in children and young adults.

The following are treatments for pilocytic astrocytomas:

Surgery may be done to remove all of the tumour or as much of the tumour as possible. Another surgery may be done if the tumour regrows.

Radiation therapy may be given after surgery if the tumour can’t be completely removed with surgery or if it regrows after surgery and radiation therapy was not given previously.

Active surveillance with regular MRI scans may be done to watch for growth of the tumour if it can’t be completely removed with surgery.

Diffuse or infiltrating astrocytoma

Diffuse or infiltrating astrocytomas are grade 2 tumours. They tend to grow slowly into nearby areas of the brain and may become more aggressive and fast growing over time. They most often affect young adults.

The following are treatments for diffuse or infiltrating astrocytomas:

Surgery may be done to remove all of the tumour or as much of the tumour as possible.

Radiation therapy may be given after surgery if the tumour can’t be completely removed. It may be given as the main treatment if surgery can’t be done.

Chemotherapy may be given after surgery or as the main treatment if surgery can’t be done. The most common chemotherapy drug used is temozolomide (Temodal). The most common chemotherapy drug combination used is PCV, which is procarbazine (Matulane), lomustine (CeeNU, CCNU) and vincristine (Oncovin). PCV is usually given with radiation therapy.

Anaplastic astrocytoma

Anaplastic astrocytomas (also called malignant astrocytomas) are grade 3 tumours that grow at a moderate rate. The average age at diagnosis is 41. Anaplastic astrocytomas tend to turn into glioblastoma multiforme.

The following are treatments for anaplastic astrocytomas:

Surgery may be done to remove as much of the tumour as possible. Surgery is usually followed by radiation therapy, with or without chemotherapy.

Radiation therapy with temozolomide is usually given after surgery. It may also be given as the main treatment, with or without chemotherapy, if surgery can’t be done.

Chemotherapy may be given after surgery or with radiation therapy if surgery can’t be done. It may also be used to treat anaplastic astrocytoma that comes back after treatment (called recurrent anaplastic astrocytoma).

The chemotherapy drug that is usually used first to treat anaplastic astrocytoma is temozolomide. Other chemotherapy drugs used to treat anaplastic astrocytoma are:

  • carmustine (BiCNU, BCNU)
  • lomustine
  • cisplatin
  • procarbazine
  • vincristine

Targeted therapy may be helpful for some people when regular chemotherapy is no longer helping. It may be given alone or with chemotherapy. The targeted therapy drug used to treat anaplastic astrocytoma is bevacizumab (Avastin).

Glioblastoma

Glioblastomas (also called glioblastoma multiforme or GBM) are grade 4 tumours. They are the most common malignant brain tumour in adults. Glioblastoma tumours grow quickly and spread to nearby tissue. They may develop in one place or in many places throughout the brain. Most cases occur in people between the ages of 45 and 70.

The following are treatments for glioblastoma:

Surgery may be done to remove as much of the tumour as possible. Surgery is usually followed by radiation therapy, with or without chemotherapy.

Radiation therapy is given with temozolomide after surgery and may also be given as the main treatment, if surgery can’t be done.

Chemotherapy may be given at the same time as radiation therapy after surgery. It may also be used to treat GBM that comes back after treatment (called recurrent GBM). During surgery, wafers containing a concentrated dose of carmustine may be placed in or near the area where the tumour was removed.

The chemotherapy drug that is usually used first to treat GBM is temozolomide. Other chemotherapy drugs used to treat GBM are:

  • carmustine
  • lomustine
  • cisplatin
  • procarbazine
  • vincristine

Targeted therapy may be helpful for some people when regular chemotherapy is no longer helping. It may be given alone or with chemotherapy. The targeted therapy drug used to treat GBM is bevacizumab.

Bevacizumab or lomustine are commonly used to treat GBM that has come back after treatment.

Corticosteroids and antiseizure medicines (anticonvulsants)

Other medicines used for people with brain tumours do not treat the tumour but help treat symptoms caused by the tumour or the treatments.

  • Corticosteroids help lessen the swelling around the brain tumour and may relieve headaches and other symptoms. A commonly used corticosteroid is dexamethasone (Decadron, Dexasone).
  • Antiseizure medicines (anticonvulsants) are given to prevent seizures. They are usually not given unless the tumour has caused seizures. A commonly used antiseizure drug is phenytoin (Dilantin).

Clinical trials

Some clinical trials in Canada are open to people with astrocytoma. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Stories

Catherine Coulson Slowly, it dawned on me that I, too, could be a survivor

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