User:DerekvG/sandbox/braintumor/anapla astrocytoma

An anaplastic astrocytoma is a high-grade, or malignant glioma, a cancerous neoplasm of the astrocytes or astrocytoma. This neoplasm grows faster and more aggressively than any grade II astrocytoma, the cells inside the neoplasm are not uniform in appearance, and are clearly anaplastic. The tumor will be highly infiltrative of the surrounding tissue. Its most common in patients in the age group between 30-50, and more common in men than women. It accounts for four percent of all brain tumors. Most people that are later diagnosed with anaplastic astrocytoma, present symptoms associated with other more common deseases, most commonly headaches and vomiting are the consequence of intracranial pressure; more neurological symptoms like fatigue weakness and behavioural changes might be a consequence of the presence of an anaplastic astrocytoma. The sudden onset of seizures is associated with the rapid evolution of the tumor.

These tumors arise primarily in the cerebral hemispheres (65 percent). Approximately 20 percent can occur in the area of the thalamus and hypothalamus or the diencephalon (that is responsible for identification of sensation, such as temperature, pain and touch, regulation of appetite/weight and body temperature, as well as connecting the brainstem to the cortex). Another 15 percent can occur in the posterior fossa (the region of the cerebellum and brain stem).

Symptoms
Patients with anaplastic astrocytoma often present symptoms like seizures, neurologic deficits, headaches, or changes in mental status. Anaplastic astrocytomas of the cerebral hemispheres and the diencephalon (often referred to supratentorial anaplastic astrocytomas), have a variety of symptoms may resemble other conditions or medical problems. Some symptoms may occur as a result of increased intracranial pressure, as well as more localizing symptoms (function of their specific location), rate of growth and associated inflammation. The duration of symptoms is variable from a slow, insidious onset to more abrupt presentations. The following are the most common symptoms of an anaplastic astrocytoma, however, each person may experience symptoms differently :
 * headaches and lethargy
 * symptoms of increased pressure within the brain. These symptoms include:
 * headache (generally upon awakening in the morning)
 * vomiting
 * seizures - can occur with supratentorial high-grade gliomas but do so less commonly than do low grade lesions
 * compression of surrounding brain structures - depending on the location of the tumor, increased pressure can cause:
 * weakness and other motor dysfunction neuroendocrine abnormalities
 * changes in behavior or thought processes

Local effects of astrocytomas include compression, invasion, and destruction of brain parenchyma, arterial and venous hypoxia, competition for nutrients, release of metabolic end products (e.g., free radicals, altered electrolytes, neurotransmitters), and release and recruitment of cellular mediators (e.g., cytokines) disrupt normal parenchymal function. Intracranial pressure (ICP) may be attributable to the direct mass effect of the tumor, increased blood volume, or increased cerebrospinal fluid (CSF) volume may in turn have secondary symptoms. Neurological signs and symptoms like focal neurological deficits (e.g., weakness, paralysis, sensory deficits, cranial nerve palsies) and seizures of various may indicate the localisation of the tumor.

Occurence
It accounts for 4% of all brain tumors, its most common in patients in their 30s-50s, and more common in men than women.

Anaplastic astrocytoma and glioblastoma multiforme, account for approximately 10 percent of pediatric central nervous system tumors.

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

Diagnosis
Most high-grade gliomas occur sporadically or without identifiable cause. They do however, occur with increased frequency in families with neurofibromatosis type I, Li-Fraumeni syndrome, hereditary nonpolyposis colon cancer and tuberous sclerosis. They have also been associated with exposure to vinyl chloride and to high doses of radiation therapy to the brain.

Treatment
Treatment depends on the location of the tumor and how far it has progressed. Surgery and radiation therapy, with chemotherapy during or following radiation, are the standard treatments. If surgery is not an option, then the doctor may recommend radiation and/or chemotherapy. Many clinical trials (experimental treatments) using radiation, chemotherapy, or a combination are available for initial and recurrent anaplastic astrocytomas.

Grade 3 and 4 astrocytoma's tend to grow rapidly, further treatment must be started asap after surgery, allowing time for the surgical incision to heal, radiation or chemotherapy is planned within 2 to 4 weeks after surgery.

While therapies help people affected by high-grade astrocytoma's, the treatments cannot fully cure these tumors. Because the tumor infiltrate into surrounding brain and thus can never be completely removed by the surgeon, and that most glioma cells are (at least partially) resistant to radiation and chemotherapy. The goals of treatment are to:
 * remove as many tumor cells as possible (with surgery)
 * kill as many as possible of the tumorous cells left behind (with radiation and chemotherapy)
 * put remaining tumor cells into a sleeping state (non-dividing) for as long as possible (using radiation and chemotherapy)

High-grade glioma cells almost always start to grow again at some point in time, an aggressive treatment is applied in order to delay recidive as long as possible.

Side effects
People affected by an anaplastic astrocytoma may experience side effects related to the tumor itself and related to the treatment.
 * Symptoms related to increased pressure in the brain often disappear after surgical removal of the tumor.
 * Effects on coordination and balance improved and might progressively (to completely) disappear as recovery progresses.
 * Steroid-treatment is often used to control tissue swelling that may occur pre- and post-operatively.

Side effects of treatment
Side effects in the treatment of anaplastic astrocytoma can arise from surgery, radiation and chemotherapy. Surgical morbidity, especially the production of neurologic deficits, is minimized when procedures are performed in specialized centers where experienced neurosurgeons, working in the most technologically advanced settings, can provide the most extensive resections while preserving normal brain tissue. Many specialized brain tumor treatment centers have now added staff who are expert in complementary or alternative medicine. These treatments including acupuncture/acupressure, therapeutic touch, massage, herbs and dietary recommendations can also help to control pain and side effects of therapy.

epileptic seizures
People that are later diagnosed with high-grade glioma's generally present seizures as a symptom of the illness before the initial treatment. However after treatment seizures will most certainly occur, however they will reduce both in intensity and in occurence rate.

chemotherapy
Some of the chemotherapy agents are associated with fatigue, diarrhea, constipation and headache. These side effects can be effectively managed under most circumstances with standard medical approaches.

radiation therapy
Radiation therapy often produces inflammation, which can temporarily exacerbate symptoms and dysfunction. To control this inflammation steroids are sometimes necessary.

expected outcome after treatment
The prognosis for anaplastic astrocytomas remains poor. The best reported survival rates for radically removed tumors treated with adjuvant radiation therapy approaches 40 percent at five years. This is a minority of patients, however, and most fall into the incompletely removed category with 5-year survival rates of less than 20 percent. The more complete removal of hemispheric tumors may be associated with greater survival.

Mortality
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