BRAIN TUMOURS Flashcards
Epidemiology of brain tumours?
3% of all tumours in 2015 and incidence is rising
In adults - most common between 85-89
In children <15 they are the second most common cancer
Secondary brain tumours are 3x more common than primary
Presentation of brain tumours?
Progressive and subacute symptoms and signs related to the area of CNS affected by tumour
Signs of raised ICP - headache, n&v, papilloedema, coma
Headache features that may indicate intracranial hypertension?
Constant headache
Nocturna
Worse on waking
Worse on coughing, straining or bending forward
Vomiting
Papilloedema on fundoscopy
What is a meningioma?
A slow-growing tumours from the arachnoid cell cap on the meninges
Most common benign brain tumour - however they have a mass effect so still produce Sx
Peak incidence of meningioma?
Women 40-60
Treatment of meningioma?
In some cases it’s managed conservatively e.g. elderly pt with an inaccessible and relatively asymptomatic tumour
Complete tumour excision with surgery or radiotherapy
Prognosis of meningimas?
Good prognosis with a 91% 5 year survival rate
What are gliomas?
An umbrella term for a variety of tumour subtypes that are tumours of the glial cells surrounding and supporting neurones in brain or spinal cord:
- astrocytomas
- glioblastoma multiforme
- pilocytic astrocytoma
- ependymomas
- oligodendrogliomas
What is the most common primary tumour of the brain?
Gliomas
(Meningiomas are second most common)
Grading of gliomas?
Grade 1 - most benign e.g. pilocytic astrocytoma
Grade 2 -
Grade 3 - aggressive
Grade 4 - most agressive e.g. glioblastoma multiforme
Mean age of onset for gliomas?
55
What is the most common and aggressive form of astroctoma?
A glioblastoma
Diagnosis of brain tumours?
MRI with biopsy or surgical reception to confirm diagnosis histologically
Treatment of gliomas?
Surgery followed by radiotherapy
Prognosis of gliomas?
Poor and rarely curable
30% of adults with high-grade gliomas survive 1 year and 13% 5 years
Medial survival of a GBM is 1 year
The exception is PCAs with >95% surviving 5 years
Which cancers most often spread to the brain?
Lung
Breast
Renal cell carcinoma
Melanoma
What % of all brain tumours are pituitary adenomas?
15%
What are the 2 types of pituitary adenomas?
Functional - secrete hormones
Non-functional and just cause symptoms by mass effect
Clinical features of functional pituitary adenomas?
Cushingoid symptoms
Acromegaly
Diabetes insipidus
Hyperpituitarism
Amenorrhea/galactorrhoea/impotence
Clinica;l features of pituitary adenomas related to the mass effect of the tumour?
Bitemporal hemianopia due to compression of the optic chiasm
Hydrocephalus
Diplopia
Management of pituitary adenomas?
Dopamine agonists e.g. bromocriptin to treat prolactinomas
Somatostatin analogues e.g. octretotide to block excess GH
Trans-sphenoidal surgery
Radiation therapy
What is pituitary apoplexy?
a serious complication of a pituitary adenoma occurring when a haemorrhage causes a rapid increase in the size of the lesion and surrounding vasogenic oedema.
Due to the mass effect, surrounding tissue necrosis occurs. This can result in sudden onset visual loss, headache and hydrocephalus.
What is an acoustic neuroma?
a benign tumour of vestibulocochlear Schwann cells (a.k.a. vestibular schwannoma).
Account for 5% of all intracranial tumours
Who are bilateral acoustic neuromas seen in?
Younger patients and in those with neurofibromatosis type 2
Presentation of acoustic neuromas?
Unilateral sensorineural hearing loss
Tinnitus
Vestibular dysfunction e.g. dizziness
Facial pains nd numbness due to trigeminal nerve compression
Facial nerve weakness due to facial nerve compression
Headaches, n&v - raised ICP
What are craniopharyngioma?
A rare type of benign brain tumour that grows near the pituitary stalk and can therefore affect the hypothalamus and pituitary
Usually found about the sella turcica and depresses the underlying optic chiasm
Derived from residual cells of Rathke’s pouch
Ttpical age for craniopharyngioma?
5-14 - most common
50-70
Clinical features of craniopharyngiomas?
Diabetes insipidus, panhypopituitarism or growt failure to to hypothalamic pituitary dysunction
Sexual dysfunction in adults
Bitemporal hemianopia or other visual disturbance due to compression of optic nerve or chiasm
Headache
Hydrocephalus - rare - due to obstruction of CSF outflow at 3rd ventricle
What is primary CNS lymphoma?
A rare type of lymphoma which starts in the CNS
Usually diffuse large B cell lymphoma
Most often diagnosed around age of 60
A late complications of HIV and other immunodeficiency states
Clinical features of primary CNS lymphomas?
Behaviour/personality changes
Memory/concentration issues
Sensory changes
Dysphasia
Balance and coordination issues
Seizures
Eyesight problems e.g. diplopia
Headaches, n&v - raised ICP
Systemic - fever, night sweats, unintentional weight loss
Prognosis of primary CNS lymphoma?
Poor
If co-diagnosed with AIDS - 4 months with radiotherapy
With methotrexate-based chemo: 10-18 months
What is the most common malignant tumour in children?
Medulloblastomas
What are medulloblastomas?
Tumours that arise from cerebellar stem cells between brainstem and cerebellum near the fourth ventricle
Tend to seed within CSF pathways giving rise to its high metastatic propensity
Clinical features of medulloblastoma?
Hydrocephalus
Cerebellar signs: coordination and gait abnormalities
Mass effect symptoms e.g. unilateral weakness, speech & vision abnormalities, drowsiness, n&v
Extraocular muscle palsies
Raised ICP - headahce, n&v worse in morning
Most common glioma?
Astroctoma
