Brain Tumours Flashcards
brain tumours are more primary or secondary in origin
secondary
what are common sites for tumours to metastasise to the brain
lung - esp small cell carcinoma breast thyroid colon renal malignant melanoma
in children brain tumours are usually supratentorial or infratentorial
infratentorial
what is the general presentation of brain tumours
headache - wakes patient up papilloedema focal neurology vomiting seizures ataxia personality change
what are the 3 symptoms to be aware of in children that is suggestive of a brain tumour
vomiting with headache
ataxia
tip toeing
VAT
what imagine is useful for diagnosing brain tumours
CT first line
MRI useful to characterise the tumour
what drug is given to manage cerebral oedema with a brain tumour
dexamethasone - can also reduce nausea by reducing oedema
what drug is given to manage seizures with a brain tumour
anti epileptics
what is the most common type of brain tumour
glioma
which two subtypes of tumours are classified as a glioma
astrocytomas
oligodendrocytomas
what is the only known risk factor for gliomas
exposure to ionising radiation
what are the names of the types of astrocytomas grades I-IV
pilocytic astrocytoma
diffuse astrocytoma
anaplastic astrocytoma
glioblastoma multiforme
describe a pilocytic astrocytoma
benign - limited potential to proliferate and no infiltration
surgery is curative
common in children and young adults
describe a diffuse astrocytoma
infiltrative but low level of proliferative activity
surgery then chemo and radiotherapy
average survival is 4 years
describe an anaplastic astrocytoma
some malignant activity, nuclear atypic, increased mitotic activity and cellular anaplasia
average survival is 2 years
describe a glioblastoma
malignant activity, high nuclear atypia, mitotic activity and necrosis
what are the 2 ways a glioblastoma can arise
primary - de novo with no preceding tumour, usually older patients or p53 mutation
secondary - progression from low grade astrocytoma, usually in younger patients
describe the imaging appearance of GBM
solitary
heterogenous with necrotic centre
ring enhancing
oedema/midline shift
how is GBM managed
not curative management, more to improve functional status
maximal debunking surgery to reduce mass effect
radiotherapy
chemotherapy - oral temozolomide
where in the brain are oligodendromas commonly seen
commonly frontal lobe with invasion to subarachnoid space
subarachnoid invasion of an oligodendroma shows what morphology
toothpaste morphology
what is a very common clinical feature of an oligodendroma
seizures
what are some histological features that differentiate an oligodendroma from an astrocytoma
oligodendromas also have calcification, cysts and haemorrhage around the tumour
how are oligodendromas managed
surgery
chemotherapy - very chemosensitive
which chemotherapy agents are used for oligodendromas
PCV - procarbazine, lomustine and vincristine
medulloblastomas are almost exclusively seen in which age group
children - second most common brain tumour in children after astrocytoma
what causes a medulloblastoma to arise
embryonal tumour - poorly differentiated and occurs in the midline of the cerebellum
describe the appearance of medulloblastomas
crumbly, chalky appearance and form drop down metastases down the spinal cord
how does a medulloblastoma present
raised ICP symptoms
cerebellar signs
medulloblastomas are particularly sensitive to which treatment
radiotherapy - however contraindicated in under 3s due to neurocognitive impairment
what is a meningioma
extra-axial tumour of arachnoid cap cells
either benign or malignant, majority are benign
how is a meningioma managed
watch and wait if patient asymptomatic
surgical resection
radiotherapy
what is the prognosis of meningioma
good - 90% survival at 5 years
what is a vestibular schwannoma
rare benign tumour arising from the internal auditory meatus
affects the vestibular portion of CN VIII
if a vestibular schwannoma is bilateral and in a young person, what condition should you think of
neurofibromatosis 2
what are the clinical features of vestibular schwannoma
unilateral SN hearing loss
tinnitus
progressive imbalance
absent corneal reflex
