ASTROCYTOMA – GRADE III AND IV

Anaplastic Astrocytoma; Anaplastic Malignant Astrocytoma; Anaplastic Oligoastrocytoma; Anaplastic Oligodendroglioma; Anaplastic Pleomorphic Xanthoastrocytoma; Astrocytoma Grade III; Astrocytoma Grade IV; Giant Cell Glioblastoma; Gliosarcoma Astrocytoma Grade IV; Mixed Glioblastoma Sarcoma

Astrocytoma is a tumor that begins in the brain or spinal cord in small, star-shaped cells called astrocytes. These tumors are graded as defined by the World Health Organization (WHO). The grading is based on microscopic analysis of levels of mitotic activity and nuclear atypia.

Grades III and IV represent the most aggressive forms of the disease. Grade III astrocytomas include anaplastic astrocytomas and sometimes the less malignant of the glioblastoma multiforme group. Grade IV astrocytomas are highly malignant and include only glioblastoma types. Cerebellar astrocytomas start in the cerebellum, which is located at the lower back of the brain. The cerebellum is the part of the brain that controls movement, balance, and posture.

These tumors affect both adults and children. About 15-25% of all childhood brain tumors are cerebellar astrocytomas. Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and lymphoma. The symptoms of astrocytoma vary and often depend on an individual's age and where the tumor is located.

Diagnostic testing: Diagnostic testing for astrocytoma includes a neurologic examination and radiologic imaging such as a computerized tomography (CT) scan and/or magnetic resonance imaging(MRI). A biopsy is performed, either before surgery by a needle biopsy or at the time of surgical resection.

Physical findings: Symptoms and physical findings of astrocytoma include:

• •

  Loss of balance;

• •

  Trouble walking;

• •

  Slow speech;

• •

  Morning headache or headache that goes away after vomiting;

• •

  Nausea and vomiting;

• •

  Unusual sleepiness or change in energy level;

• •

  Change in personality or behavior;

• •

  Seizures;

• •

  One-sided weakness;

• •

  Sensory loss; and

• •

  Visual changes.

ICD-9: 191.9

ICD-10: C71.9

Astrocytomas tend to grow and become more malignant over time. Brain stem gliomas have relatively poor prognoses. The overall median survival is between 44 and 74 weeks.

Treatment depends on the location of the tumor and its progression. Standard treatment is surgery followed by radiation therapy. If surgery is not an option, radiation therapy is given. Chemotherapy is sometimes given during or after radiation therapy.

Suggested MER for Evaluation:

• •

  Clinical history and examination that describes the diagnostic features of the impairment;

• •

  A pathology report; and

• •

  If a pathology report is unavailable, a surgical report or all radiological studies especially the MRI and CT scans may be substituted.

Suggested Listings for Evaluation:

REMARKS

Pathologically confirmed or clinically diagnosed astrocytoma or glioma of the brain stem or thalamus (independent of grade).

Grade IIII or IV astrocytoma, oligodendroglioma, or glioblastoma.

Grade III or IV astrocytoma or glioblastoma.