Brain Tumours

Question 1

Which genetic disorders can pre-dispose you to brain tumours

Answer 1

NF- 1 - acoustic neuromas
Li Fraumeni syndrome
Tuberous sclerosis - astrocytomas
MEN type 1 -pituitary macroadenoma

Question 2

What makes you suspect a brain tumour in patient

Answer 2

Morning headache
N+V 
Confusion
New onset of seizures
Motor deficit
Sensory deficit
Personality change
Dypshasia
Ataxia

Question 3

How would you investigate a suspected brain tumour

Answer 3

CT brain

MRI brain/spine – to exclude multiple metastatic deposits; to better characterise tumour

Question 4

If someone has cerebral lymphoma which other condition must be exclude

Answer 4

HIV

Question 5

Which primary tumours commonly met to the brain

Answer 5

Lung
Breast
GI

Though any primary potentially

Question 6

How do you treat oedema caused by brain tumours

Answer 6

Steroids

Question 7

List the types of benign primary brain tumours

Answer 7

Pituitary – adenoma, cranio-pharyngioma
Meningioma
Acoustic neuroma
Dermoid tumour

Question 8

How do you treat a benign brain tumour

Answer 8

Observation
Surgery
Radiotherapy
Best supportive care

Question 9

Benign brain tumours can behave in a malignant fashion - true or false

Answer 9

True

Due to their location and reccurent nature

Question 10

List the types of malignant primary brain tumours

Answer 10

Glioma - many grades/subtypes 
Primary Cerebral Lymphoma
Germinoma
Pineoblastoma
Medulloblastoma

Question 11

What is the most common malignant primary brain tumour

Answer 11

Glioma

Question 12

List the different grades of glioma

Answer 12

I: Fibrillary astrocytoma
II: Astroctytoma or Oligodendroglioma
III: Anaplastic Astrocytoma /oligodendrglioma
IV: Glioblastoma multiforme

Question 13

How do you treat gliomata

Answer 13

Surgery

Radiotherapy 60Gy in 30# over 6 weeks +/- Temozolamide chemotherapy
Or 30Gy in 6# over 2 weeks (gives you months)

Can use Gliadel wafers - chemo that is placed directly in the brain after tumour is resected

Or best supportive care - usually gets you weeks

Question 14

Which type of brain tumour is associated with HIV

Answer 14

Primary cerebral lymphoma

Question 15

How do you treat primary cerebral lymphoma

Answer 15

Steroids
Chemo (methotrexate based)+/- XRT

However has poor outcomes

Question 16

What is an ependymoma

Answer 16

Rare tumour - primary CNS
Starts in the brain or spinal cord in the ependymal cells (line the CSF passages)
Type of glioma