Brain tumours Flashcards by E Thomas

What are the 3 cardinal signs of a brain tumour?

Raised intracranial pressure

Progressive neurological deficit

Epilepsy

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What are some symptoms of raised ICP?

Drowsiness
Headache
Nausea + vomiting
Papilloedema

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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

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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

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Why does raised ICP result in coma?

Compression of brain stem

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Why does raised ICP cause death?

Compression of brainstem cuts of vascular supply to the brain
Cerebral infarction = death

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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

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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

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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

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What are the clinical features of a colloid cyst?

Raised ICP headache

worse on waking
increased by coughing, straining

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Investigations of colloid cyst?

CT scan, shows up white on a scan.

Usually small and in centre of the brain (3rd ventricle)

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What is papilloedema?

Optic disc swelling caused by raised ICP

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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

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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

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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

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When should you consider a brain tumour as a cause of epilepsy?

If the epilepsy is recent onset in an adult

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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

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What two categories of brain tumour are there?

Primary

Secondary (from a metastasis)

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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