Treating pilocytic astrocytoma
The treatment for astrocytomas depends on the grade of the tumour, as well as its size and location.
Grade 1 astrocytomas are normally treated with surgery where possible. The aim is to remove as much of the tumour as possible. How much can be removed will depend on where the tumour is in the brain. At this point you may be told about, or may like to ask about 'biomarker testing' and 'biobanking'.
If the tumour is in the cerebrum or cerebellum they can often be removed completely. You may hear this referred to as a 'complete or total resection'.
If the tumour is completely removed, more treatment may not be needed. Your hospital will continue to monitor you with regular MRI scans, with no treatment given, unless you develop symptoms, existing symptoms worsen or your scan shows changes. This is often called 'watch and wait'.
With tumour locations other than the cerebrum or cerebellum, complete removal may still be possible, but the benefits need to be weighed up against various possible after-effects. For example, if the tumour is in the optic nerve, complete removal may be achieved, but it can result in blindness in the affected eye. Or if the tumour is in one of the 'midline structures' (e.g. hypothalamus, brain stem, spinal cord), surgery can affect the functions these areas control, such as breathing, sleep, body temperature, particularly in children younger than 2 years old.
In some cases, complete removal of the tumour may not be possible. It may be located in a difficult area of the brain to operate, or near important parts of the brain where surgery could do more harm than good. In this case, the surgeon will remove as much of the tumour as they can. This is known as 'debulking' or 'partial resection'.
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, 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.
Further surgery may be needed later to remove the rest of the tumour that was left, or if it starts to regrow. You may also need further surgery if the tumour is blocking the flow of the cerebro-spinal fluid (a condition called 'hydrocephalus'), to insert a shunt to remove the excess fluid from the brain.
For children, chemotherapy is often the first line of treatment. Find out more about chemotherapy for children.
Watch and wait
In some cases, your medical team might decide not to use surgery initially, but to use the 'watch and wait' approach. You may also hear this referred to as 'active monitoring'. The reason for adopting this approach may be that it is felt that surgery carries more risks than giving no initial treatment. This may feel like they are 'doing nothing'. However, 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. Some tumours have also been known to reduce in size with no apparent cause. This is known as 'spontaneous regression'.
If your symptoms worsen, or the tumour changes or starts to grow, your medical team will then look at other treatment options.
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