Lymph enters the circulatory system through. What is lymph: functions, composition, movement pattern. Diet after cleansing

There are a specific type of cells in the brain called astrocytes. They provide support, nutrition and are responsible for regeneration nerve tissue. During certain pathological changes From these cells a tumor is formed - an astrocytoma. There are two main groups of neoplasms: with weak (pilocytic and fibrillary astrocytoma) and with strong infiltration (anaplastic astrocytoma, glioblastoma).

In adult patients, the typical location of the tumor is the cerebral hemispheres. In children, astrocytomas occur in both the hemispheres and the brain stem. According to incidence statistics, 5.4 new cases per 100,000 population occur annually. Although the genetic influence in the development and progression of astrocytoma has been well studied, no correlation depending on race has been recorded. Some types of tumors (fibrillary, anaplastic) are more common in men. A tendency was also noted that the less malignant the tumor, the younger it occurs.

Classification

Depending on the level of malignancy world organization Healthcare (WHO) divides astrocytomas into four stages, the gradation of which depends on the growth rate and the severity of invasion into the nearest brain structures. Those. the higher the grade, the higher the malignancy.

The WHO classification scheme is international and is based on certain characteristics: atypia, mitosis, endothelial proliferation and necrosis. The severity of these factors reflects the malignant potential of the tumor in terms of invasion and growth rate. Neoplasms that lack the above characteristics are classified as class I, and those that have one of these characteristics (usually atypia) are classified as class II. Astrocytomas with 2 criteria are included in class III, and with 3 or 4 – in class IV. Thus, the low-grade group of astrocytomas belongs to classes I and II.

Class I and II astrocytomas are slow-growing formations with a weak predisposition to infiltration. Low-grade astrocytomas are less common than their more malignant counterparts. In North America alone, 1,500 new cases of the disease are recorded annually.

Pleomorphic xanthoastrocytoma;

Mixed oligoastrocytoma

ICD-10 code:

• C71 Malignant brain tumor;
• D43 Brain and central nervous system tumor of undetermined or unknown type.

Causes and risk group

The causes of astrocytoma and other glial neoplasms are still unknown. Some studies have identified gene abnormalities in different chromosomes of astrocytes, which may play a role in the genesis of the disease. The course of the disease is also influenced by the natural mechanisms of brain aging.

Despite a large number of environmental, professional, family and genetic studies, it has still not been possible to find a common connection between patients. Most brain tumors are not hereditary, but they are typically associated with certain congenital conditions:

• neurofibromatosis;
• Li-Fraumeni syndrome;
• von Hippel-Lindau disease;
• Turcotte's syndrome;
• tuberculous sclerosis.

The above disorders occur in only 5% of people suffering from astrocytoma.

Symptoms

Clinical manifestations Astrocytomas are caused by tumor growth, as well as compression and damage to brain tissue. Disruption of the central nervous system is caused by the influence of the following factors:

• hypoxia;
• steal syndrome;
• release of metabolic end products (free radicals, altered electrolytes, neurotransmitters);
• release of cellular mediators (cytokines, histamine, etc.).

Because the skull cannot expand in response to tumor growth, the first symptoms occur due to increased pressure. A large tumor can block the flow of blood and cerebrospinal fluid, which manifests itself in the form of headaches, seizures, memory loss and behavioral disorders.

Astrocytomas can occur in the right and left hemispheres of the brain. When the tumor is localized in the frontal lobe, muscle weakness, gait disturbance, or the development of epileptic seizures are observed. Such patients forget recent events and also make inappropriate comments that do not correspond to the topic of conversation. They may also experience sudden changes in behavior.

The temporal lobe is the part of the brain responsible for memory, speech perception, interpretation of sensations, and analysis of visual images. When a tumor grows into this area, as a rule, the perception and/or reproduction of speech is impaired, and seizures also appear. Sometimes the development of an attack is preceded by the sensation of unusual odors.

Due to the difficulties that arise during the collection of complaints, diagnosing the disease in young children is a rather problematic task. Typical symptoms of astrocytoma in children are:

• headache;
• feeling tired and lethargic;
• epileptic seizures not associated with high fever;
• vision problems, double vision;
• retardation in growth and development.

Varieties

Although all astrocytomas originate from the same cell type, they are very different in their properties, appearance, treatment methods and prognosis for the patient. To understand the characteristics of the disease, it is best to analyze each type of tumor separately.

Pilocytic astrocytoma

Also called piloid. It is the most common histological type in class I. The tumor grows slowly, but can quickly reach large sizes. There is an association with neurofibromatosis type 1 that is so strong that up to 20% of all patients with NF1 will suffer from pilocytic astrocytoma. In contrast, approximately 1/3 of pilocytic astrocytomas involving the optic nerves are associated with NF1.

Piloid astrocytoma of the brain is usually located in the cerebellum, hemispheres, along the path optic nerve and in the trunk. Clinical manifestations depend on the location of the tumor. When localized in the PCF area, the signs predominate intracranial hypertension, especially in the presence of hydrocephalus. Bulbar symptoms and cerebellar symptoms may also be present.

As a rule, it is infiltrative in nature. It is also commonly called diffuse astrocytoma. Predominantly consists of a microcystoid tumor matrix within which embedded fibrillar neoplastic astrocytes with mild nuclear atypia and low cell density. Microcystic spaces containing mucin fluid are often present. Gemistocytes may be detected. Mitoses, microvascular proliferation and necrosis are absent.

Fibrillary astrocytoma of the brain grows relatively slowly and does not have defined edges. A tumor can grow in any part of the brain, but is more often found in the hemispheres, in the cortex. It develops in people between 22 and 40 years of age, but can occur in children and the elderly.

Due to its rapid growth, it is classified as malignant. Occupies an intermediate value between low-grade astrocytomas and glioblastoma. Typical symptoms include seizures and neurological disorders, hypertension. Key features present in anaplastic astrocytomas that are absent in low-grade tumors are mitotic activity and anaplasia. But unlike glioblastoma, they do not have necrosis or vascular proliferation. It occurs in people aged 30 to 50 years and accounts for 4% of all brain tumors.

Glioblastoma

Most aggressive tumor nervous system. Its cells multiply quickly and grow into the tissue of the hemispheres. Tends to spread along condensed areas white matter, such as corticospastic pathways and the corpus callosum, which is why the contralateral hemisphere is involved in the pathological process. Glioblastomas can arise in any part of the brain and have a predilection for the subcortical white matter and the deep gray matter of the hemispheres, especially the temporal lobe.

Glioblastomas are traditionally divided into primary and secondary. In the first case they arise de novo (90%), and in the other they arise from a pre-existing tumor of a lower grade (10%). Primary ones are more aggressive than secondary ones, and they tend to occur mainly in old age.

Glioblastoma can occur at any age, but most often occurs in patients over 40 years of age, with a maximum incidence between 65 and 75 years of age. There is a slight male predominance with a 3:2 ratio. Europeans suffer more often than other ethnic groups: Europe and North America– 3-4 per 100,000, while Asia – 0.59 per 100,000. Accounts for 23% of all primary brain tumors.

The vast majority of glioblastomas are sporadic cases. Less commonly, they are associated with previous radiation exposure. May also occur as part of rare inherited tumor syndromes, such as those associated with p53 mutations (NF1, Li-Fraumeni syndrome). Other diseases in which GBM occurs are Turcotte's syndrome, Ollier's disease and Maffucci's syndrome.

Clinical manifestations are similar to anaplastic astrocytoma. In less than 2% of cases, glioblastoma is complicated by intratumoral bleeding, which can cause Clinical signs, similar to hemorrhagic stroke.

Oligoastrocytoma

It is a mixed tumor because it contains not only abnormal astrocytes, but also oligodendrocytes. Peak manifestation is observed at the age of 35-50 years. The tumor occurs in both men and women.

Oligoastrocytomas belong to the category of infiltrating gliomas, i.e., according to the degree of malignancy, they are close to grades III and IV. Histologic features of malignancy, such as pleomorphism, nuclear atypia, and increased mitotic activity, are commonly found in anaplastic oligoastrocytomas. Necrosis and microvascular proliferation may also be present. Sometimes difficulties arise when differential diagnosis with astrocytoma.

Diagnostics

To develop optimal treatment tactics, it is necessary to correctly determine the size, location, class and histological type of the tumor. In this process, the doctor is greatly helped by a variety of visualization and laboratory methods research.

At the very beginning, the patient is shown a neurological examination. Based on the collected complaints, medical history and identified symptoms, the presumptive localization of the neoplasm is established.

Then an MRI, CT scan or any other available imaging diagnostic method is prescribed. In some cases, the study can be performed using a special dye that improves the image of the boundaries, contours and contents of the tumor.

Some doctors prescribe magnetic resonance spectroscopy (MRS) to their patients, which determines the chemical and mineral composition of the astrocytoma. Based on the data obtained from the MRS, assumptions are made about whether the tumor is malignant. This method also helps in differentiating astrocytoma from other brain diseases such as infection (tuberculosis, helminthiasis, abscess), demyelination (a disease that damages the myelin sheath of brain neurons) or stroke.

On MRI with contrast, class III and IV astrocytomas are well “highlighted” (enhancement). At the same time, tumors with low infiltration do not fill well with dye and do not show up as well on scans. Be that as it may, only microscopic examination and molecular analysis of astrocytoma tissue will accurately determine the type of neoplasm.

Histology. Histological diagnosis is based on the degree of growth activity and changes in visible cellular structure observed in the tissues. This type of research is carried out by a specialist in the field of pathology. First, he examines the macroscopic specimen of the tumor, assesses its structure, color and consistency. Then a micropreparation is examined on a glass slide, its cellular density, protoplasm contents, etc. are examined. Surgical resection of the tumor provides a large amount of research material, which makes it possible to more accurately make a diagnosis, which subsequently influences treatment tactics.

Tumor markers. More recently, specific markers characteristic of class II and III astrocytomas have been discovered. They are characterized by mutations in a gene called IDH1. Such changes are usually not observed in the patient's healthy cells. The presence of IDH1 mutations in cancer cell genes is usually associated with a more positive prognosis.

The second tumor marker can be detected in glioblastoma - methylated MGMT. When present, it usually indicates a good response to chemotherapy (temozolomide).

Features of the course of the disease in pregnant women

The appearance of a brain tumor during pregnancy is an extremely rare condition, approximately 0.7-1% of all cases of the disease. If a malignant astrocytoma is detected, a medical abortion may be appropriate if the diagnosis is made in the first trimester. The decision about treatment should be made by the patient during the second or third trimester. All pregnant women need to take anticonvulsants, since there is big risk development of seizures, embryonic hypoxia and acidosis.

Corticosteroids may be prescribed to reduce swelling and symptoms. Prednisolone is preferred during pregnancy because it breaks down before it crosses the placental barrier. It is advisable to carry out delivery with the help of caesarean section or using special forceps to shorten the second stage of labor, especially in nulliparous women. In those who have previously given birth, childbirth can also occur through natural channels without serious increase in intracranial pressure.

Treatment

Astrocytomas vary greatly depending on the class being defined, so therapeutic management will depend on the histology of the tumor. With low-grade astrocytomas, as a rule, it is possible to manage with a single surgical intervention, while with glioblastoma such manipulations will be ineffective.

Complete removal of the tumor and excision of surrounding healthy tissue is the most common treatment for astrocytoma. During the manipulation, the neurosurgeon tries to cut off the tumor as much as possible, but sometimes, due to the difficult location of the tumor, this is not possible. When the tumor is localized in the area of ​​important cortical centers responsible for movement, speech, tactile, visual and other types of perception, partial resection is indicated. Such tactics will relieve the patient from intracranial hypertension, as well as from excessive electrical activity that provokes the development of convulsive seizures.

Surgical intervention is carried out by opening the skull in the area of ​​projection of the neoplasm. Several intraoperative technologies have been developed to improve the work of the neurosurgeon. Brain mapping, MRI tractography, functional MRI - all this allows the doctor to more accurately determine the location of the tumor, as well as avoid damage to important areas of the brain. Stereotactic CT scan and intraoperative MRI are used by doctors as navigation devices, similar to GPS in a car. These devices help the neurosurgeon navigate the cranial cavity and select the optimal access for deep-lying brain tumors.

Astrocytoma has certain characteristics of germination, which can greatly complicate the treatment process. Since malignant cells have a stellate structure, during invasion they embrace healthy tissue from several sides, and sometimes it is not possible to separate them. In such cases, partial resection is recommended to relieve symptoms, followed by other treatment modalities.

Pilocytic astrocytomas have sharply defined borders, which is why they can often be cured surgical method. If the tumor is located in a hard-to-reach area or if it cannot be completely excised, then radiation and/or chemotherapy is prescribed.

Radiotherapy. For class I and II astrocytomas, gamma irradiation is prescribed at the first stage of treatment. Radiation therapy is used to shrink the tumor and reduce the severity of clinical manifestations.

For adult patients, radiation is usually given immediately after the biopsy. There are several types of radiation therapy that may be indicated for astrocytoma. External fractional irradiation is the treatment standard, prescribed 5 times a week for 1.5 months.

Local radiation therapy, which increases the intensity of radiation, may also be prescribed. In addition, it allows you to concentrate the flux of photons in the area of ​​the tumor and protect healthy cells from radiation exposure. This technique includes:

• Conformal radiation therapy is a modern treatment method that takes into account the size and shape of the tumor. This can be done in several ways, including intensity-modulated radiation therapy and three-dimensional conformal radiation therapy, in which the contours of the radiation correspond to the configuration of the tumor.
• Image-guided radiation therapy is a method that involves changes in body position during the procedure with an accuracy of 1 mm, resulting in a targeted bombardment of photons.
• An alternative to standard radiotherapy is proton irradiation. The method ensures ideal dose distribution, avoids damage to healthy tissue and reduces overall toxicity.
• Interstitial radiotherapy involves the direct introduction of a special implant responsible for radiation into the area of ​​the astrocytoma. Can be performed during surgery.
• Stereotactic radiosurgery is a special form of high-dose, highly focused radiation used for small, localized lesions. Prescribed as a single dose or fractionated treatment over 4-5 days.
• Photodynamic therapy uses a sensitizing drug and laser light to kill tumor cells during surgery.

Chemotherapy. Method involving the use pharmacological drugs to destroy tumor cells. Typically, this effect is achieved due to damage in the metabolic mechanisms of malignant cells.

Typically, patients with glioblastoma are given a six-week course of temozolomide in combination with radiotherapy. This drug is an alkylating agent that is able to pass through the natural barriers of the brain and penetrate directly into the tumor tissue. Recent recommendations require a three-week course of radiation for patients over 65 years of age, and this should be considered as a uniform standard. Oncology experts recommend taking temozolomide one hour before radiotherapy to increase the sensitivity of the tumor to gamma radiation and maximize the beneficial effect. Due to the lack of necessary standards, a similar combination is also used for anaplastic astrocytoma.

Chemotherapy may be given after radiation to eliminate any remaining tumor cells. Sometimes these two methods are prescribed simultaneously. Due to great risk brain damage to young children antitumor drugs often prescribed instead of radiotherapy. The type of chemotherapy, as well as its duration and number of courses, is determined by the oncologist. His decision is based on the characteristics of the disease, the success of previous treatment and general condition patient.

Chemotherapy may also be given to infants and young children to slow the growth of astrocytoma and delay the time until the child is old enough for radiation treatment.

Innovative techniques. Immunotherapy is a new, promising treatment method that triggers the patient’s body’s defense systems to fight and suppress the growth of tumors. Studying the mechanisms of immunosuppression induced by malignancy, as well as understanding the processes of T-cell activation, has made it possible to create an effective antitumor response. The group of immunotherapeutic techniques includes checkpoint inhibitors and cancer vaccines using tumor antigens:

• Checkpoint inhibitors are specific antibodies that program immune T cells to attack tumors.
• The vaccine attacks malignant cells using genetically modified astrocytes that stimulate the immune system, thereby causing a protective response.

Traditional treatment. Regardless of the class and degree of malignancy, astrocytomas pose a great threat to the patient’s life, so rationality and timeliness of treatment plays an important role in the recovery process. The harmful effects have been proven more than once alternative medicine on the condition of patients. A huge number of cancer patients, instead of seriously addressing their illness, visit shamans and traditional healers, which ultimately ends badly for them.

The main methods of treating astrocytoma have been and remain surgery, radiation and chemotherapy, so you should not look for a replacement for them from incompetent people who are unable to provide competent medical care.

Rehabilitation

Tumor growth, as well as the treatment process itself, can cause cognitive and physical impairment. The extent of damage directly depends on the characteristics of the tumor and the part of the brain involved. Even healing procedures were successful, and the tumor was finally defeated, this does not mean that the disease will pass without a trace for the patient. Many patients still have the following complaints after therapeutic manipulations:

• memory problems/poor concentration;
• decline mental abilities;
• difficulty finding words to express thoughts;
• speech difficulties;
• general weakness;
• problems with balance and coordination;
• convulsions;
• vision problems;
• peripheral neuropathy;
• dysphagia (difficulty swallowing);
• depression.

Such changes in neurological function negatively affect communication and interaction with others and interfere with the ability to perform daily household tasks. In addition, the ability to maintain mobility is important, since prolonged stay in a static position negatively affects the healing process.

Oncological rehabilitation includes wide range techniques aimed at building endurance, developing independence, reducing stress and maintaining energy to participate in daily activities.

There are the following areas of rehabilitation treatment:

• Physiotherapy. Specialists in the field develop a personalized exercise program that combines training to reduce fatigue and improve physical fitness.
• Occupational therapy. An area of ​​rehabilitation medicine that focuses on optimizing living and working spaces and developing special devices to make life easier for patients.
• Speech pathology. Many patients who have undergone treatment for astrocytoma experience certain difficulties communicating with others. In such cases, assistance is provided by rehabilitation therapists who deal with problems of speech pathology, as well as treatment of dry mouth, difficulty swallowing, and loss of voice.
• Massage. Relaxation massage helps reduce intensity pain associated with the tumor, as well as improve the quality of life during the treatment period. Chiropractors use special techniques to relieve bone, muscle, or joint pain without the use of drugs or surgery.

In case of persistent incapacity, a decision is made to assign a disability group. This process is handled special commission, consisting of several specialists.

Relapse

When malignant cells cannot be completely removed despite all efforts therapeutic measures, then the disease is predicted to return. Over time, the remaining cancer cells begin to actively divide, which leads to re-growth of the tumor. Returning astrocytoma sometimes takes on a more life-threatening form than before treatment. It may contain a higher percentage of anaplastic or astrocytic cells, and may also grow into the spinal canal area.

Treatment for recurrent tumors includes additional surgery. If the tumor has not previously been irradiated, then radiotherapy is prescribed, and if it has been, then local radiation is used. A number of clinical trials are currently being conducted to study recurrent astrocytomas. Researchers are testing new medications and their combinations, which make it possible to effectively eliminate the growth of tumors.

Complications

The very fact of the growth of an astrocytoma in the cranial cavity is already a life-threatening condition, regardless of its class and degree of malignancy. Even tumors that do not have a predisposition to infiltrative growth pose a threat to the patient’s health, due to probable development complications.

Hydrocephalus, which develops against the background of impaired outflow of venous blood and cerebrospinal fluid, can lead to herniation medulla oblongata in the area of ​​the foramen magnum. This condition is very dangerous and, as a rule, leads to death.

Complications may also arise during the treatment process. During surgery, areas of the cerebral cortex are sometimes damaged. Depending on the affected lobe, hemiparesis, hemianesthesia, cognitive and verbal impairments develop.

Negative consequences when prescribing gamma therapy in childhood are the following states:

• decreased mental abilities; lag in growth and development from peers;
• hormonal disorders;
• behavioral disorders;
• secondary tumors and radiation necrosis of the white matter of the brain.

Chemotherapy also has a number of side effects and can lead to serious complications. Many medications have adverse effects on the kidneys, so it is recommended to regularly check your excretory function. The same can be said about the functioning of the liver and lungs. The use of cytotoxic drugs in combination with radiation therapy sometimes leads to necrotizing leukoencephalopathy.

Forecast

The histological type of tumor, its size, location, as well as the effectiveness of treatment - all this allows us to predict the future fate of the patient. It must be borne in mind that the prognosis is tentative and everything goes individually for each patient.

As can be understood from the table, tumors of the first and second classes have a more favorable prognosis for life. This is due to their slower growth, as well as the lack of a tendency to form secondary lesions. When confirming the diagnosis of glioblastoma and anaplastic astrocytoma, the opposite situation is observed. Without appropriate treatment, these tumors begin to actively multiply. The main goal of treatment in this case is to slow down the increase in size and increase life expectancy.

In adults, after complex treatment of glioblastoma with temozolomide and radiotherapy, the average life expectancy is about 14.6 months with a 2-year median survival rate of 27% and a 5-year median survival rate of about 10%. However, there have been cases where patients were able to live about 20 years from the date of diagnosis.

Children with malignant tumors (class III and IV) have a more favorable prognosis compared to adults, the five-year survival rate is about 25%.

However, not all glioblastomas have similar biological and metabolic features. Therefore, many patients respond differently to the same treatments.

Dietary habits and other factors environment have little effect on the development of astrocytoma, therefore there is no special food which can effectively prevent the development of the disease. There have also been no official recommendations from the oncology community regarding diet during the treatment period. However, patients suffering from astrocytoma are advised to eat the same foods as all other cancer patients.

About 20% of all nutrients must be proteins. Proteins are also called building blocks human body, so cancer patients require large amounts of these elements. A lot of proteins are found in meat, fish, legumes, soybeans, and dairy products.

Another 20% of the diet should be given to fats and preferably vegetable ones. This element is necessary for the creation of bile, absorption vitamins A, D, E, K, as well as to remove some toxins. In addition, many components of the brain are composed of fat, so its replenishment will be very important for patients with astrocytoma.

The remaining 60% should be redistributed to carbohydrates, which are the main energy molecules involved in metabolic processes. It is best to replenish these elements through fresh vegetables and fruits.

Prevention

As a rule, after recovery from astrocytoma, patients have an additional incentive that encourages them to change previously routine habits. After surgery and other antitumor treatment procedures, children may develop lifelong pathological weakness, as well as a violation of the body's defense mechanisms. For prevention possible complications it is recommended to carry out modification measures, including feasible physical exercise, a balanced diet and psycho-emotional balance.

When entering adulthood, the use of tobacco and alcohol-containing drinks is discouraged, since there is a high probability of developing neurological disorders. It is best to discuss the modification plan with your doctor.

Treatment of astrocytoma in Israel

Israeli clinics are deservedly considered one of the most effective in the world. Every year hundreds of thousands of patients fly here and receive the best neurosurgical and oncological care, which can only be found. Israel takes a leading position in the treatment of brain tumors, and in particular astrocytomas.

The main advantages of treatment in Israel:

• Accurate diagnosis. Diagnostic specialists quickly determine the type of tumor, its location and stage of the disease.
• Unique surgical interventions performed by highly qualified neurosurgeons using the latest medical equipment (operating optics, neuronavigation, etc.).
• Individual approach. When choosing therapeutic tactics, the doctor can combine various protocols and recommendations to select the optimal treatment for astrocytoma.

Upon admission to the hospital, the doctor first conducts an examination and prescribes tests aimed at assessing the state of the nervous system - reflexes, strength, sensitivity in the limbs.

Examination of the optic nerve is important, since its swelling indicates increased intracranial pressure. Then they will be appointed lab tests blood, urine and cerebrospinal fluid as necessary.

Imaging methods include CT and/or MRI, which are prescribed to determine the location and characteristics of the tumor. CT involves the use of X-rays to create a three-dimensional image. Injections of a contrast solution may be recommended to achieve better visualization of the tumor being studied. This test is painless and takes about 30 minutes. MRI uses a magnetic field to create precise images of specific areas of the body. A contrast solution may also be used to improve visualization.

To accurately diagnose an astrocytoma, a biopsy is required. This test involves performing surgery to remove biological material. To do this, the neurosurgeon makes a small hole in the skull and uses a thin needle to remove tumor tissue. For better control, the manipulation can be carried out under the control of computed tomography.

Treatment tactics for astrocytoma in Israeli clinics depend on several important factors:

• histological type of neoplasm;
• presence of secondary foci;
• localization;
• general condition of the patient.

The treatment plan is developed by a team consisting of a neurosurgeon, neurologist and oncologist. The goals of therapy, its advantages, disadvantages and risks will be explained to the patient in detail.

The best clinics in Israel

Clinic "Herzliya". Treatment of astrocytoma at this institution is planned individually and is based on the specific type of tumor, its size and location. A multidisciplinary team is working to solve the problem, which includes neurosurgeons, oncologists, radiologists and other specialists from the center. Treatment of brain tumors is carried out using the latest surgical and conservative methods: radiosurgery, conformal and intensively modulated radiation therapy, multicomponent chemotherapy. Herzliya Medical Center also uses experimental treatments based on advanced techniques, the effectiveness of which has been confirmed by independent studies. This group includes: biological therapy, targeted therapy, stimulation immune system, aimed at targeted suppression of the growth of malignant cells.

Department of Neurosurgery medical center"Rambam". Specializes in providing quality medical care and elimination of pathological neoplasms affecting the nervous system. The department is deservedly considered one of the best in Israel. It employs specialists with enormous surgical experience accumulated over many years. The department uses high-tech equipment that allows it to perform the most complex operations. For example, the use of ultrasound navigation technology, as well as innovative fluorescence techniques used to detect brain tumors.

Anaplastic astrocytoma of the brain: symptoms and manifestations

is a primary neuroepithelial tumor, which occupies a leading place among all brain tumors. It originates from the parenchyma of this organ and covers varieties such as oligodendroglioma, ependymoma and, which occurs in 40% of cases.

Divides everything into 4 degrees of malignancy, depending on the presence of certain criteria.

The first degree (g1) is relative benign tumors, which in structure are practically no different from brain tissue. Why relatively? Because any neoplasms in the brain are malignant, since even the most “quiet”, slow-growing nodes can cause intracranial pressure, neurological disorders, and can also change the degree of malignancy to a greater one at any time.

Grade 1 astrocytomas also include giant cell forms.

Grade 2 tumors (g2) are those that have 2 signs of malignancy. The total number of patients with grades 1 and 2 is 20%. They occur more often in children, adolescents and people 20-45 years old.

Anaplastic astrocytoma (AA), which we will look at today, belongs to grade 3 malignancy (g3). Such tumors are poorly differentiated, that is, their cells have practically lost their resemblance to the tissue from which they originated. Anaplastic astrocytomas of the brain are characterized by cellular and tissue atypia, the presence of mitoses, they grow quickly and lead to intoxication of the body. Such tumors are prone to metastasis and transformation into which has grade 4 malignancy and the worst prognosis.

It is not uncommon for anaplastic astrocytoma to be a consequence of the degeneration of a diffuse type of tumor, so it may have signs of nodular growth and diffuse (infiltrating). In most cases, the latter form is observed when cancer cells germinate into the surrounding tissue and destroy it.

Also, anaplastic astrocytoma can appear de-novo, that is, without precancerous changes.

Another feature of these tumors is the rapid development of the vascular network and the ability to form cysts, which accelerates and often leads to hemorrhage in the brain.

Informative video:

Anaplastic astrocytoma: symptoms

TO common features Anaplastic astrocytoma, which occurs as a result of increased intracranial pressure, includes headache, dizziness, vomiting, and epileptic seizures. Most often, these symptoms appear spontaneously in the morning. Headaches are usually diffuse, but they can also be localized, depending on the location of the tumor.

Anaplastic astrocytoma located in the frontal lobe is characterized by:

• motor and sensory Jacksonian seizures. At the beginning, cramps may be weak, appearing in the arm, leg or facial muscles, then they acquire a generalized appearance;
• disturbances in muscle tone and motor functions (unsteadiness of gait, unclear or involuntary movements, weakening of facial movements, trembling of hands);
• visual and speech disorders;
• psychopathological symptoms (decreased intelligence, memory, inattention, apathy, euphoria). The appearance of certain disorders again depends on the location of the tumor;
• sensitivity disorders;
• congested optic discs;
• decreased sense of smell.

Oncology in the temporal lobe of the brain causes:

• auditory, visual, gustatory, olfactory hallucinations (they often precede epileptic seizures);
• absence seizures;
• disturbances of consciousness;
• sensory speech disorders.

Astrocytomas of the parietal lobe manifest themselves:

• sensitivity disorders of varying degrees;
• apraxia;
• astereognosis;
• homonymous hemianopsia.

Benign astrocytomas can progress very slowly and may take a while from the onset of one symptom to the appearance of a second. long time. In this regard, many people do not attach due importance to them, do not consult a doctor, and at this time the disease develops. Therefore, in more than half of patients, malignant forms are detected at the time of diagnosis. There are more symptoms and they are more pronounced. Treatment at this stage will be more difficult.

Causes of anaplastic astrocytoma

The causes of brain tumors are not reliably known. There are only negative factors that are present in many cases of brain cancer.

Among them:

• influence of chemical carcinogens and radiation. This means that prolonged repeated contact with chemicals or radiation can lead to oncotransformation;
• DNA damage, genetic diseases. Disturbances in the chain of genes that are directly related to the brain can lead to the formation of astrostoma;
• from family members;
• alcohol and smoking;
• inflammatory processes, viruses;
• immunodeficiency;
• head injuries.

Diagnosis of anaplastic astrocytoma of the brain

As stated earlier, on initial stages Symptoms of anaplastic astrocytoma of the brain can be subtle, so the tumor is often found by chance, for example, during a routine examination.

The gold standard is magnetic resonance imaging. This test is safe, simple and relatively affordable. MRI is based on the use of nuclear magnetic resonance, which is not dangerous to health. It allows you to get a clear three-dimensional image of the brain and determine in which part the tumor is located, how widespread it is, and what its nature is. In addition, you can evaluate the functions of an organ by viewing its operation in real time. Additional information about the circulatory system of the brain and the tumor itself can be obtained by MRI angiography, which is performed after injection of a contrast agent into a vein or without it.

If a person has contraindications to an MRI (for example, iron implants in the body or a health condition that does not allow lying still during the procedure), then a CT scan of the brain is done. This method is not so accurate, because computed tomography does not detect small tumors on early stages or metastases. Images of brain structures are also displayed on a computer screen, as with MRI, but X-ray radiation is used to obtain them. There is a multislice CT method, the devices of which use several detectors rather than one, so it is more sensitive.

To diagnose brain cancer, positron emission tomography is also used, which allows one to evaluate the biological activity of the brain by staining the blood with a radiofrequency preparation and subsequent scanning in a tamograph. As a result of this study, a color image of the organ is obtained. Areas of low activity will be highlighted in dark colors; they indicate the presence of pathologies. In this way, it is possible to determine the malignancy of the formation and identify those areas in which the transformation processes have just begun. Such information will allow you to establish the optimal treatment regimen and prevent relapses. It is also possible to scan the brain and spinal cord at once or even the entire body to detect metastases. PET scanning is not yet widespread because the procedure is expensive.

The control method of research is a biopsy, that is, taking tumor material, which is then sent to the laboratory for histology. During a biopsy, a mini-operation is performed: a small hole is drilled in the skull and a very thin needle is inserted. Under the control of a CT or MRI machine, a piece of tissue is taken. Only by examining the sample under a microscope can a diagnosis be made with accuracy. But in some cases, a biopsy is not recommended (for example, if the tumor is located in vital centers of the brain), since it is associated with risk neurological complications, so the diagnosis is made based on MRI findings.

Treatment of anaplastic astrocytoma of the brain

Treatment of g3 astrocytoma should be comprehensive and consist of surgical removal tumors followed by radiation and chemotherapy. Other methods are selected optionally. Each individual case requires an individual approach.

Surgery for anaplastic astrocytoma of the brain presents certain difficulties. If the tumor has spread widely throughout the brain or is located in hard-to-reach vital centers, then it is inoperable, since removing an extra millimeter of brain tissue can lead to disability and even death. If MRI results show demarcated, clear areas of astrocytoma, they can be removed.

Before surgery, patients with severe cerebral edema are prescribed high doses. Removal of anaplastic astrocytoma is carried out after craniotomy. In this case, an area of ​​soft tissue and bone is opened or a hole is drilled in it. Upon completion of the procedure, the defects are eliminated with plastic surgery. Open tumor resection can be performed not only with a scalpel. There are also cryoprobes and ultrasonic aspirators. The first option is based on the effects of very low temperatures, and the second – on powerful ultrasound. Both methods are aimed at destroying cancer cells.

The ability to remove 100 or 95% of a tumor significantly affects a person’s life expectancy, so neurosurgeons try in every way to increase the radicality of the operation. This can be solved by using neuronavigation systems (CT and MRI), mapping, and ultrasound neurosonography during surgery, which make it possible to accurately determine the boundaries of a space-occupying lesion. For this purpose, microscopes and so-called staining of tumor tissue are also used.

After surgery (2-3 weeks), local radiation therapy is usually prescribed to include +2 cm of surrounding tissue. For anaplastic astrocytoma, the total focal dose is 60 Gy. The number of fractions per course is 25-30. Another promising, but unfinished method is . This is the introduction of radioactive sources to the tumor itself, which will inhibit its growth for a long time. The substances used are iridium, palladium, iodine. Brachytherapy has not yet gained popularity due to the high likelihood of complications.

For anaplastic astrocytoma, in combination with radiation, it increases the effectiveness of treatment by 2-3 times. The decision to prescribe it is made based on the results of radiation treatment, which will be visible on MRI. The course of chemotherapy lasts about 6 months. Drugs that are used in the treatment of anaplastic astrocytoma are Temodal (Temozolomide), Carmustine, Lomustine, Procarbazine,. The doctor may prescribe a combination of several of them. There are options in the form of droppers and tablets.

As additional treatment residual tumor or if relapses occur, radiosurgery may be used. This is a promising method based on the application high doses irradiation, which should completely destroy the tumor. This setting is used in devices and. Their difference is that the first uses a fixed frame, and the second uses movable linear accelerators. Also, Cyber ​​Knife installations use a more powerful radiation stream, which allows the operation to be performed in one go. Radiosurgery has a limitation on the size of the tumor: its diameter should not exceed 3 cm.

Another method that can be used to treat the tumor bed after partial resection is photodynamic therapy.
helps to significantly improve the patient’s condition and partially or completely remove neurological symptoms. To monitor the patient's condition after surgery, examinations must be carried out regularly. For the first year, it is necessary to do an MRI of the brain quarterly, then once every six months.

Glial tumors have a high recurrence rate, occurring in 70% of cases. If a relapse occurs six months or more after the end of treatment, then it is possible to perform surgery again, followed by radiation and chemotherapy with platinum drugs.

Anaplastic astrocytoma: prognosis

If it was carried out complex treatment(surgery, chemotherapy, etc.), that is, there is every chance of living for 2.5 years or more, but when transformed into glioblastoma, these indicators are reduced by 2 times. Of course, the prognosis will be worse if the operation was not performed for some reason, or the tumor was partially removed (especially if the tumor is large).

Overall survival rates are:

• 1 year – 85%;
• 2 years – 70%;
• 3 years – 27%.

Life expectancy is much shorter in older patients than in younger ones. Cancer recurrences also have a negative impact. After them, the median survival is 8 months.

The proportion of patients diagnosed has increased over the past decade, but even modern advances in the field of neurosurgery do not allow them to significantly prolong the lives of these people. Therefore, the question of introducing new effective methods Treatment for anaplastic gliomas remains open.

Informative video:

Astrocytes surround every nerve cell, which means the tumor can be located anywhere, both in the central nervous system (brain) and in the peripheral part (spinal cord).

Brain astrocytoma

There are 4 stages of tumor malignancy:

Stage I (pilocytic astrocytoma of the brain)

A benign, slow-growing tumor with clear boundaries. Often found in the cerebellum, brain stem, along the optic fibers. Young children suffer.

In the photo: Pilocytic astrocytoma at the cellular level

Stage II (fibrillary astrocytoma)

Characterized by slow, invasive growth, it occurs in adolescents and young adults.
In the photo: a brain affected by fibrillary astrocytoma

Scattered astrocytomas are also isolated. They can grow into nearby tissue, but they grow slowly. Also called low-grade or second-grade astrocytomas, they may return as higher-grade tumors.

Stage III (anaplastic astrocytoma)

They are rare. This is stage 3 cancer that grows quickly and spreads to nearby tissues. They are difficult to remove completely because of their tentacle-like extensions that grow into nearby brain tissue.

It is a malignant, rapidly progressing neoplasm with no clear boundaries due to invasive growth.

Stage IV (brain glioblastoma)

One of the most malignant tumors, which has no clear boundaries, is characterized by rapid growth, invading surrounding tissue. It is diagnosed in the 6-7 decades of life, mainly in men.

Regardless of the stages, the following types are also distinguished:

Brain stem gliomas

Brainstem gliomas are rare in adults. Rarely, gliomas can form in the brain stem, the part that connects to the spinal cord.

Pineal astrocytic tumors

Pineal astrocytic tumors can be of any variety. They form around pineal gland. This tiny organ in the brain produces melatonin, which helps control sleep and wakefulness.

A glial neoplasm can be localized in any part of the brain, which will lead to a disruption or change in the functioning of the corresponding structures of the body.

Wherever the tumor is located, it will give several similar symptoms:

1. Headache bursting, pressing nature, worsening after physical exertion;
2. Apathy, lethargy, characterized by a decrease in interest in the environment, life initiative, and activity.

Fibrillary astrocytoma of the brain

Spinal cord astrocytoma

Glial neoplasms of the peripheral nervous system are 4 times less common than those of the central nervous system.

Astrocytoma is typical for children of younger and middle age than older child, the likelihood of developing a tumor decreases.

Most astrocytic gliomas are localized at the cervical level, cervicothoracic regions spinal cord...

Piloid astrocytomas of the spinal cord (stage I), as well as the brain, have a clear boundary from healthy tissue of the nervous system in 70% of cases, which makes it easy to detect and radically remove the tumor. The following stages: anaplastic astrocytoma (stage III), glioblastoma (stage IV), have more progressive and invasive growth, which worsens the prognosis in treatment.

The clinical picture is characterized by local pain, spinal deformity, forced head position, which reduces pain, and decreased motor skills.

- a tumor that occurs due to mutations in astrocytes - glial cells. Any tumor that arises in the cells of the central nervous system is dangerous due to its location.

Even a small benign formation can compress brain tissue, leading to serious consequences. In terms of frequency of occurrence among tumors of the nervous system, astrocytoma ranks 1st. Most of the sick people are under 40 years of age.

Kinds

Astrocytomas are classified according to their grade of malignancy. There are 4 degrees in total:

1. pilocytic - 1 degree;
2. fibrillar - 2nd degree;
3. anaplastic - 3rd degree;
4. glioblastoma - stage 4.

Anaplastic astrocytoma is a grade 3 tumor, which defines it further treatment and the patient's life prognosis.

Glioblastoma

Glioblastoma is a grade 4 tumor. Its cells are characterized by pronounced cellular atypia and rapid division. The tumor exhibits infiltrating growth, but sarcoma metastases to other organs are rare. It can occur against the background of a pre-existing anaplastic astrocytoma, or it can arise primarily from glial cells.

May be:

• giant cell;
• epithelioid;
• gliosarcoma.

Complete removal of glioblastoma is impossible due to its location and high degree malignancy, therefore all therapy is aimed at reducing the size of the tumor and increasing the patient’s life expectancy.

Anaplastic astrocytoma of the brain

This is a grade 3 tumor and is caused by mutations in astrocytes. WP53 is a gene that is responsible for arresting a cell in the G1 phase of mitosis, during which mutations in DNA are detected and eliminated. If any damage is detected in the genetic apparatus of the cell, repair mechanisms or apoptosis mechanisms are activated. If a mutation of the WP53 gene occurs, the cell will not be able to repair DNA damage, and such a pathological cell will begin to divide, giving rise to a tumor.

An astrocytoma can occur in any part of the brain. The cells are practically undifferentiated; the tumor is also characterized by tissue atypia, frequent mitoses and rapid growth. Metastases to other organs of astrocytoma, like glioblastoma, are extremely rare.

The causes of a tumor can be oncogenic viruses, carcinogenic substances, radiation and other harmful factors that lead to mutations in cells.

Due to compression, the cells of the central nervous system cease to function normally, which is why the following symptoms appear:

• headache, which is a consequence of increased intracranial pressure;
• weakness, nausea;
• memory losses;
• attention disorder;
• blurred vision;
• difficulty speaking;
• lack of coordination.

The key influence on symptoms is the location of the tumor and which tissues it compresses.

Symptoms of astrocytoma localized in the frontal lobe:

• cramps of the lower and upper limbs, facial muscles;
• tremor of the limbs, unsteady gait, unclear movements;
• state of euphoria, denial of the seriousness of the problem;
• memory impairment;
• visual impairment;
• decreased intelligence.

Symptoms of astrocytoma localized in the parietal lobe:

• astereognosis - inability to recognize objects by touch;
• speech disorder;
• impaired ability to write;
• apraxia.

Symptoms of astrocytoma localized in the temporal lobe:

• hallucinations:
• epileptic seizures;
• uncontrolled head turns;
• convulsions.

Complete recovery from astrocytoma is almost impossible, which is explained by its low degree of differentiation and rapid invasive growth, in which the tumor quickly grows into nearby tissues, making its surgical removal impossible. Therapy is aimed at increasing the duration and quality of life of the patient.

Fibrillary astrocytoma of the brain

The tumor is grade 2, it is characterized by a relatively benign course, but nuclear atypia is already present in the tumor cells, growth is slow, but it is capable of malignancy.

If the astrocytoma is located conveniently for surgical removal and has not yet grown into the tissue, then when it complete removal it is possible to cure the patient without subsequent relapse.

Pilocytic astrocytoma of the brain

The tumor is benign and characterized by slow nodular growth. The tumor grows, pushing away brain tissue, but not growing into it. The cells have a high degree of differentiation, but the tumor can become malignant if left untreated.

With complete surgical removal of the astrocytoma, the patient's recovery without subsequent relapse is possible. The operation can be performed if the tumor is conveniently localized, is small in size and has no contraindications.

Diagnostics

Thanks to early and correct diagnosis of the stage of the disease, treatment and prognosis of the disease will be more favorable.

The following methods are used for diagnosis:

1. Magnetic resonance imaging. It is one of the most common and accurate studies, because allows you to detect the disease at an early stage. During an MRI, the doctor receives a three-dimensional image of the brain, thanks to which he can identify the presence and location of a tumor. The oncologist can also determine the degree of malignancy of the astrocytoma.
2. CT scan. This method is less common because... cannot detect diseases in the early stages; it is performed when MRI is contraindicated. CT scans use X-rays and display the image on a computer screen. Allows you to identify features of the localization and structure of the tumor.
3. Positron emission tomography (PET). The patient is injected into a vein with radioactive glucose, which will act as an indicator. Thanks to this method biological activity of the brain can be assessed. If the doctor detects areas of dark color, he can conclude that they have low biological activity. These are pathological areas. Also, using PET, an oncologist can evaluate the correctness and effectiveness of the treatment he has chosen.
4. Angiography. Allows us to draw a conclusion about the blood circulation of healthy brain tissue and tumors.
5. Electroencephalography. It is based on bioelectric signals sent by the brain, which makes it possible to evaluate its functioning.
6. Biopsy. A piece of brain tissue is taken and examined under a microscope, which makes it possible to determine from which cells the tumor was formed and the degree of its malignancy.
7. Scintigraphy. The method involves introducing radioactive isotopes, resulting in a two-dimensional image. Carried out if necessary.
8. Neurological examination. The patient's reflexes are determined.

Treatment

The specialist selects the treatment program and examination program in accordance with the patient’s condition, the stage of development of the disease and its localization.

Surgical intervention

This method of therapy is possible when the tumor is located in a convenient location for the surgeon and is small in size. Surgical intervention is effective for grades 1 and 2 malignancy of astrocytoma, and if it is completely removed, the patient can recover completely.

If the tumor has infiltrating growth and has penetrated into the brain tissue, then complete removal of the tumor is impossible.

It is important not to damage the vital centers of the brain during the operation, therefore this method of treatment has a large number of contraindications.

Radiation therapy

Affects the tumor ionizing radiation, due to which the DNA of cells is damaged, which causes their death and reduces the rate of spread of the disease. Can be done independently or after surgery.

One type of radiation therapy is brachytherapy. Radioactive materials such as iridium, palladium, iodine are introduced into the body, but this technique is rarely used due to large quantity complications.

Chemotherapy

They use substances that disrupt the DNA synthesis of tumor cells, reducing their rate of division. These are drugs such as Carmustine, Lomustine, Vincristine and Temodal. It is possible to use several of them simultaneously, the duration of chemotherapy is up to six months.

Radiosurgery

It consists of a single irradiation of the tumor with a large dose of radio radiation. It is carried out for neoplasms up to 3 cm in diameter that have clear boundaries. The method is based on precise computer calculations, which ensures that healthy tissue is not affected during the procedure.

Forecast

The prognosis for astrocytoma is unfavorable, because even a small tumor puts pressure on healthy brain tissue, disrupting its function.

The patient's life expectancy depends on the size of the tumor, its location, the degree of its malignancy and the correctness of the treatment. If the tumor is completely removed surgically at stages 1 and 2, the patient’s life expectancy can be up to 10 years.

If the tumor has transformed into anaplastic astrocytoma, the patient's life expectancy does not exceed 3 years. The lifespan of a patient with glioblastoma does not exceed 1 year.

What are the consequences of astrocytoma?

The consequences of astrocytoma depend on the area in which it is localized. Possible hearing, vision, motor activity. An advanced disease can lead to disability; if left untreated, the tumor can develop into glioblastoma, so it is important to undergo the treatment prescribed by the doctor.

Prevention

The tumor arises from cells with genetic mutations, so prevention consists of reducing the carcinogenic effect on the body.

Smoking, drinking alcohol, and eating large amounts of foods containing chemical additives increases the likelihood of mutations, so cancer prevention involves avoiding the use of hazardous substances.

It's also good to eat more fresh vegetables and fruits, which contain vitamins with antioxidant activity. These are apples, leafy greens, citrus fruits.