Brain Tumours Flashcards
What are primary and secondary types of brain tumour?
Primary - neuroepithelial tissue, glioma, meningioma and adenoma of pituitary
Secondary - commonest tumours which spread to brain - renal cell, lung, breast, malignant melanoma and GIT
What is the most common brain tumour?
Metastases
15-30% of cancer patients get cerebral metastases
Increasing incidence
Describe gliomas
Are derived from astrocytes - structural and nutritional support to nerve cells
Grade IV is most common and aggressive
Glioblastoma multiforme GBM
Spread by tracking though white matter and CSF
What are some characteristics of meningiomas?
Slow growing, extra-axial, usually benign, arises from arachnoid, usually cured if completely removed and mainly occur along falx, convexity or sphenoid
Describe pituitary tumours
Adenoma most common
Only 1% tumour malignant
Presents with visual disturbance and hormone imbalance
What is the clinical presentation of brain tumours?
Raised intracranial pressure
Focal neurological deficit
Epileptic fits
CSF obstruction
What are some raised ICP symptoms?
Headache - typically morning
Nausea and vomiting
Visual disturbance - diplopia and blurred vision
Somnolence
Cognitive impairment
Altered consciousness
What are some raised ICP signs?
Papilledema
6th nerve palsy
Cognitive impairment
Altered consciousness
3rd nerve palsy - diplopia
What tumours cause hydrocephalus?
Tumours in or close to CSF pathways
Esp. posterior fossa tumours
Especially children
How are brain tumour diagnosed?
History and exam
CXR sources of secondary tumour
CT and MRI scans
Biopsy
What are symptoms of focal neurological deficit?
Hemiparesis, dysphasia, hemianopia, cognitive impairment, cranial nerve palsy and endocrine disorders
Where would lesion suspected to be if left landed women presents with ataxia and in-coordination?
Cerebellum
Where would lesion suspected to be if women is right handed and presents with acalculia, agraphia, finger agnosia and right/left confusion?
Left parietal lobe
What occurs with left (dominant) parietal lobe lesions?
Gerstmann’s syndrome
Where would lesion be suspected if right handed man has bi temporal hemianopia?
Pituitary
Where would the lesion be suspected if right handed man has cognitive language dysfunction?
Left temporo-parietal area
Describe epilepsy and brain tumours
Focal or generalised epilepsy
Only in lesions above tentorium
Affects cerebrum - mainly frontal and temporal
Can indicate the location of tumour
What investigations are done?
CT, MRI and PET
Angiography possibly
If suspect metastases - CT chest/abdo/pelvis, mammography and biopsy skin lesions and lymph nodes
What is the management goals for brain tumours?
Accurate tissue diagnosis
Improve QoL
Aid effect of adjuvant therapy
Prolong life expectancy
What are the management principles for brain tumours?
Corticosteroids - dexamethasone
Treat epilepsy - anticonvulsant drugs
Analgesics/ antiemetics
Surgery, RT, Chemo and endocrine replacement
What are the management options for glioblastoma multiforme?
Complete surgical excision impossible - biopsy or debulk only
Medical - steroids and anticonvulsants
RT and Chemo - temozolomide
What is the management options of metastasis?
Confirm diagnosis
Medical - steroids and anticonvulsants
RT - whole brain or stereotactic
Surgery
What is the prognosis of meningioma?
Commonly cured by surgery
May require anticonvulsants
What is the prognosis of GMB?
Low grade then long life expectancy
High grade then average 1 year
What is the prognosis of metastases?
Frequently good medium term remission
What is the treatment of meningioma?
Surgical excision
When should lumbar puncture not be performed?
When there is signs and symptoms to suggest an intracranial mass lesion
Why not do a LP if intracranial lesion?
Might cause herniation syndrome and patient could die
What are primary benign brain tumours?
Meningioma and pituitary adenoma
