Brother's unusual brain tumor

  Dear Doctor,
  My 27 year old brother was diagnosed in July '98 with an anaplastic diffuse fibrillary astrocytoma.  He underwent resection surgery in July and will undergo another in September as there was another section of tumor that was not removed in July.  The surgeon (a very skilled man) seems unwilling to give a prognosis or tell the severity (if any) of this type of tumor.  I wish to know how severe the disease is and how I can best support my brother.  I have a general understanding from reading several articles on the internet that anaplastic astrocytoma is bad.  I have not found a prognosis for astrocytoma, could you give me an idea: and what do the other words mean (diffuse and fibrillary.)  How does this description affect the prognosis?
  Thank you for your time,
  Cheryl
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Dear Cheryl,
An anaplastic astrocytoma is a malignant tumor of the supporting cells of the
brain.  The term fibrillary simply refers to the characteristic appearance
of the cells when viewed under a microscope.  Astrocytes are one of a few support
cells in the brain that surround neurons and their connections, providing
nutrients and substance to the brain, among other things.  There are generally
three pathological grades of astrocytomas: low grade, anaplastic (intermediate
grade), and high grade (or glioblastoma multiforme, GBM for short).  Because
these are tumors of the brain substance itself, they are difficult to remove
completely.  In spite of what may appear to be an excellent resection at surgery,
there are always malignant cells left behind.  
Treatment for anaplastic astrocytomas of the brain includes cytoreductive surgery,
postoperative radiation, followed by any number of different therapies.  These
may include chemotherapy, immunotherapy, and endocrine blocking therapies, to
name a few.  There is a tremendous amount of ongoing research on these tumors
and new trials and therapies are surfacing all the time.  
These tumors are difficult to treat in the long run, as they tend to recur
locally and they tend to become increasingly malignant with time.  Your brother
is young and he has a tough battle ahead of him.
The discussion of long-term prognosis should be undertaken with the physician
or surgeon and the patient and his family.  There are serious family, health
and emotional factors that arise in such discussions making this a difficult
endeavour to undertake on the internet.  Set up a time for you and your family
to speak with your brother's physicians to fully discuss this issue.
Good luck.