Brain Tumours Flashcards
what are common types of primary brain tumours?
neuroepitheal tissue
glioma (glioblastoma multiforme)
meninges
meningioma
pituitary
adenoma
what are common tumours that spread to the brain?
renal cell carcinoma
lung carcinoma
breast carcinoma
malignant melanoma
GI tract
what is a glioma?
Gliomas can be not cancer (benign) or cancer (malignant). They make up about 3 in 10 of all tumors that start in the brain.
derived from astrocytes
how are gliomas graded?
WHO grade I-IV
how are grade IV gliomas described?
most common
most aggressive
Glioblastoma multiforme (GBM)
spread by tracking through white mater and CSF pathway
very rarely spread systemically
what is a meningioma?
A meningioma is a primary central nervous system (CNS) tumor. This means it begins in the brain or spinal cord. Overall, meningiomas are the most common type of primary brain tumor.
what are the characteristics of a meningioma?
slow growing
extra-axial
usually benign
arise from arachnoid
frequently occur along
falx, convexity, or sphenoid bone
usually cured if completely removed
what is the most common type of pituitary tumour?
Adenoma most common
Only 1% tumours malignant
how does a pituitary tumour present?
visual disturbance
compression of optic chiasm
hormone imbalance
how does a brain tumour present clinically?
raised intracranial pressure
(mass effect)
focal neurological deficit
epileptic fits
CSF obstruction
what are symptoms of raised ICP?
headache (typically morning headache)
nausea / vomiting
visual disturbance (diplopia, blurred vision)
somnolence
cognitive impairment
altered consciousness
what are raised ICP signs?
papilloedema
6th nerve palsy
cognitive impairment
altered consciousness
3rd nerve palsy
how much CSF is produced per day?
400 - 450 cc / day
which tumours cause hydrocephalous?
tumours in or close to csf pathways
especially posterior fossa tumours
especially in children
How is a brain tumour diagnosed?
history and examination
think of sources of secondary tumours (eg CXR)
CT scan
MRI scan
biopsy
whay are symptoms of focal neurological defecit?
hemiparesis
dysphasia
hemianopia
cognitive impairment
(memory, sense of direction)
cranial nerve palsy
endocrine disorders
A 66 year old, left handed, woman presents with ataxia and
in-coordination.
Where would you suspect
her lesion to be?
cerebellum
A 44 year old, right handed, woman presents with acalculia, agraphia,
finger agnosia and right/left confusion.
Where would you suspect
her lesion to be?
Gerstmann’s syndrome occurs with left (dominant) parietal lobe lesions
A 30 year old, right handed, man presents with a bi temporal hemianopia.
Where would you suspect
his lesion to be?
Pituitary (macro)adenoma
50Y old right handed man Presented to medical team with cognitive language dysfunction:
difficulty reading e mails
difficulty expressing what he wished to say
short-term memory impairment
6 week history of posterior rib pain
PMHx included a left nephrectomy for renal cell carcinoma 5 years previously?
Lesion in left temporo -parietal area
which brain tumours cause epilepsy?
only in lesions above tentorium
first fit - 20% chance of tumour
draws attention to possibility of tumour
indicates location of tumour
what investigations are done for brain tumours?
Adequate cerebral imaging
CT
MRI
PET
(Angiography)
If suspecting metastasis
CT chest/abdo/pelvis
mammography
biopsy skin lesions/ lymph nodes
what are management foals for brain tumour?
accurate tissue diagnosis
– improve quality of life
decreasing mass effect/
improve neurological deficit
– aid effect of adjuvant therapy
(if required)
– prolong life expectancy
what are management principles for brain tumours?
corticosteroids (Dexamethasone)
treat epilepsy (anticonvulsant drugs)
analgesics / antiemetics
counselling
surgery
radiotherapy
chemotherapy
endocrine replacement
what are manaement options?
Glioblastoma multiforme
complete surgical excision impossible
biopsy or debulk only
medical
Steroids
anticonvulsants
radiotherapy
chemotherapy
temazolamide
Metastasis - most important to confirm diagnosis
11% with abnormal cerebral imaging and a history of cancer, do not have cerebral mets.
medical
steroids, anticonvulsants
radiotherapy
whole brain, steriotatic
surgery
what is the prognosis for meningiomas?
commonly cured by surgery
may require anticonvulsants
what os the prognois for astrocytomas?
low grade - long life expectancy
high grade / GBM - average 1 yr survival
what is the prognosis for metastases?
frequently good medium term remission
what do brain tumours present with?
signs of raised intracranial pressure (headache, nausea/vomiting/papilloedema)
seizures
neurological deficit
