Thalamic or hypothalamic astrocytoma

We understand that you may have a lot of questions when your child is diagnosed with a thalamic/hypothalamic astrocytoma:

• What exactly is it?
• What are potential complications in my child’s case?
• What are the treatments?
• What are possible side effects from treatment?
• How will it affect my child long term?

We’ve tried to provide some answers to those questions here, and when you meet with our experts, we can explain your child’s condition and treatment options fully.

How are thalamic/hypothalamic 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 and prognosis. Staging is the process of determining whether the tumor has spread and if so, how far.

There are four “grades” of astrocytomas. Ordered from least to most severe, they are:

• grade I (pilocytic)
• grade II (fibrillary)
• grade III (anaplastic)
• grade IV (glioblastoma multiforme)

Thalamic/hypothalamic astrocytomas are usually classified as grade I or grade II tumors.

What causes thalamic/hypothalamic astrocytomas?

It’s important to understand that these tumors most often have no known cause. There’s nothing that you could have done or avoided doing that would have prevented them from developing.

Research has shown that there is a link between some types of low-grade astrocytomas (including thalamic/hypothalamic astrocytomas) and certain genetic diseases, specifically neurofibromatosis I and tuberous sclerosis.

What are the symptoms of thalamic/hypothalamic astrocytomas?

Since thalamic/hypothalamic astrocytomas grow relatively slowly, your child may have been having symptoms for many months by the time he is diagnosed, or symptoms may appear more suddenly.

Many children with thalamic/hypothalamic astrocytomas have symptoms related to increased pressure in the brain, including:

• headache (generally upon awakening in the morning)
• nausea and vomiting (often worse in the morning and improving throughout the day)
• fatigue

Other symptoms your child may show include:

• symptoms of hormone imbalance (weight loss/gain, symptoms of salt and water imbalance in the body such as retaining water (swelling) or frequent urination)
   
• changes in vision (since the thalamus and hypothalamus are found close to the visual pathway system of the brain)

Keep in mind that these symptoms may resemble other, more common conditions or medical problems. If you don’t have a diagnosis and are concerned, always consult your child's physician.

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:

• 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: Will my child be OK?

A:The outcome after treatment for thalamic/hypothalamic astrocytomas can vary, depending on  whether the tumor has spread and whether it can be completely removed through surgery. In general, low-grade tumors are more likely to be successfully treated than high-grade tumors. Your doctor will discuss treatment options with you and your family including clinical trials and supportive care.

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

A: We offer a variety of support services to help you, your child and your family get through this difficult time.

Q: Where will my child be treated?

A: Children treated on an outpatient basis through Dana-Farber/Children’s Hospital Cancer Center are cared for 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, he will stay at Children’s Hospital Boston on the ninth floor of the Berthiaume Building.

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

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

Reviewed by Mark Kieran, MD, PhD
© Children’s Hospital Boston, 2010