Brain tumours Flashcards
What are the 3 cardinal signs of a brain tumour?
Raised intracranial pressure
Progressive neurological deficit
Epilepsy
What are some symptoms of raised ICP?
Drowsiness
Headache
Nausea + vomiting
Papilloedema
Why does a brain tumour cause raised ICP?
There is a mass growing in your head, inside a non-expandable box (skull)
So any expanding causes raised pressure
As a brain tumour increases in size, ICP rises proportionally.
True or false? Why?
False
The brain is like a sponge, so it is compressible to a certain extent
But it will hit a point when it can’t compress anymore and pressure will rise
Why does raised ICP result in coma?
Compression of brain stem
Why does raised ICP cause death?
Compression of brainstem cuts of vascular supply to the brain
Cerebral infarction = death
What are the features of a headache caused by raised ICP?
Headache is present in the morning and is worse at this time
Worsened by coughing, straining, bending forwards
Can be relieved by vomiting
What is a colloid cyst?
A cyst containing gelatinous material found in the brain
Almost always found in the 3rd ventricle
Can be fatal very quickly
What is so bad about a colloid cyst?
Occur in the 3rd ventricle
They can block flow of CSF out of the lateral ventricles
Acute hydrocephalus develops
Which can kill in hours
What are the clinical features of a colloid cyst?
Raised ICP headache
- worse on waking
- increased by coughing, straining
Investigations of colloid cyst?
CT scan, shows up white on a scan.
Usually small and in centre of the brain (3rd ventricle)
What is papilloedema?
Optic disc swelling caused by raised ICP
How can you check if someone has papilloedema?
Look at their optic discs
You should see yellow-ish centre that looks uneven
Plus haemorrhages + dilated blood vessels
What is meant by focal neurological deficit?
Signs shown by a patient that indicate damage has occurred to a specific part of the brain
I.e.
Gait problems caused by a lesion in frontal lobe
Deafness caused by a lesion in the temporal lobe
What are some common focal neurological deficits seen with brain tumours?
Motor deficit
Sensory deficit
Speech deficit: expressive, receptive, both
Visual deficit
Deafness
Deteriorating memory
Personality change
When should you consider a brain tumour as a cause of epilepsy?
If the epilepsy is recent onset in an adult
What types of epilepsy do brain tumour patients often get?
Allsorts
Motor
Sensory
Temporal lobe
Plus
Olfactory aura, deja vu, transient funny sensation in stomach
What two categories of brain tumour are there?
Primary
Secondary (from a metastasis)
Are primary or secondary brain tumours more common?
Secondary
What are the most common sites from which brain metastases originate from?
Lung cancer: small cell or non-small cell
Breast
Melanoma
Renal cell
GI
Lower GI cancer tends to metastasis to which part of the brain?
What about upper GI cancer?
Lower GI to lower brain, cerebellum
Upper GI to upper brain
What cell type do most primary brain tumours originate from?
Glial cell
What is a glial cell?
Surround neurons and provide support for and insulation between them
Name some types of glial cell?
Astrocytes
Oligodendrocytes
Schwann cells
Ependymal cells
What is the grading system for gliomas?
The WHO grading system
Grade 1: pilocytic astrocytoma
Grade 2: diffuse astrocytoma
Grade 3: anaplastic astrocytoma: malignant
Grade 4: gliobastoma multiforme (GBM): cancer, common, fast growing
What does GBM stand for?
Glioblastoma multiforme
Describe some features of GBM?
Malignant
Most common one seen
Grows so fast it gets necrotic
What happens to gliomas if they are given enough time and not much treatment?
All gliomas develop into GBM eventually
Management of a glioma?
Surgery: debulking, in progression for radiotherapy
Analysis of the tumour to grade it
Treatment of hydrocephalus if there is any
Radio + chemotherapy
Dexomethasone
Palliative care
Why is excising gliomas usually quite difficult?
They are usually irregular shaped, so it is easy to miss a bit
How can you treat acute hydrocephalus?
Ventriculo-peritoneal shunt
What is a ventriculo-peritoneal shunt?
A tube that runs from CSF space down the peritoneum where it can be reabsorobed
What is dexamethasone?
A type of chemotherapy, a very powerful steroid
It is an artificial version of hydrocortisone
It reduces oedema and tumour inflammation
Why should you not give a dose of dexamethasone after lunchtime?
It is a drug that makes you really awake, because it is a replacement for hydrocortisone
So if you take it too late you won’t sleep that night
What happens to patients when they are at the very late stage of brain tumour?
They slow down
Spending more time asleep
Become disinterested in life, other people
How can benign gliomas cause problems? What damage/complications can they cause?
Transformation to malignancy
Progressive mass effect due to slow tumour growth
Progressive neurological deficit as brain is destroyed by tumour
What is glioma?
An umbrella term for tumours of glial cells
What is an oligodendroglioma?
A tumour of oligodendrocytes
A type of glioma
What is a drug used to treat GBM?
Temozolomide
It improves survival
Temozolomide - what is it used for?
What can you do to make it work better?
Used to treat GBM
Debulk the tumour first
Who gets benign gliomas?
Young people, in their 20s and 30s
What is the prognosis for benign glioma?
Not good
Median survival of 5-7 years
What treatments are there for benign glioma?
Not a lot
Chemo, radiotherapy and surgery have not been proven to be beneficial
What is the relationship between a benign glioma and GBM?
Benign gliomas progress to GBMs in time
Is it better to have a benign glioma or an oligodendroglioma?
Oligodendroglioma
The life expectancy is 10-15 years rather than the 5-7 it is for benign glioma
Do oligodendrogliomas become malignant?
Yes, they become anaplastic
Occasionally they progress to GBM
