Brain astrocytoma: consequences, complications, prognosis

Brain astrocytoma is one of the common tumors of the head or spine. Since this neoplasm appears in the brain (from its own cells), the main controlling organ, it cannot but affect the patient’s quality of life. Constant headaches, nausea, vomiting exhaust the patient, reducing his performance. As the tumor grows, the symptoms are aggravated and overgrown with new ones: a violation of sensitivity, paresis and paralysis, visual and hearing disorders, a decrease in mental abilities, etc.

Even a benign astrocytoma, if not removed, can make a person a disabled person. So, a piloid astrocytoma of the 1 st degree of malignancy is a nodular tumor with multiple cysts inside, which tend to grow (albeit not quickly) and reach large sizes. The risk of reincarnation of such a tumor is extremely small even after the passage of time, but this does not mean at all that a person does not need to be treated.[1]

It is terrible to imagine what consequences such a tumor can cause if it is found in a child. A piloid astrocytoma can grow for several years, and gradually parents will notice how their child simply becomes stupid in front of their eyes, lags behind their peers in development, becomes an outcast, not to mention the painful symptoms that haunt the baby.

The hope that after the removal of the tumor, impaired mental functions will be restored, it fades away as the child grows up, because most of them are easily formed only at preschool age. Do not teach a child to speak up to 6-7 years, and in the future it will be almost impossible to do so. The same applies to other higher mental functions, which at a young age should develop, and not degrade. Poor memory and insufficient concentration of attention will be the reasons for poor performance in school, developmental delay, which will be hard to catch up on.

If the tumor grows to a huge size, which is even outwardly easy to notice, it actually kills the brain, even without “devouring” its cells. Squeezing the vessels, it deprives the brain of normal nutrition, and it dies from hypoxia. It turns out that you can die even from a benign neoplasm.

The smaller the tumor, the easier it is to remove, and thus avoid dangerous consequences and complications during surgery. Yes, such complications are also possible. Most often, postoperative complications are detected when malignant tumors are neglected or when deep-seated rather large neoplasms are removed. It is clear that a significant role is played by the competence and experience of a neurosurgeon.

By agreeing to an operation, a person has the right to know what the positive and negative consequences can be. Positive consequences include both complete recovery and stopping the growth of a tumor (even if only for a while). Possible negative consequences include: paresis and paralysis of the limbs, loss of vision or hearing, development of epilepsy, mental disorders, ataxia, aphasia, dyslexia, etc. It is not necessary to exclude the risk of bleeding during or after surgery.

If an operation is unsuccessful, there is a risk that a person will not be able to serve himself and become a “vegetable” incapable of performing elementary actions. But again, the risk of negative consequences is the higher, the more neglected the tumor is, the deeper it penetrates into the brain structures.

It is clear that the most complications occur in the treatment of malignant neoplasms, which can take root ( metastases ) not only in the brain, but also other vital organs. Completely remove such a tumor is almost impossible, because it is extremely difficult to track the paths of movement of its cells. Prone to rebirth diffuse tumors penetrate into different parts of the brain, quickly spreading to nearby space, destroying its cells. Removal of such a tumor does not always help to restore the lost functions.[2], [3]

Relapse of astrocytoma after surgery is  no exception, even in the case of a benign tumor. If not all cells of the neoplasm were removed, but the tumor was disturbed, this may increase the risk of its transformation into a malignant one. And all astrocytomas of the brain have such a risk in varying degrees.[4], [5]

Whether to agree to an operation, everyone decides for himself (or the child's parents), but you need to understand that all the described complications occur in the absence of treatment. Only in this case their probability approaches 100%.

Prediction of life with astrocytoma

The astrocytoma of the brain in different people manifests itself in different ways, so to say exactly  how many  patients live is simply impossible. With low-grade tumors, surgery gives hope for a long life. If the tumor is not treated, over time it can not only increase in size, squeezing the brain and causing a lot of unpleasant symptoms, but also under certain conditions develop into a malignant form, the treatment of which has a worse  prognosis of life.

For example, if you do not treat anaplastic astrocytoma, the patient can live for a couple of years at best. But the surgical treatment of malignant tumors of grade 3, even with an adequate response to chemotherapy or radiation therapy, often ends with a relapse of the disease and the death of the patient. On average, the life expectancy of such patients is 3–4 years, although some are overstepping the control 5-year mark of survival. The 5-year survival rate is 68% for diffuse astrocytomas aged 20 to 44 years, and 54% for anaplastic astrocytomas. [6]  For highly differentiated astrocytomas, patients under 43 years of age and those who received chemotherapy had better overall survival [7]. When astrocytoma II degree, the average survival time is 5-8 years, they also have a high frequency of relapses.[8]

With glioblastoma multiforme, the prognosis is even worse - from several months to 1 year, although with the right approach to the treatment and use of the ketone diet  can reduce the rate of their progression [9]. With optimal treatment in patients with glioblastoma, the average survival rate is less than one year. About 2% of patients survive for three years. [10]  Low-Grade Glioma (LGG) is an incurable fatal disease of young people (mean age 41 years), with an average survival rate of about 7 years.[11]

Doctors clearly answer the question, is  it possible to fully recover  from astrocytoma of the spinal cord or brain? 

• More than 90 out of 100 people (more than 90%) with grade 1 astrocytoma survive for 5 years or more after diagnosis.
• About 50 out of 100 people (about 50%) with grade 2 astrocytoma survive 5 years or more after diagnosis.
• More than 20 out of 100 people (20%) with grade 3 astrocytoma survive for 5 years or more after diagnosis.
• Approximately 5 out of 100 people (about 5%) with grade 4 astrocytoma survive 5 years or more after being diagnosed. [12]

In the leading clinics of Israel, doctors successfully carry out such operations and declare not only a high percentage of survival, but also a complete recovery of the majority of patients.

But with diffuse tumors, the localization of which is difficult to visualize, even in the case of a benign neoplasm, it is difficult to promise recovery. Without defining the exact boundaries of the tumor, it is impossible to say with complete certainty that all its cells will be removed. Radiation therapy, of course, can improve the prognosis of treatment, but its effect on the body in the future is difficult to predict. True, modern technologies (linear accelerators) help minimize the harmful effects of ionizing radiation on healthy cells, but radiation therapy still remains a serious blow to the immune system.

As for malignant astrocytomas, here doctors hold the opinion that it is impossible to fully recover from them. Sometimes it is possible to achieve a rather long remission (3-5 years), but sooner or later the tumor begins to recur, repeated treatment is perceived by the body harder than the first, it requires reducing the dosages of chemotherapeutic drugs and radiation, as a result of which its effectiveness is lower.

Disability in benign astrocytoma (operated, non-operated, with a dubious diagnosis) occurs not in the case of a tumor, but when manifestations of the disease become an obstacle to the performance of professional duties. The patient is assigned the 3rd disability group and recommends work that is not related to physical and neuro-psychological stress, which excludes contact with harmful environmental factors. In the future, when the patient’s condition deteriorates, the MSEC opinion may be revised.

In the event that the symptoms of the disease cause a pronounced disability, i.e. A person can no longer work even in light work, a patient is assigned a 2nd disability group.

With malignant tumors, the presence of severe neurological symptoms, irreversible disruption of the functioning of vital organs, as well as in the case of the last stage of cancer, when a person cannot serve himself, he gets 1 disability group.

When determining the disability group, many factors are taken into account: the patient's age, degree of malignancy, whether there was an operation, what the consequences are, etc., therefore the commission makes a decision for each patient individually, relying not only on the diagnosis, but also on the patient's condition.

Prevention

 Cancer prevention is usually reduced to a healthy lifestyle, avoiding contact with carcinogens and radiation, giving up bad habits, eating healthy, preventing injuries and infections [13]. Alas, if everything was so simple, the problem of brain tumors would not be so acute. Perhaps in the future, we will know the causes of the development of astrocytomas of the brain, and genetics will learn to “repair” pathological genes, but so far we have to limit ourselves to the above-mentioned measures in order to minimize the possible risk. In three prospective cohort studies, caffeine use (coffee, tea) is associated with the risk of gliomas in adults [14]. The use of stem cells to prevent the recurrence of glioblastoma is being studied.[15]

Brain astrocytoma is a disease that leaves its dark imprint on human life. But while the disease is at an early stage, do not take it as a sentence. This is a test of strength, faith, patience, the ability to evaluate your life differently and do everything possible to regain your health or at least save a few years of more or less fulfilling life. The sooner the disease is revealed, the more chances to overcome it, coming out victorious from a difficult but extremely important battle. After all, every moment of a person’s life has value, and especially one on which the future depends.