Brain Tumours Flashcards
1
Q
Commonest cause of cancer death under 40?
A
Brain tumours
2
Q
Commonest cause of cancer death under 40?
A
Brain tumours
3
Q
Describe the headaches in brain tumours: when are they worse? which position are they worse in? What are they associated with?
A
- Worse in the morning
- Worse leaning forward
- May be associated and decrease with vomitting
- Symptoms similar to tension HA/migraine
4
Q
Cushings triad of raised ICP
A
- irregular breathing
- bradycardia
- systolic hypertension
5
Q
Which lobe:
- thought
- reasoning
- behaviour
- memory
A
Frontal lobe
6
Q
Which lobe:
- intellect
- thought
- reasoning
- memory
A
Parietal lobe
7
Q
Which lobe:
- motor and sensory functions
- abstract concepts
A
Motor and sensory functions: left
Abstract concepts: right
8
Q
Which lobe:
- Memory, hearing and vision pathways
- Emotion
A
Temporal lobe
9
Q
If you have metastases in the brain, what scan could you do to find the primary tumour?
A
PET scan
10
Q
What establishes the diagnosis of glioblastoma multiforme?
A
The presence of necrosis (remember glioblatoma multiforme is grade IV)
11
Q
Glial tumour arise from which cells?
A
- glial cells
- oligodendrocytes
12
Q
What age group are affected by grade 1 astrocytomas
A
Children, young adults
13
Q
Where do pilocytic astrocytomas arise?
A
- Optic nerve, hypothalamic gliomas
- Cerebellum, brainstem
14
Q
Treatment for grade 1 astrocytomas
A
Surgery
15
Q
Most common presentation of low grade glioma (low grade astrocytoma)
A
Seizure
16
Q
Cellular features of a low grade astrocytoma
A
- Hypercellularity
- Pleomorphism
- Vascular proliferation
- Necrosis
17
Q
Most common type of diffuse low grade astrocytoma
A
Fibrillary astrocytoma
18
Q
Poor prognostic factors for low grade astrocytomas (fibrillary)
A
- age >50
- focal deficit (cf. seizures)
- short duration of symptoms
- raised ICP
- altered consciousness
- enhancement on contrast studies
19
Q
What does IDH-1 or 1p19q indicate in grade II astrocytomas?
A
Better prognostic function
20
Q
Treatment for low grade astrocytomas II?
A
Surgery +/- radiation/chemotherapy/combination
21
Q
What is brachytherapy?
A
Placement of radioactive isotopes directly into the area to be treated
22
Q
Poor prognostic factors for grade II astrocytomas (glioblastomas)
A
- age >45
- low performance score
- large tumours (dia>6cm) / crossing midline
- incomplete resection
23
Q
Median survival for anaplastic astrocytoma
A
2 years
24
Q
Median survival for glioblastoma multiforme?
A
25
How do glioblastoma multiforme spread?
White matter tracking / CSF pathways
26
How do you improve survival in malignant astrocytomas?
- surgery +
- radiotherapy +
- TMZ (temozolomide)
- improves survival to 14 months
- live longer is MGMT methylated tumour
27
Significance of MGMT methylated tumour?
Live longer
28
Side effects of radiotherapy?
Drops IQ by 10
Skin
Hair
Tired
29
How do oligodendroglial tumours present?
Seizures
30
Which lobes do oligodendroglial tumours affect?
Frontal lobes
31
Age group affected by olgidendroglial tumours?
-25-45 years (smaller peak in children 6-12)
32
Oligodendroglial tumours are difficult to distinguish from astrocytomas, what can you look for? (CCP)
- calcification
- cysts
- peritumoural haemorrhage
33
"toothpaste" morphology
Oligodendroglial tumours
34
What is a collision tumour?
Oligodendroglial cells can coexist with astrocytic cells in a neoplastic collision type of tumour
35
Which type of tumour is chemosensitive?
Oligodendroglial tumours
36
Treatment for oligodendroglial tumours
Chemotherapy (chemosensitive)
- procarbazine
- lomustine
- vincristine
37
Meningiomas arise from which type of cell?
Arachnoid cap cell
38
Meningiomas arise from which type of cell?
Arachnoid cap cell
39
Describe the headaches in brain tumours: when are they worse? which position are they worse in? What are they associated with?
- Worse in the morning
- Worse leaning forward
- May be associated and decrease with vomitting
- Symptoms similar to tension HA/migraine
40
Cushings triad of raised ICP
- irregular breathing
- bradycardia
- systolic hypertension
41
Which lobe:
- thought
- reasoning
- behaviour
- memory
Frontal lobe
42
Which lobe:
- intellect
- thought
- reasoning
- memory
Parietal lobe
43
Which lobe:
- motor and sensory functions
- abstract concepts
Motor and sensory functions: left
| Abstract concepts: right
44
Which lobe:
- Memory, hearing and vision pathways
- Emotion
Temporal lobe
45
If you have metastases in the brain, what scan could you do to find the primary tumour?
PET scan
46
What establishes the diagnosis of glioblastoma multiforme?
The presence of necrosis (remember glioblatoma multiforme is grade IV)
47
Glial tumour arise from which cells?
- glial cells
| - oligodendrocytes
48
What age group are affected by grade 1 astrocytomas
Children, young adults
49
Where do pilocytic astrocytomas arise?
- Optic nerve, hypothalamic gliomas
| - Cerebellum, brainstem
50
Treatment for grade 1 astrocytomas
Surgery
51
Most common presentation of low grade glioma (low grade astrocytoma)
Seizure
52
Cellular features of a low grade astrocytoma
- Hypercellularity
- Pleomorphism
- Vascular proliferation
- Necrosis
53
Most common type of diffuse low grade astrocytoma
Fibrillary astrocytoma
54
Poor prognostic factors for low grade astrocytomas (fibrillary)
- age >50
- focal deficit (cf. seizures)
- short duration of symptoms
- raised ICP
- altered consciousness
- enhancement on contrast studies
55
What does IDH-1 or 1p19q indicate in grade II astrocytomas?
Better prognostic function
56
Treatment for low grade astrocytomas II?
Surgery +/- radiation/chemotherapy/combination
57
What is brachytherapy?
Placement of radioactive isotopes directly into the area to be treated
58
Poor prognostic factors for grade II astrocytomas (glioblastomas)
- age >45
- low performance score
- large tumours (dia>6cm) / crossing midline
- incomplete resection
59
Median survival for anaplastic astrocytoma
2 years
60
Median survival for glioblastoma multiforme?
61
How do glioblastoma multiforme spread?
White matter tracking / CSF pathways
62
How do you improve survival in malignant astrocytomas?
- surgery +
- radiotherapy +
- TMZ (temozolomide)
- improves survival to 14 months
- live longer is MGMT methylated tumour
63
Significance of MGMT methylated tumour?
Live longer
64
Side effects of radiotherapy?
Drops IQ by 10
Skin
Hair
Tired
65
How do oligodendroglial tumours present?
Seizures
66
Which lobes do oligodendroglial tumours affect?
Frontal lobes
67
Age group affected by olgidendroglial tumours?
-25-45 years (smaller peak in children 6-12)
68
Oligodendroglial tumours are difficult to distinguish from astrocytomas, what can you look for? (CCP)
- calcification
- cysts
- peritumoural haemorrhage
69
"toothpaste" morphology
Oligodendroglial tumours
70
What is a collision tumour?
Oligodendroglial cells can coexist with astrocytic cells in a neoplastic collision type of tumour
71
Which type of tumour is chemosensitive?
Oligodendroglial tumours
72
Treatment for oligodendroglial tumours
Chemotherapy (chemosensitive)
- procarbazine
- lomustine
- vincristine
73
Median survival for oligodendroglial tumours
-10 years
74
Meningiomas arise from which type of cell?
Arachnoid cap cell
75
Symptoms of meningioma
Headaches
Skull base: cranial nerve neuropathies
Regional anatomica disturbance
76
CT findings of Meningioma
Homogenous, densely enhancing
Oedema
Hyperostosis / skull 'blistering'
77
MRI findings of meningioma
Dural tail
| Patency of dural sinuses
78
Why might you perform preoperative embolisation before surgery for meningioma?
Meningiomas are usually quite vascular so preoperative embolisation can ease complete tumour resection by diminishing operative time and intraoperative blood loss
79
The classic angiographic appearance of
a _____ is that of increasing hypervascular tumor
blush throughout the arterial phase, persisting well into
the late venous phase with slow washout
Meningioma
80
Age group affected by germ cell tumours?
90% affect those under 20
| Peak incidence 10-12 years
81
CT findings of germ cell tumours
ISO or HYPERdense
82
How might germ cell tumours metastasise?
Via CSF
83
What treatment are germinomas very sensitive to?
Germinomas are VERY radiosensitive
| chemo second line, CIS-PLATIN has 80-100% response rate
84
Tumour markers present in germinoma?
Beta HCG and PLAP
85
Tumour markers present in teratoma?
AFP
86
Tumour markers present in yolk sac tumour?
AFP and PLAP
87
Tumour markers present in choriocarcinoma?
Beta HCG and PLAP
88
Why might you give dexamethasone for brain tumours?
Can help to reduce the oedema
89
Drugs you give post-operatively for seizure
Phenytoin and lorazepam (not diazepam as it stays in the fat, leaks out later and they stop breathing)
