Brain Tumours Flashcards
What is the most common extra-axial tumour
Meningioma
Benign tumour
Give examples of extra-axial tumours
Meningioma Pituitary adenoma Acoustic neuroma or vestibular schwannoma Choroid plexus papilloma Craniopharyngioma
How do brain tumours cause raised ICP
Additional mass within the closed box of the skull
Can cause mass effect, blockage of CSF flow or haemorrhage
All will raise the pressure
How does raised ICP present
Headache,
Vomiting,
Low GCS and seizures
How does uncal herniation present
Unilateral blown pupil (dilated)
Due to compression of 3rd nerve
What are the signs of a tumour headache
Worse in the morning
The pain wakes them up
Worse on coughing and leaning forward
May be associated with vomiting
When would a tumour cause a headache
If it is pressing on the dura or periosteum
The brain itself doesn’t have pain receptors but these structures do
Can be due to raised ICP
Secondary to visual disturbances
What visual disturbances can tumours cause
Diplopia - due to compression of CNIII, IV, VI
Difficulty focusing
Blown pupil - CNIII
Functional symptoms of a brain tumour are related to the location - true or false
TRUE
Will affect the function controlled by that lobe of the brain
What is the sign of papilloedema
Loss of the optic disc on fundoscopy
What is the most common brain tumour
Metastasis from another tumour
What are the most common investigations for brain tumours
CT MRI PET scan Lumbar puncture Angiogram Biopsy EEG
What are the 4 grades of astrocytic tumours
I = pilocytic astrocytoma II = low grade astrocytoma III = anaplastic astrocytoma IV = glioblastoma multiforme
From which cells do glial tumours arise
astrocytes or oligodendrocytes
Describe pilocytic astrocytoma
Benign - slow growing
More common in children
Surgery is curative
Where do low grade astrocytoma most commonly affect
Temporal lobe
Frontal lobe - posterior and anterior sections
How do low grade astrocytoma’s present
Seizures
What are the poor prognostic factors for a low grade astrocytoma
Age over 50 Focal deficit (seizures) Raised ICP Short duration of symptoms Altered consciousness Enhanced contrast studies Incomplete resection
How do you treat low grade astrocytoma’s
Resect tumour within reason (may need to leave small areas if near a crucial structure)
If the tumour is incompletely resected then we give radiotherapy and chemotherapy
The tumour will most likely come back but they can have a good quality of life in the
Describe anaplastic astrocytomas
Malignant tumour
Median survival of <2 years
Can operate to reduce symptoms but wont cure - surgery and radiation
Describe glioblastoma multiforme
malignant
most common primary tumour
survival is around 14 months regardless of treatment
Treatment to improve QoL not cure - surgery and radiation
How can tumours be visualised for surgery
5AMA
Patient drinks the substance and it taken up in the brain
Shows up tumour cells as pink if blue light is shone on it
Which chemotherapy is commonly used for brain tumours
Temozolomide – oral chemotherapy
PCV
Can deliver chemo onto brain itself with carmustine wafers but it does impede wound healing
How is radiotherapy used in the treatment of brain tumours
Used after surgery on malignant tumours
Used if there has been incomplete resection
Used for recurrence of benign tumours
Describe oligondendriglial tumours
Arise from oligodendrocytes
Affect the frontal lobes
Occur in adults 25-40
Present with seizures
What are collision tumours
Oligodendroglial cells coexist with astrocytic cells in a neoplastic collision type of tumour
Both cell types in tumour
How do you treat oligodendroglial tumours
Tend to be chemosentive
Treat with chemo and surgery
How might brain tumours present in children
Tiptoeing, ataxia and vomiting
How do meningiomas present
Most are asymptomatic
May cause headache or cranial nerve neuropathies
Meningiomas can be induced by radiation - true or false
True
common after treatment for childhood leukaemia
What is tumour blush
Sign seen on angiogram
Diffuse spread of contrast on image in the area of the tumour
How do you treat meningiomas
Preoperative embolization
Surgery
Radiotherapy
How do temporal lobe tumours present
With seizures
How do frontal lobe tumours present
Personality changes
How do acoustic neuromas present
Hearing loss
Tinnitus
Balance problems
What are acoustic neuromas
also called vestibular schwannomas
Tumours of the 8th cranial nerve
How do you treat acoustic neuromas
Hearing aids and monitoring when small
Surgery
Radiation
Hydrocephalus management
What tumour markers must be tested in a child with a midline tumour
AFP, HCG and LDH
Need to check if its a germ tumour
How can you surgically treat hydrocephalus
VP shunt - ventriculoperitoneal
Fluid transferred to peritoneum where it can be reabsorbed
How do brain tumours generally present
Focal symptoms - dependant on location Headache Vomiting Seizures Visual disturbance Papilloedema
Where do most childhood brain tumours occur
below the tentorium cerebelli
What types of cancer most commonly metastasise to the brain
Breast Bronchus Kidney Thyroid Colon Metastatic melanomas
Where in the brain are mets often found
Boundaries between grey and white matter
Benign brain tumours usually don’t cause much of a problem - true or false
FALSE
Can still cause significant symptoms due to compression of brain
High grade malignant brain tumours often don’t metastasise - true or false
TRUE
Describe medulloblastoma
2nd most common tumour in kids
Poorly differentiated
Occurs in the midline
Radiosensitive - good survival with resection and radiotherapy
If you suspect a headache is caused by a brain tumour, what is the first test you can do in clinic to confirm
Fundoscopy - look for papilloedma
If someone is found to have multiple brain mets, what should you do
Urgent CT chest, abdo, pelvis to look for the primary
