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Management of Disorders > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What are the most common types of brain tumour in adults?

A

Glioma and meningioma

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2
Q

How has the incidence of brain tumours changed in the last 30 years?

A

Increased by 30%

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3
Q

Why has the incidence of brain tumours likely changed recently?

A

▪️Better ability to detect incidental tumours
▪️Ageing population
▪️Better ability to manage other tumour types but not brain metastases

(NOT mobile phones)

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4
Q

What are the two most fatal neurological disease?

A
  1. Stroke
  2. Brain tumours
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5
Q

What are the four main types of primary brain tumour?

A

▪️Meningioma
▪️Glioma
▪️Primary CNS lymphoma
▪️Pituirary/craniopharyngiomas

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6
Q

What is a meningioma?

A

A tumour that arises from the meninges. They are benign, usually well circumscribed, and typically grow very slowly but can cause damage if they push onto the brain.

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7
Q

What are the main categories of glioma?

A

▪️Glioblastoma multiforme
▪️Low grade (e.g. astrocytoma, oligodendroglioma)
▪️Rarer subtypes (e.g. ependymoma)

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8
Q

What is the most malignant primary brain tumour?

A

Glioblastoma multiforme (GBM)

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9
Q

Who usually manages pituitary/craniopharyngiomas?

A

Endocrinology teams

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10
Q

What type of tumour is most commonly seen in adult neurooncology clinics?

A

Gliomas

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11
Q

Who usually manages primary CNS lymphomas?

A

Haemato-oncology

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12
Q

What is an extrinsic tumour?

A

Tumours that grow from outside of the brain parenchyma (e.g. meningioma)

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13
Q

What is the main problem with extrinsic tumours?

A

They’re typically benign but when put enough can put pressure onto the brain.

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14
Q

What is a grade 1 meningioma?

A

▪️Benign
▪️Slow growing
▪️Majority of cases

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15
Q

What is at grade 2 meningioma?

A

▪️Atypical meningioma
▪️Benign but slightly faster growing
▪️Often post radiotherapy many years later (e.g. craniospinal radiotherapy for leukaemia)

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16
Q

What is a grade 3 meningioma?

A

▪️Very rare (1 or 2 a year at KCH)
▪️Malignant and fast growing
▪️Very poor prognosis
▪️Operable but not sensitive to chemotherapy or radiotherapy

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17
Q

What is an intrinsic tumour?

A

A tumour that grows from inside the brain (e.g. glioma, lymphoma)

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18
Q

What might you see on a scan around an intrinsic tumour?

A

▪️Haemorrhagic lesions
▪️Oedema

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19
Q

What is a grade 1 glioma?

A

▪️Pilocytic astrocytoma
▪️Benign and slow growing
▪️Usually in childhood
▪️Very rare
▪️Cured if clear of it for 10 years

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20
Q

What is the only completely curable glioma?

A

A pilocytic astrocytoma

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21
Q

What stage do astrocytoma and oligodendrogliomas usually start as?

A

Grade 2

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22
Q

Do all low grade gliomas eventually become high grade (4)?

A

No

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23
Q

What grade can an oligodendroglioma be?

A

2 or 3

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24
Q

What is a grade 2 glioma?

A

▪️Oligodendroglioma
▪️Astrocytoma
▪️Slow growing
▪️Can be there a long time without detection

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25
Q

Why do oligodendrogliomas typically not progress last grade 3?

A

They can be very slow growing

(Often takes a long time for them to be detected)

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26
Q

What is the only type of glioma that can become glioblastoma multiforme?

A

Astrocytoma

27
Q

What is a grade 3 glioma?

A

▪️Anaplastic astrocytoma
▪️Anaplastic oligodendroglioma
▪️Malignant
▪️Fast growing

28
Q

What is a secondary GBM?

A

A GBM that has developed from an astrocytoma

29
Q

What is a grade 4 glioma?

A

▪️Glioblastoma multiforme
▪️Very aggressive
▪️Fast growing
▪️Poor prognosis

30
Q

What is a primary GBM and who is most at risk?

A

A tumour that begins at grade 4.

Particularly in the older population

31
Q

Which has a better prognosis, a primary GBM or a secondary GBM?

A

Secondary

(they have different molecular pathology)

32
Q

How might you manage a diffuse astrocytoma?

A

▪️Chemotherapy or radiotherapy
▪️May blend in too much for surgery

33
Q

How do the majority of people with CNS tumours present initially?

A

Asymptomatic - often picked up incidentally

34
Q

What is the second most common presentation seen with brain tumours?

A

Seizures

35
Q

When are you most likely to see raised intracranial pressure with tumours?

A

At the end stages.

Very rarely a presenting symptoms (would have to be very fast growing or other symptoms ignored)

36
Q

How do you differentiate focal neurological deficit caused by a tumour from a stroke?

A

Much slower onset

(UNLESS sudden bleed in tumour or swelling)

37
Q

What neuropsychiatric symptoms may people with tumours first present with?

A

▪️Slow cognitive decline
▪️Slow personality change

38
Q

What might slow cognitive decline and personality change tell us about the location of the tumour?

A

Frontal or temporal lobes

39
Q

What is a seizure?

A

Abnormal electrical activity in the brain at the wrong time, either partial or generalised.

(2 or more = epilepsy)

40
Q

What percentage of people with brain tumours will have 2 or more seizures (tumour-associated epilepsy)?

A

40-60%

41
Q

With what type of tumour is epilepsy more common and why?

A

Low grade gliomas because they infiltrate the tissue and thus are more likely to disrupt activity

(65-95%)

42
Q

Why is epilepsy less likely to occur in GBMs?

A

They grow very fast and are more likely to just kill the cells

43
Q

What type of brain metastases are most likely to cause tumour-associated epilepsy and why?

A

Melanoma metastases, because they tend to bleed into the brain.

(67%)

44
Q

How might a meningioma cause tumour-associated epilepsy?

A

By pressing on the brain, disrupting activity

(25%)

45
Q

What are the main signs of raised intracranial pressure?

A

▪️Headache (particularly in the morning)
▪️Changes in consciousness
▪️Vomiting
▪️Double vision
▪️Drowsiness and confusion
▪️Unsteady
▪️Changes in vital signs (Cushings triad)

46
Q

Why might you get double vision with raised intracranial pressure?

A

6th cranial nerve may be pulled, causing lateral retinas palsy

47
Q

How do focal neurological deficits typically present with tumour?

A

Slow focal LOSS over days or weeks
Particularly in the limbs, eyes, and face

48
Q

How can you usually spot a high grade glioma on a scan?

A

▪️Irregular enhancement
▪️Necrosis in the middle

49
Q

Why has prognosis of high grade gliomas massively increased in recent years?

A

▪️Better and safer surgical techniques
▪️Safer oncology treatments
▪️Better understanding of molecular pathology

50
Q

How has brain tumour surgery advanced in recent years?

A

▪️Greater extent of resection
▪️Multiple surgeries if necessary
▪️Gliolan
▪️Intraoperative MRI and monitoring
▪️Awake surgery

51
Q

How have oncology treatments advanced recently?

A

▪️Temozolamide for chemo
▪️Safer radiotherapy techniques

52
Q

How often can you have radiotherapy?

A

Once every 10 years

53
Q

What is Gliolan?

A

A photosynthetic drug that can be drunk an hour before surgery. It makes the tumour cells shine pink under blue light, helping to detect tumour that looks like healthy tissue.

54
Q

What have contributed to safer surgery?

A

▪️Functional MRI
▪️Awake craniotomy (wake them after removing the skull)
▪️Intra-operative monitoring
▪️Electrophysiological methods if unable to be awake (shocks)

55
Q

What is Temozolamide?

A

An oral chemotherapeutic agent with very few side effects

56
Q

What is the Stupp protocol and when is it used?

A

Combination of radiotherapy and Temozolamide for high grade gliomas.

(Has very low toxicity and increased survival rate by 26.5%)

57
Q

What is the DC vaccine?

A

A vaccine created from the individuals own brain tissue that works against the person’s personalised tumour

(Only at King’s atm)

58
Q

If someone is methylated, how does this affect their response to chemotherapy and why?

A

Increases it, makes them much more responsive, especially to Stupp protocol.

It inactivated the MGMT gene which creates resistance to chemo

59
Q

What can tumour markers help us with?

A

▪️Determining what the tumour is
▪️Determine prognosis

60
Q

What does a positive IDH-1 marker indicate?

A

Low grade glioma or secondary GBM

(negative = primary GBM)

61
Q

What does a 1p19q codeletion indicate?

A

Oligodendroglioma

Sensitive to chemo

62
Q

What is ATRX a marker for?

A

Astrocytoma

(NOT so chemosensitive)

63
Q

What is usually the best intervention for low grade gliomas that can be fully resected?

A

Early radiotherapy plus chemo (PCV)

64
Q

How do you manage tumour-associated epilepsy?

A

▪️Treat after first seizure
▪️Avoid enzyme-inducing AEDs incase they need chemo
▪️Tumour treatment takes precedence

Management of Disorders (28 decks)

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