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What are pilocytic astrocytomas?

About one third of all brain tumours diagnosed in the UK are astrocytomas and grade one astrocytomas are known as pilocytic astrocytomas.

Pilocytic astrocytomas are slow growing, relatively contained and unlikely to spread to other parts of the brain. They're non-cancerous and you might hear them referred to as low grade or benign. They are most often found in children and young adults under the age of 20 and are very rare in adults over 50 years.

Pilocytic astrocytomas tend to occur in the cerebellum, the part of the brain at the back that controls balance, but they can also occur in the optic pathways that are vital for your sight.

Anaplastic astrocytoma symptoms

Some of the common symptoms associated with astrocytomas are:

  • tiredness
  • headaches
  • blurred vision
  • double vision
  • nausea
  • dizziness
  • seizures
  • balance problems

Treating pilocytic astrocytomas

Neurosurgery (complete or total resection)

Where possible, treatment for pilocytic astrocytomas in adults is normally surgery to remove as much of the tumour as possible - depending on the location. 

If the tumour is completely removed, no more treatment may be necessary. You will continue to be monitored with regular MRI scans and treatment will only be given if your symptoms worsen, you develop new symptoms or your scan shows the tumour growing. This is often called watch and wait. 

Neurosurgery (partial resection or debulking)

In some cases, complete removal of the tumour may not be possible, either because it's located in a difficult area of the brain to operate on or near parts of the brain where surgery could do more harm than good. 

Instead, the surgeon will remove as much of the tumour as they can and, depending on how much of the tumour is removed, you may be put on a watch and wait approach after surgery.  

Alternatively you may be given radiotherapy after your surgery to treat the remaining tumour cells, though doctors try to avoid this in people with the genetic condition NF1 and also in children under three years old. 

Occasionally chemotherapy may also be given to treat the remaining tumour cells.

Further surgery may be needed later to remove the remaining tumour or if it starts to regrow. You may also need further surgery to insert a shunt if the tumour is blocking the flow of the cerebrospinal fluid, a condition called hydrocephalus.

Chemotherapy

For children, chemotherapy is often the first line of treatment. 

Chemotherapy treatment plans vary enormously and your child's chemotherapy will be carefully planned and tailored to them individually. As a result, it could vary from daily chemotherapy for a while, as a day case in hospital, to being admitted to the ward for several days every two to three weeks.

Watch and wait

In some cases, your medical team may decide not to use surgery initially, but to use the watch & wait approach instead.The reason for adopting this approach may be that surgery carries more risks than giving no initial treatment. This may be used if the tumour is:

  • growing very slowly
  • not causing any symptoms or causing only a few symptoms that aren't affecting your quality of life.

It may feel like your medical team aren't doing anything. But, they will monitor your tumour and, where necessary, treat any symptoms. 

In this situation, treatment may not be needed for many months or even years. Some people may never need any further treatment.

Pilocytic astrocytoma prognosis

Adults

The average survival time after surgery is six to eight. More than 40% of people live for longer than 10 years.

Children

Almost 90% of children that are diagnosed with a pilocytic astrocytoma survive for five years or more after surgery.

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