Brain Tumours Flashcards
What are the WHO classifications of CNS 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 commonest tumours that spread to the brain?
- Renal cell carcinoma
- Lung carcinoma
- Breast carcinoma
- Malignant melanoma
- GI tract
What are common types of primary brain tumours?
- Gliomas
- Meningiomas
- Adenomas
What is the most common type of brain tumour seen clinically?
Metastatic disease
What percentage of cancer patients will have cerebral metastases?
- 15-30% patients with cancer will get cerebral metastasis
- 15% cerebral metastasis is presenting symptom
- 9% cerebral met is only detectible site of spread
What ae gliomas derived from?
Astrocytes
What are astrocytes?
Structural and nutritional support to nerve cells
What is the most common grade of gliomas?
Grade IV
What are the features of grade IV glioblastomas?
- Most common
- Most aggressive
- Spread by tracking through white mater and CSF pathway
- Very rarely spread systemically
What do meningiomas arise from?
Arachnoid matter
Where do meningiomas frequently occur?
- Frequently occur along falx, convexity or sphenoid bone
- Extra-axial
How fast do meningiomas grow?
Slow growing
What type of tumours are meningiomas?
Usually benign
How are meninigiomas cured/
Usually cured if completely removed
What is the most common pituitary tumour?
Adenoma
How do pituitary tumours present?
- Visual disturbance due to compression of optic chiasm
- Hormone balance
What type of tumours are pituitary tumours?
- Mainly benign
- Only 1% are malignant
How can brain tumours present?
- Raised intracranial pressure (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)
- Somnolence
- Cognitive impairment
- Altered consciousness
- Papilloedema
- 6th nerve palsy
- Cognitive impairment
- Altered consciousness
- 3rd nerve palsy
When can brain tumours result in hydrocephalus?
- Tumours in or close to CSF pathway especially posterior fossa tumours
- Especially in children
How much CSF is produced in hydrocephalus?
CSF production 400 - 450 cc / day
How are brain tumours diagnosed?
- History and examination
- Think of sources of secondary tumours (eg CXR)
- CT scan
- MRI scan
- Biopsy
What symptoms can occur with focal neurological deficit?
- Hemiparesis
- Dysphasia
- Hemianopia
- Cognitive impairment (memory, sense of direction)
- Cranial nerve palsy
- Endocrine disorders
What are 2 main classifications of epilepsy?
- Focal epilepsy
- Generalised epilepsy
When can epilepsy occur with brain tumours?
Only in lesions above tentorium
What percentage of 1st fits are due to tumours?
First fit - 20% chance of tumour
What types of imaging can be used for brain tumours?
- CT
- MRI
- PET
- (Angiography)
What investigations should be carried out if you suspect metastatic disease?
- CT chest/abdo/pelvis
- Mammography
- Biopsy skin lesions/lymph nodes
What are the goals of management of brain tumours?
- Accurate tissue diagnosis
- Improve quality of life by decreasing mass effect and improving neurological deficit
- Aid effect of adjuvant therapy
- Prolong life expectancy
What types of treatment can be used to manage brain tumours?
- 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 so biopsy or debulk only
- Steroids
- Anticonvulsants
- Radiotherapy
- Chemotherapy (temazolamide)
What are the management options for metastatic disease?
- Must confirm diagnosis
- Steroids
- Anticonvulsants
- Radiotherapy ( whole brain, steriotatic)
- Surgery
What is the prognosis of meningiomas?
- Commonly cured by surgery
- May require antoconvulsants
What is the prognosis of low grade astrocytomas?
Long life expectancy
What is the prognosis of high grade GBM?
Average 1 year survival
What is the prognosis of metastatic disease?
Frequently good medium term remission
When should you definitely not perform an LP?
When there are signs and/or symptoms to suggest an intracranial mass lesion
Why should a LP not be carried out when there is suggestion of an intracranial mass?
You might cause a herniation syndrome and the patient could die
What is a common primary malignant tumour?
Glioma (GBM)
What are common primary benign tumours?
- Meningioma
- Pituitary adenoma
