Brain Tumours Flashcards
WHO classifications of CNS tumours
Tumours of neuroepithelial tissue Tumours of meninges Tumours of cranial and spinal nerves Haematopoietic neoplasma Germ cell tumours Cysts and tumour-like lesions Tumours of the sellar region Local extensions from regional tumours Metastatic tumours
Common primary types of brain tumours
Neuroepithelial tissues - glioma
Meninges - meningioma
Pituitary - adenoma
Commons secondary types of brain tumours (spread from)
Renal cell carcinoma Lung carcinoma Breast carcinoma Malignant melanoma GI tract carcinoma
Pathological features of gliomas
Derived from astrocytes
WHO grade I - IV
Pathological features of grade IV gliomas
Most common and most aggressive
Glioblastoma multiforme (GBM)
Spread by tracking through white matter and CSF pathway
Rarely spread systemically
Features of meningiomas
Slow growing Extra-axial Usually benign Arise from arachnoid Frequently occur along the falx, convexity or sphenoid bone Usually cured if completely removed
Features of pituitary tumours
Adenoma most common
Only 1% will be malignant
Presents with visual disturbance due to compression of optic chiasm, and hormone imbalance
What percentage of cancer patients will develop cerebral metastases?
15-30%
In what percentage of cancer patients is cerebral metastases the cause of the presenting symptom?
15%
Clinical presentation of brain tumours
Raised ICP
Focal neurological deficit
Epileptic fits
CSF obstruction
Raised ICP symptoms
Headache (typically in morning) Nausea/vomiting Visual disturbance Somnolence Cognitive impairment Altered consciousness
Raised ICP signs
Papilloedema Sixth nerve palsy Cognitive impairment Altered consciousness Third nerve palsy
In what tumours does hydrocephalus occur?
Tumours in or close to the CSF pathway, especially in posterior fossa tumours and in children
How is hydrocephalus diagnosed?
History and examination CT MRI Biopsy Consider sources of secondary tumour
Lesions in what part of the brain might result in epilepsy?
Only in lesions above the tentorium
Investigations for brain tumours
CT
MRI
PET
Angiography
Investigations if suspecting brain metastases
CT chest, abdomen and pelvis
Mammography
Biopsy skin lesion/lymph nodes
Management goals of brain tumours
Accurate tissue diagnosis
Improve quality of life - decrease mass effect and improve neurological deficit
Aid effect of adjuvant therapy if required
Prolong life expectancy
Possible managements of brain tumours
Corticosteroids e.g. dexamethasone Treat epilepsy - anticonvulsants Analgesics/antiemetics Counselling Surgery Radiotherapy Chemotherapy Endocrine replacement
Management options for Glioblastoma multiforme
Complete surgical excision if possible - biopsy or debunk only
Medical - steroids, anticonvulsants
Radiotherapy
Chemotherapy - temazolamide
Management options for brain metastases
Confirm diagnosis
Medical - steroids, anticonvulsants
Radiotherapy - whole brain, stereotactic
Surgery
Prognosis of meningioma
Commonly cured by surgery, may require anticonvulsants
Prognosis of astrocytomas low grade
Long life expectancy
Prognosis of high grade astrocytomas/GBM
Average 1 year survival
Prognosis of brain metastases
Frequently a good medium-term remission
