brain tumours Flashcards
commonest brain tumour? where are they usually found in the brain?
metastases
seen at boundaries between grey + white matter
difference between location of brain tumours in kids vs adults
kids = 70% BELOW tentorium cerebelli
adults = 70% ABOVE
(2nd most common cancer in kids)
commonest primary cancers of metastatic brain tumours?
lung
breast
renal cell carcinoma
melanoma
how do infratentorial and supratentorial present differently?
infra = cerebellum/posterior fossa -> ipsilateral symptoms
supra -> contralateral
infra more common in kids
inherited syndromes that increase risk of brian tumours
neurofibromatosis
von hippel-lindau
tuberous scelrosis
Li-fraumeni syndrome
ionising radiation
immunosuppression
brain tumour presentation
progressive neurological deficit - correlate to tumour location
headache
- with or without raised ICP
- worse in morning, wakes them uo
- worse on coughing/leaning forward
- assoc with vomiting
motor weakness
papilloedema
sizures
endocrine disturbances
visual disturbances
management of metastatic tumours
cerebral oedema surrounding the tumours responds to steroid therapy
resection via surgery, stereotatic radiotherapy + whole brain radio therapy
NB: many systemic therapies for primary tumours do not cross blood brain barrier + therfore do not control brain metastases
urgent cancer referral criteria
progressive neurological deficit (in absence of alternative disorder)
change in behaviour - psycholocial, cognitive
seizure
headache with vomiting and/or papilloedema
types of primary brain tumour - glioma + non-glioma
glioma (intrinsic)
- astrocytic = commonest
- oligodendroglioma
non-glioma
- craniopharyngioma
- meningioma
- schwannoma
- lymphoma (high grade)
astrocytoma
from astrocytes
- star shaped with multipolar cytoplasmic processes
maintain BB barrier
envelope synaptic plates, wrap around vessels + capillaries within the brain
4 grades
astrocytoma grading
I = pilocytic -> children
o Pleomorphic xanthoastrocytoma – babies
o Subependymal giant cell – tuberous sclerosis
II – low grade astrocytoma -> all become malignant at some point, atypia
III – anaplastic astrocytoma, atypia + mitosis
IV – glioblastoma multiforme, atypia + mitosis with vascular proliferation or necrosis
grade I astrocytoma
truly benign, slow growing
children, young adults
imaging - sometimes enhance but well demarcated
- often secrete fluid causing hydrocephalus -> signet ring shape
pilocytic astrocytoma
- tend to be in posterior fossa - cerebellum brain stem
- NF1 - optic nerve
- hypothalamic gliomas - uncontrollable laughin but actually a seizure
mx - surgery =curative
presentation of kids with cerebellum tumours
walk on tip toes
hypotonia
see changes on ipsilateral side to tumour
general management of brain tumours
must tell DVLA
chemo - temoxolomide
radio
- post surgery
- use in low grade if incomplete removal, malignant degeneration
- not in benign
- drops iq by 10(don’t give to <3yrs)
novel therapies - immunotherapies, focused ultrasound
grade II low grade astrocytoma
atypia
not truly cancerous - pre-cancer
common loction - temporal lobe, pos. frontal, ant. parietal
seizures common
poor prognostic factors for grade II astrocytoma
age >50
short duration of symptoms
raised ICP (papilloedema)
altered consciousness
enhancement on contrast studies
diameter >6cm
tumours crossing midline
treatment of grade II astrocytoma
serial imagin - monitor
radio/chemo
gold = surgery +/- above
seizure control, herniation, CSF obstruction
malignant astrocytomas
grade III-IV
contrast enhancement on imagin is a key sign
anaplastic astrocytoma
can arise de novo
median survival -> 5yrs
glioblastoma multiforme (IV astrocytoma)
commonest primary tumour
median survival <1yr - 15months
conditions with multiple gliomas - neurofibromatosis, tuberous sclerosis
spread - white matter tracking/csf pathways -> EVERYWHERE
glioblastoma multiforme of histology + imaging
imaging = solid tumour with central necrosis + a rim that enhances with contrast
histology = pleomorphic tumour cells border necrotic areas
management of glioblastoma multiforme
Stupp protocol = surgery + radio + temozolomide -> improves survival to 14 months
very difficult to get all
cytoreduction/non-curative surgery
tell DVLA
oligodendroglia tumours
20% of glial tumours
produce myelin
frontal lobes
benign, slow growing
adult 24-45yrs
seizure presentation
calcifications with FRIED EGG appearance
management of oligodendroglia tumours
chemo sensitive - PCV
! radio + PCV -> double survival !
median survival - 10yrs low grade
medulloblastoma
2nd most common tumour in kids after pilocytic astrocytoma
poorly differentiated
occurs midline of cerebellum
treatment = super RADIOSENSITIVE
(75% 5yr survival with resection + radiotherapy)
important bits about intrinsic tumours
headaches that wake you +/- vomitng - check pupils
new neurological deficit - incl seizures
kids (posterior fossa) - tiptoeing, ataxia
-> vomiting with headache in kids
meningiomas
2nd commonest primary in adults (to glioblastoma)
typically benign
arise from arachnoid cap cells of meninges + typically located next to the dura
-> causes symptoms of compression rather than invasion
types of meningioma
CCRAP
clear cell
chordoif
rhabdoid
anaplastic
papillary
after childhood leukaemai - radiotherapy indiced mid line menignioma
meningioma presentation + management
majority asymptomatic
headaches
cranial nerve neuropathies
if small - just treat seizures
if vascular supply - embolise them
surgery = curative
acoustic neuroma presentation
often seen at cerebellopontine angle
“cone shape”
bilateral assoc with NF2
hearing loss unilateral
tinitus
facial nerve palsy
dizziness/imblance
sensation of fullness in ear
pineal tumours
midline tumours of kids
important in diurnal rhythm + sleep
*any midline tumour in kid -> do tumour markers, test serum + CSF
- alpha-fetoprotein
- beta HCG
- LDH
(if neg - biopsy, test CSF)
