Brain Tumours Flashcards
What area of the brain may be affected if patient is demonstrating problems with balance and coordination?
Cerebellum
Where might the tumour be if the patient is showing behavioural changes, abnormal emotional responses, and problems with their hearing and vision?
Temporal Lobe
What lobe is implicated when the patient is showing problems with their thought, reasoning, behaviour, smell, memory and movement.?
Frontal lobe
What lobe is involved if patient demonstrates symptoms involving their hearing, sensation, reasoning, intellect, thought and memory?
Parietal Lobe
What area of the brain could be affected if patient is showing abnormal speech, motor and sensory functions along with vision problems?
Left occipital lobe
What area of the brain could be affected if patient is demonstrating abstract concept problems and vision problems?
Right occipital lobe
What cells are found in astrocytic tumours?
Glial cells
Oligodendrocytes
How are astrocytic tumours graded?
Using the WHO grading
What is a grade 1 astrocytoma?
Benign slow growing astrocytoma with 97% 5 year survival rate?
What category of patients are grade 1 astrocytoma’s commonest in?
Children and young adults
What is the treatment for a grade 1 astrocytoma?
Surgery = curative
Do grade 1 astrocytoma’s have malignant potential?
Yes
Slowly may progress into malignancy if left untreated
Progression accompanied by increased neurological symptoms
What are some negative prognostic factors in grade 1 astrocytoma’s?
>50y/o Focal deficits Altered consciousness Sudden onset/short duration of symptoms Increased ICP
What is the main presenting symptom in low grade astrocytoma?
Seizures
What are the treatments for grade 2 astrocytoma?
Surgery +/-
Chemo and radiotherapy
Depends on morphology
What are some negative prognostic factors in grade 2 astrocytoma’s?
>45 y/o >6cm diameter incomplete resection during surgery Tumour crosses midline Low performance score
What re grade 3 astrocytoma’s referred to as?
Anaplastic Astrocytoma’s
What is the median survival rate for anaplastic astrocytoma’s?
2 years
Surgery is curative in anaplastic astrocytoma - True/False
False
Can provide symptomatic relief
What is the most common primary brain tumour?
glioblastoma multiforme
What is the median survival rate for a glioblastoma multiforme?
<1 year
In malignant astrocytoma’s, what type of tumour has a better prognosis?
MGMT methylated tumour
Where are oligodendroglia tumours mainly found?
Frontal lobe
What age group is most commonly affected by oligodendroglial tumours?
25-45 y/o
What is the main presentation of oligodendroglia tumours?
Seizures
What is the appearance of an oligodendroglial tumour?
solid
Grey-pink in colour
Toothpaste consistency
Look for calcification and cysts
What % of glial tumours are oligodendroglial tumours?
20%
How do we treat oligodendroglial tumours?
Chemotherapy - procarbazine, vincristine Radiotherapy - decreases seizures
Surgery (only in lower grade)
What is the median survival for (low grade) oligodendroglial tumours ?
10 years
What are warning/red flag signs in children with potential brain tumours?
Tiptoeing
Ataxia
Vomiting with headache
What is the most common type of extra-axial tumour?
Meningioma
What do patients normally present with?
Most are asymptomatic
Headaches - at skull base
Regional anatomical disturbances
Meningiomas are more common in Males/Females?
Females
Meningioma’s are associated with what other type of cancer?
Breast cancer
What chromosome s considered to be associated with meningiomas/breast cancer?
22q
Meningioma’s are benign. True/false
True
In 90% of cases they are benign and slow growing
List some types of aggressive meningiomas:
Clear cell
Choroid
Rhabdoid
Papillary
What can occur in children who have previously suffered from leukaemia?
Radiation-induced meningiomas
Commonly found in the midline
What treatment options are there for meningiomas?
Pre-op embolization
Surgery
Radiotherapy
What is the median survival of meningiomas?
90% survival at 5 years
What investigations are done for meningioma?
CT
MRI
Angiography - if planning embolization
List a few examples of nerve sheath tumours:
Neurofibromas
Schwannomas
Malignant peripheral nerve sheath tumour (MPST)
What condition is an acoustic neuroma associated with?
Neurofibromatosis II
What are the symptoms of an acoustic neuroma?
Hearing loss
tinnitus
Disequilibrium
What is an acoustic neuroma?
A schwannoma of the 8th cranial nerve
Are acoustic neuroma’s benign?
Yes
Malignant transformation is extremely rare
How are acoustic neuromas treated?
25% managed medically
50% surgically
Radiation, gamma knife etc
What are some post op complications of acoustic neuroma surgery?
Facial palsy
Corneal reflex
Nystagmus
Abnormal eye movement
What is a complication of gamma knife treatment in acoustic neuroma?
Gradual decline in hearing over the years
Vestibular function decreases in first months then stabilises
What is the common group affected by germ cell tumours?
<20 years old
Peak age range 10-12
Males more than females
What is the most common type of CNS germ cell tumour?
germinomas
What is the survival rate of germinomas?
5 years 65-95% survival
What therapy are germinoma’s particularly sensitive to?
Radiotherapy
Where do roughly 11% of germinoma’s metastasize to?
Spine
List some non-germinomatous germ cell tumours:
Teratoma
Yolk sac tumour
Choriocarcinoma
Embryonal carcinoma
What tumour markers must you test for in a child with a midline brain tumour?
AFP
HCG
LDH
These detect different germ cell tumours
What can be used to treat hydrocephalus?
A ventriculoperitoneal shunt
How do you treat non-germinomatous germ cell tumours?
If benign operate
Radiotherapy 1st line (if >3y/o)
Chemotherapy 2nd line
What is the survival rate for non-germinomatous germ cell tumours?
17-38% 5 year survival
List the common presenting complaint in a person with a pituitary tumour?
Bitemporal hemianopia
Headache
Endocrine abnormalities e.g. galactorrhoea
What condition would you suspect in a patient with pallor, yellowing skin, no axillary hair, puffy face and fine wrinkles but expressionless?
Panhypopituitarism
What tests can be done to diagnose panhypopituitarism?
GH is the first hormone to decrease
Then LH and FSH
TSH, prolactin and ACTH will be the last hormones to decrease so test in that order
