Glioblastoma multiforme and anaplastic astrocytoma

We understand how overwhelming a diagnosis of a brain tumor can be. Right now, you probably have a lot of questions. How dangerous is this condition? What is the very best treatment? What do we do next?

We at Boston Children's Hospital have tried to provide some answers to these questions in the following pages, and our experts can explain your child’s condition fully when you meet with us.

What is glioblastoma multiforme or anaplastic astrocytoma?

Glioblastoma multiforme (GBM) and anaplastic astrocytomas (AA) are types of brain tumors—masses of tissue that develop from abnormally growing cells.  GBM and AA arise from a certain kind of brain cell known as a glial cell—for this reason, they may also be known as "gliomas."

The specific kind of glial cell that they come from is called as an astrocyte, and this is why they can also be called "astrocytomas."  Both GBM and AA are malignant tumors, meaning that they grow and metastasize, or spread.  GBM tend to be more aggressive than AA.

What’s the difference between glioblastoma multiforme and anaplastic astrocytomas?

When doctors diagnose a brain tumor, they “stage” it, or give it a grade, according to whether it has spread, and if so, how far. This helps us determine treatment options and prognosis. The World Health Organization classification scheme includes four grades of glioma:

• Glioblastoma multiforme is a grade IV tumor. This means that these are aggressive tumors that spread to adjacent healthy brain tissue.
• Anaplastic astrocytoma is a grade III tumor. While anaplastic astrocytomas grow less rapidly than glioblastoma multiforme, they are equally malignant.

Where does glioblastoma multiforme and anaplastic astrocytoma occur?

Glioblastoma multiforme and anaplastic astrocytoma can occur in different parts of the brain. Depending on the size and location of the tumor, children may experience different symptoms.

• About 65 percent of these tumors arise in the cerebral hemispheres, which control many higher functions such as speech, movement, thought and sensation.
• About 20 percent can occur in the area of the thalamus and hypothalamus or the diencephalon, which is responsible for identification of sensation, such as temperature, pain and touch, regulation of appetite/weight and body temperature, and also connects the brainstem to the cortex).
• Another 15 percent can occur in the region of the cerebellum and brain stem known as the posterior fossa (at the base of the brain). Ths area coordinates balance and motor function.

The median age at diagnosis is when a child is 9 or 10 years old, and these tumors occur with equal frequency in boys and girls.

As you read further below, you’ll find information about glioblastoma multiforme and anaplastic astrocytoma. If you would like to view summary information about brain tumors first, see the overview on brain tumors.

What causes a glioblastoma multiforme and anaplastic astrocytoma?

As a parent, you undoubtedly want to know what may have caused your child’s tumor. Unfortunately, doctors don’t have a lot of answers to this question, since high-grade gliomas occur without an identifiable cause in most patients. There’s nothing that you could have done or avoided doing that would have prevented the tumor from developing.

We do know that these tumors can occur with increased frequency in families with certain hereditary conditions, including:

• Li-Fraumeni syndrome
• hereditary nonpolyposis colon cancer
• tuberous sclerosis
• neurofibromatosis Type 1

What are the symptoms of a glioblastoma multiforme and anaplastic astrocytoma?

Each child may experience symptoms differently and they vary greatly depending on the size and location of the tumor and whether it has spread.

Glioblastoma multiforme and anaplastic astrocytoma can cause symptoms that result from increased pressure within the head, as well as other symptoms related to the tumor’s specific location, rate of growth and associated inflammation.

Symptoms can develop slowly over time or begin very suddenly. The following are the most common:

• headache and lethargy (generally upon awakening in the morning)
• seizures, depending on tumor type and location
• compression of surrounding brain structures. Depending on the location, this can cause:
  • weakness and other motor dysfunction
  • hormonal abnormalities
  • changes in behavior or thought processes

How are glioblastoma multiformes and anaplastic astrocytomas classified?

An important part of diagnosing a brain tumor involves staging and classifying the disease, which will help your child’s doctor determine treatment options. Staging is the process of determining whether the cancer has spread and, if so, how far.

Gliomas are composed of different parts and are classified according to their most aggressive-appearing elements. The World Health Organization classification scheme includes four grades of glioma.

• Glioblastoma multiforme is a grade IV tumor.
• Glioblastoma multiformes are aggressive tumors that spread to adjacent healthy brain tissue.
• Anaplastic astrocytoma is a grade III tumor.
• Anaplastic astrocytomas, while less rapidly growing than glioblastoma multiforme, are equally malignant.

Your child’s doctor can provide additional information on the classification of glioblastoma multiforme and anaplastic astrocytoma tumors.

Glossary

Questions to ask your child’s doctor    

After your child is diagnosed with a brain tumor, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed. 

If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

Some of the questions you may want to ask include:

• What type of brain tumor does my child have?
• Where in the brain is the tumor located? How might this affect my child?
• Has my child’s brain tumor spread?
• Can the tumor be treated with surgery?
• How long will my child need to be in the hospital?
• What are the possible short- and long-term complications of treatment? How will they be addressed?
• What is the likelihood of cure?
• What services are available to help my child and my family cope?

FAQ

Q: What is the expected outcome after treatment?

A: Unfortunately, the prognosis for glioblastoma multiforme and anaplastic astrocytoma tumors remains poor. In general, more complete removal of tumors results in a greater chance of survival. Your child’s physician will discuss treatment options with you, including experimental clinical trials and supportive care.

Q: Where will my child be treated?

A: Children treated through Dana-Farber/Children’s Hospital Cancer Center receive outpatient care at the Jimmy Fund Clinic on the third floor of the Dana Farber Cancer Institute. If your child needs to be admitted to the hospital, she will stay at Children’s Hospital Boston on the ninth floor of the Berthiaume building.

Q: What services are available to help my child and my family cope?

A: We offer many services to help you, your child and your family get through this difficult time. Read about our support services.

Q: What kind of supportive or palliative care is available for my child?

A: When necessary, our Pediatric Advanced Care Team (PACT) is available to provide supportive treatments intended to optimize the quality of life and promote healing and comfort for children with life-threatening illness. In addition, PACT can provide psychosocial support and help arrange end-of-life care when necessary.