Brain Tumours Flashcards
What is included in the WHO classifications of brain tumours?
- Tumours of Neuroepitheal tissue
- Tumours of meninges
- Tumours of cranial and spinal nerves
- Haematopoietic neoplasms
- Germ cell Tumours
- Cysts and tumour like lesions
- Tumours of the sellar region
- Local extensions from regional tumours
- Metastatic tumours
What are the common primary brain tumours?
Neuroepitheal tissue
-Glioma (Glioblastoma Multiform)
Meninges:
-Meningioma
Pituitary
-Adenoma
What are the common types of secondary brain tumour?
Commonest tumours that spread to the brain are:
- Renal cell carcinoma
- Lung Carcinoma
- Breast carcinoma
- Malignant Melanoma
- GI tract
What may help you distinguish between primary and secondary brain tumours on a scan?
Primary is usually 1 lesion
Secondary is more likely to be multiple
What is the most comon brain tumour seen clinically?
Metastases (secondary tumour)
15-30% patients with cancer will get cerebral metastases
15% cerebral metastasis is presenting symptom as primary tumour will have given no symptoms
9% cerebral met is only detectable site of spread
Increasing incidence
What are gliomas derived from?
What do these cells do?
Astrocytes
-Structural and nutritional support to nerve cells
How are gliomas graded?
What is the most serious grade?
WHO grade I-IV
Grade IV
- Most common
- Most aggressive
- Glioblastoma multiforme (GBM)
- Spread by tracking through white matter and CSF pathway
- Very rarely spread systemically
What are the characteristics of meningiomas?
- Slow growing
- Extra-axial
- Usually benign
- Arise from arachnoid
- Frequently occur along falx, convexity, or sphenoid bone
- Usually cured if completely removed
Describe pituitary tumours
Adenoma most common
Only 1% malignant
Presentation:
- Visual disturbance (compression of optic chiasma)
- Hormone imbalance
What is the clinical presentation of brain tumours?
- Raised ICP (mass effect)
- Focal neurological deficit
- Epileptic fits
- CSF obstruction
What are the symptoms of raised ICP?
- Headache (typically morning headache)
- Nausea/ vomiting
- Visual disturbance (diplopia, blurred vision)
- Cognitive impairment
- Altered consciousness
What are the signs for ICP?
- Papilloedema
- 6th nerve palsy
- Cognitive impairment
- Altered consciousness
- 3rd nerve palsy
How do tumours result in hydrocephalus?
Tumours in or close to csf pathways
Especially posterior fossa tumours
Especially in children
How do you diagnose brain tumours?
- History and examination
- Think of sources of secondary tumours (e.g. CXR)
- CT scan
- MRI scan
- Biopsy
What focal neurological deficits may present in brain tumours?
- Hemiparesis
- Dysphasia
- Cognitive impairment (memory, sense of direction)
- Cranial nerve palsy
- Endocrine disorders
What does Gerstmann’s syndrome occur with?
Left (dominant) parietal lobe lesions
What are the two types of epilepsy?
Focal epilepsy
General epilepsy
Explain epilepsy in brain tumour
Only in lesions above the tentorium
First fit -> 20% chance of tumour
Draws attention to possibility of tumour
Indicates location of tumour
What investigations could/ should you carry out in brain tumours?
Adequate cerebral imaging:
- CT
- MRI
- PET
- (Angiography)
If suspecting metastasis
- CT chest/abdo/pelvis
- Mammography
- Biopsy skin lesions/ lymph nodes
What are the management goals in 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 should you do in terms of management?
- Corticosteroids (Dexamethasone)
- Treat epilepsy (Anticonvulsant drugs)
- Analgesics/ antiemetics
- Counselling
- Surgery
- Radiotherapy
- Chemotherapy
- Endocrine replacement
What are the management options for glioblastoma multiforme?
Complete surgical excision impossible
-Biopsy
Medical
- Steroids
- Anticonvulsants
Radiotherapy
Chemotherapy
-Temezolamide
Whats the most important thing to do with metastatic brain tumours?
Most important to confirm diagnosis
11% with abnormal cerebral imaging and a history of cancer, do not have cerebral mets
What is the management options for metastatic brain tumour?
Medical
- Steroids
- Anticonvulsants
Radiotherapy
- Whole brain
- Steriotactis
Surgery
What is the prognosis for meningioma?
Commonly cured by surgery
May require anticonvulsants
What is the prognosis for low grade astrocytoma?
Long life expectancy
What is the prognosis for High grade astrocytoma/ glioblastoma multiforme?
Average 1 year survival
What is the prognosis for metastases?
Frequently good medium term remission
