Brain Tumours Flashcards
What can CNS tumours be
Primary
Secondary mets = more common than primary
What are other areas where brain tumours develop
Cells outside brain
Cranial nerve
Peripheral nerve
Where do childhood cancers tend to occur
Above tentorium
Where do adult brain tumours tend to occur
Below tentorium
What is most common brain tumour
Glioma’s
What are glioma’s
Form from glial cells - brain supporting cells
- Oligodendroglioma if oligodendrocyte
- Astrocytoma if from astrocytes = most common
- Ependyoma if from ependymal cells
- Glioblastoma multiform if high grade
Malignant but don’t metastases outside CNS
Spread through white matter and CSF
- Can’t resect as spread through whole brain by time of presentation
Graded 1-4
What is an oligodendroglioma
Arise from myelin sheath of cells in brain
Schwann cells = support cells of myelin sheath in PNS
Where does it typically affect and causing what
Frontal lobe
Seizures
Headache
Neurological
How do you differentiate from astrocytoma
Fried egg appearance
Where do ependymoma arise from
Lining of ventricle
What are features of epndymoma
Benign but can obstruct
Affect brain in children and spinal cord in adult
What is medullablastoma
Malignant tumour from embryonic neural cells
Often childhood
Affects posterior and brain stem
Difficult for surgery Mx
What are tumours from outside CNS
Meningioma - arachnoid cells that cover meninges - Stay local Schwannoma - nerve sheath cell Pituitary adenoma Lymphoma Haemangioblastoma
What are astrocytoma’s
Low grade
Grow slowly
Commonly frontal region
How do they present and how do they treat
Seizure
Headache
Slow near decline
Rx
Aggressive as can have good prognosis
Do a wake procedure
What are glioblastoma’s
High grade Common middle age adult Atypical tumour with necrosis Grows quickly Butterfly lesion Frontal / temporal / basal ganglia
How do they present and how do you Rx
Seiure
Headache
Slow neuro decline
Area of necrosis on CT
Rx
- Surgical to debulk but won’t clear
- Surgery will give Dx of underlying cell and grade
- Require post op chemo + RT
- Dexamethasone for oedema
- Rx is never curative
Prognosis
- 15 months with Rx
- Weeks- months without
What is a CNS lymphoma
High grade Usually B cell Common in immunocompromised e.g. HIV Often deep and difficult to biopsy Do not metastasise
What are mengioma
Benign cancer from arachnocytes Attached to dura Do not metastasie Can be locally invasive causing raised ICP Slow growing Often resectable but can be challenging if in difficult area - Posterior fossa - Cavernous sinus - Skull base
What are mengioma associated with
NF-2
How do they present
Asymptomatic
Focal or generalised seizure
Gradual worsening neurological function
On CT
Area of calcification
Smooth lobulated mass
What does pituitary adenoma cause in children
Hormone deficiency or surplus
Dwarfism
Slow growth
Absent sexual development / puberty
What does pituitary adenoma cause in adults
Increased fat Decreased muscle mass Decreased bone density Bitemporal hemianopia - UQ defect CSF obstruction Seizure Raised ICP
What is a vestibular schwanoma
Tumour of Schwann cells that surround vestibular nerve
When are bilateral seen
NF2
What do they cause
Depends what CN affected Vertigo Hearing loss - unilateral sensorineural = common Tinnitus Absent corneal if trigeminal affected Facial palsy if facial affected
How do you Dx
Refer ENT
Audiogram
MRI of cerebropontine angle as where they commonly occur
How do you Rx
Surgery
RT
Can just observe as often slow growing
What are common presentations of brain tumour
Neurological deficit Headache Seizures Signs of raised ICP Hydrocephalus Papilloedema
How do cerebral tumours present
Headache Vomiting Visual field Hemiparesis Hypokinesia Seizure Change in personality
How do brain stem tumours present
Hearing loss Facial pain and weakness Dysphagia Decreased gag reflex Nystagmus Failure up gaze
How do cerebellar tumours present
Ataxia
Dysarthria
Coordination
DANISH P
How do pituitary tumours present
Endocrine dysfunction
Visual defect - bitemporal hemianopia - UQ
Headache
Frontal lobe
Headache Motor dysfunction Broca's dysphasia Executive dysfunction Inappropriate behaviour Personality change Poor concentration Memory loss Unilateral anmosia
Parietal Lobe
Hemisensory loss / paresthesia Loss 2 point discrimination Agnosia Sensory inattneiton Dysphasia
Temporal Lobe
Seizures Behaviour change Hallucination Visceral Sx Superior homonymous hemianopia Dysphasia LOC
Occipital lobe
Visual disturbance
Contralateral visual field defect
How do you Dx
History CT with contrast = 90% MRI MRA PET LP Biopsy
What is mainstay treatment
Surgical
RT
Chemo to slow cell growth
Surgical options
Resection
Craniotomy
Transphenoidal
Endoscopic
RT options
External beam
Intersitital brachytherapy
What do you give to control oedema caused by RT / surgery
Corticosteorids - dexamethasone
What are complications of chemo
Oral mucositis Bone marrow suppression Fatigue Hair loss N+V Peripheral neuropathy
What are complications post op
Increased ICP Haematoma Hypovolaemia Hydrocephalus Menignitia Pulmonary oedeema Wound infection Seizure CSF leak
What is tumour grade vs stage
GX = not assessed G1 = low grade, well differentiaed G2 = moderate differentiation G3 = poorly differentiated, high grade G4 = high grade
Stage = spread
If brain tumour is discovered what should you do
Always look for a primary
How does craniopharyngioma present
LQ bitemporal hemianopia
Hormonal disturbance
Symptoms of hydrocephalus
How do you Dx craniopharyngioma / pituitary adenoma
Full blood profile and MRI
Why do brain tumours not met
BBB
How do brain tumour cause headache
Raised ICP
Vascular
Meningism
Why is dexamethasone useful
Vasogenic oedema e..g due to disrupted BBB
What causes
High grade glioma
Mets
What kills with brain tumour
Cerebral oedema and raised ICP
Where are brain mets common
Lung =. 50% Breast Colon Prostate Kidney Melanoma
Histology = same as primary if biopsy
How do you investigate
MRI with contrast
What will MRI show
Multiple discrete well demarcated lesion Hypointense on T1 Hyperintense on T2 Marked gadolinium enhancement Considerable vaosgenic oedema
How do you manage
High dose dexamethasone with PPI cover
Symptom control e.g. seizure
Liase with oncology to Dx primary
Whole brain RT
Consider chemo if chemo-sensitive tumour - SCLC / breast
Consider neurosurgery - biopsy useful if unknown primary
What tends to be ring enhancing lesion
TB
Absess
