Brain Tumours Flashcards
What are the symptoms of a brain tumour?
generalised - apathy, personality change, dementia, drowsiness
- CN palsy
- seizures (often initial presentation)
What does focal and generalised symptoms mean?
Focal - to do with part of brain injured
Generalised - anything to do with rest of brain
What is the common presentation of a space occupying tumour?
(due to raised ICP) - headache - papilloedema - vomiting (often also get drowsiness, coma, personality changes or dementia
Why are headaches from raised ICP more common at night?
- ICP increases naturally at night anyway
- so with already high ICP worsened at night
What type of headache will raised ICP cause?
- not great intensity
- throbbing
- aggravated by coughing, sneezing, stooping down or exertion
What will be the background of vomiting caused by raised ICP?
- before breakfast
- accompanied by headache
- no nausea so no warning
What are the most common primary intracranial tumours?
Gliomas (arise from glial cells)
Meningiomas (form meninges)
pituitary adenomas (pituitary cells
schwanommas (cranial nerves)
What are the most common secondary intracranial tumours?
spread from:
- lung
- breast
- melanoma
- renal
- thyroid
How are gliomas treated?
1) biopsy of tissue for diagnosis (either closed or can need open surgery)
2) debulking of tumour surgically
3) radio therapy (sometimes chemo)
4) give temozolomide for glioblastomas
Which tumours are hardest to remove surgically?
subcortical or cortical
- more limited to biopsy
- surgery not possible
Which gliomas have highest/lowest survival rates?
Astrocytomas high grade worst prognosis
Astrocytomas grade I has highest survival
Oligodendrogliomas low grade good prognosis, high grade = bad prognosis
Are most meningiomas benign or malignant?
Benign
- if resectable can become disease free
- complications of resection if near or connected to nerves/blood vessels
What different treatments can be used for brain metastases?
1) surgical resection
2) stereotactic radio surgery
3) whole brain radiotherapy
4) chemotherapy/systemic anti-cancer treatment
What is stereotactic radio surgery?
- low dose radiation is beamed from multiple angles to focus on tumour location (concentrated at location)
What visual disturbances can occur with raised ICP?
- enlargement of blind spot and peripheral construction of fields
- loss of vision (more commonly intermittent)
- attacks precipitated by getting up or sleeping
What are the types of gliomas and what cells do they arise from?
1) Astrocytoma (astrocytes)
2) Oligogendrogliomas (oligodendrocytes)
3) Ependymomas (ependymal)
What is the most common malignant brain tumour?
Glial accounts for 80%
What is the prognosis of astrocytomas?
Prognosis poor even in grade II tumours, likely to progress to malignant, mean survival 5-7 years
What are the common complications of surgery for brain tumours?
- can render patient disabled
- death
- stroke like symptoms
- haemorrhage
- seizures
- wound infection
What surgical techniques are used to reduce complications?
- detailed image guidance (pre-op)
- Real-time scans
- Tumour florescence
- Awake surgery to monitor speech and movement
What is the most common presenting symptom of low grade glioma?
Seizures
What are the type radiation techniques?
1) Conventional fractionated
2) Advanced EBRT techniques
3) Stereotactic radiosurgery/therapy
What are the most common childhood brain tumours?
1) pilocytic astrocytoma
2) medulloblastoma
3) ependypmoma
What is the optimal treatment option for childhood brain tumours?
1) complete surgical resection is optimal
- radiotherapy is avoided where possible in younger than 4 yr due to toxicity on developing brain
What is proton therapy?
dose of high energy protons to be precisely targeted at a tumour, reducing the damage to surrounding healthy tissues
How do vestibular shwannomas present?
Hearing loss
Tinnitus
Balance problems
(benign)
How do pituitary macroadenomas present?
will compress adjacent structures e.g. optic nerve
resulting in
- vision loss in outer field of both right and left eye
How do pituitary microadenomas present?
- prolactinoma
- GH-secreting (acromegaly)
- ACTH (Cushing)
When is chemotherapy used instead of radiotherapy for brain tumours?
malignant gliomas
What are the palliative care options for terminal brain tumours?
- medication to manage symptoms
- dexamethasone for peri-tumoural oedema
- hospice
- refer to palliative care team
