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BMSc - Neuropharmacology and Behaviour > Brain Tumours > Flashcards

Brain Tumours Flashcards

1
Q

What is a brain tumour?

A 
Overgrowth of tissue 
Can be benign or malignant
Primary or secondary 
Supratentorial or infratentorial 
Extrinsic (meninges, bone, blood vessel) or intrinsic
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2
Q

How do brain tumours commonly present?

A

Progressive neurological deficit - usually contralateral motor weakness
Headache
Seizure

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3
Q

What are the consequences of increased ICP (normal is 5-10 mmHg)?

A

Headaches
Vomiting
Mental changes
Seizures

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4
Q

Describe the monroe kelly doctrine?

A 
The head is a "rigid closed box" 
3 components: 
Brain (80%) 
Blood (10%) 
CSF (10%)
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5
Q

Describe a classical headache assoc with brain tumours

A

Can occur with/without raised ICP
Worse in morning - wakes them up
Increased with coughing/ learning forward
May be associated with and increase vomiting

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6
Q

Describe the aetiology of a tumour headache

A

Raised ICP
Invasion/ compression of dura, BVs, periosteum
Diplopia (CN 6)
Difficulty focussing
Cushing’s triad (tonsillar herniation; extreme hypertension, brady)
Psychogenic (stress of loss of functional capacity)

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7
Q

What is the imaging of choice for someone with suspected brain tumour?

A

MRI

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8
Q

How can tumours of the CNS be classified?

A 
Meninges
Neuroepithelial tissue
Nerve sheath cells
Developmental lesions
Sella lesions
Germ cells
Local extension from adjacent structures
Haemopoietic/ lymphomas 
Mets
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9
Q

What is the commonest type of brain tumour?

A 
Neuroepithelial tissue: 
Astrocytes - 60% (2/3rd are high grade) 
Oligodendrocytes
Ependymal
Neuronal
Pineal 
Embryonic
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10
Q

How can astrocytic tumours be graded?

A

1; purely benign; pilocytic, pleomorphic xanthoastrocytoma, subependymal giant cell
2; low grade
3; anaplastic
4; GBM

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11
Q

How are tumours graded in terms of pathology?

A

Microvascular proliferation
Nuclear pleomorphism
Excess mitoses
Angiogenesis

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12
Q

Describe grade 1 astrocytoma’s

A 
Truly benign 
Slow growing 
Common in children/ young adults 
Commonly cause increased ICP 
Tx; surgery (curative)

T1 MRI scan used - you can tell as the CSF is black, contrast used (only use contrast in T1 weighted MRI images)

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13
Q

Describe grade 2 astrocytoma’s

A

Fibrillary, gemistocytic, protoplasmic

Show hyper cellularity, pleomorphism, vascular proliferation, necrosis

Predilection; temporal lobe

Presentation; seizures

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14
Q

Describe the poor prognostic factors associated with low grade astrocytoma’s

A 
Age >50 
Focal deficit 
Short duration of symptoms
Raised ICP
Altered consciousness
Enhancement on contrast studies
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15
Q

Describe the tx of grade 2 astrocytoma’s

A

Surgery +/- radiation, chemo, radio/chemo combo

Surgical biopsy; stereotactic vs open
Seizure control, herniation, CSF obstruction, cytoreduction

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16
Q

Describe a landmark trial in the treatment of grade 2 astrocytoma’s

A

N=251 with a follow up of 11.9 years
55% had died
Patients who received radio + chemo (PCV) has an overall longer survival (13.3 vs 7.8 years)
Rate of progression free survival at 10 years was 51% compared to 21% in group that received radio alone

17
Q

Describe the malignant astrocytoma’s

A

Grade 3; arise de novo. Median survival 2 yrs

Grade 4; most common primary brain tumour. Median survival 14-15 months
Spread; white matter tracking/ CSF pathways

Multiple gliomas = NF, TS, PML

18
Q

What is the treatment for malignant astrocytoma’s

A

Non curative surgery - survival quality

Surgery; cytoreduction without causing a neurological deficit (reduce mass effect)

Post op radio; external beam therapy

Stupp protocol; Sx + Rt + TMZ (temozolomide)

If MGMT methylated tumour - increased life expectancy

19
Q

When is radiotherapy utilized in brain tumours?

A

Always after malignant tumours
Low grade; incomplete removal, malignant degeneration
Benign astrocytoma’s; only if recurrence/ progression not amenable to surgery

20
Q

Are there any novel therapies for treatment of brain tumours currently in phase 3 of clinical trials?

A

Yes; TTFs (electrical current) which prevents tumour mitoses
Increased survival of 2 months

21
Q

Describe meningiomas

A

Originate from arachnoid cap cells
Extra-axial
20% of intracranial neoplasms
Majority are asymptomatic

Assoc with breast cancer and NF 2 (22q)
Associated with bone = meningioma en plaque

90% are benign and slow growing
Classification; classic, angioblastic, atypical, malignant

22
Q

Symptoms of meningioma

A

Headache
Skull base; CN neuropathy
Regional anatomical disturbance

23
Q

Describe grade 3 meningiomas

A 
Clear cell
Choroid
Rhabdoid
Papillary 
Radiation induced meningioma (after childhood leukaemia - typically in midline)
24
Q

How can meningiomas be assessed preoperatively?

A

CT; homogenous (lights up like a lightbulb), densely enhancing, oedema, hyperostosis
MRI; dural tail, patency of dural sinuses

Angio +/- embolization; external carotid artery feeders, occlusion of sagittal sinus

25
Q

What is the treatment for a meningioma?

A 
Small; expectant
Periop embolization 
Surgery 
Radiotherapy 
Recurrence; depends on grade and extent of resection 
Outcome; 5 yr survival is 90%
26
Q

Describe nerve sheath tumours

A

Schwannomas
Neurofibromas
Malignant peripheral nerve sheath tumours

27
Q

Describe vestibular schwannomas

A 
Sensorineural hearing loss
Tinnitus
Disequilibrium 
CN palsies; 5, 7, 8 
Brainstem function 
Hydrocephalus
28
Q

What is the treatment for vestibular schwannomas

A

Expectant - perform audiometry, radiographic evaluation. 1/3rd won’t grow
Hydrocephalus management - shunt insertion
Radiation - stereotactic radiosurgery
Surgery

29
Q

What needs to be analysed post op after surgery for vestibular schwannoma

A

Facial nerve palsy (grading system)
Corneal reflex (ulcer, sympathetic ophthalmoplegia)
Nystagmus
Abnormal eye movement

30
Q

What blood tests should be performed in children with midline tumour on MRI scanning?

A

AFP
b-HCG
LDH

If neg; needs a biopsy and CSF sample via ETV

Germ cells are chemo and radio sensitive

31
Q

How can hydrocephalus be treated?

A

VP shunt

50% revision rate within 10 years

32
Q

Describe the pituitary gland tumours

A

Px; bitemporal hemianopia, HA, endocrine abnormalities

Ix; prolactinoma (cabergoline CURES)
GH/ IGF-1; acromegaly can kill due to HOCM; surgery and somatostatin analogues
Cortisol (test in morning); Cushing’s disease can be fatal
TSH, fT4, fT3
FSH, LH (high only after menopause)
VA and visual fields = indication for surgery

33
Q

Describe the signs of panhypopituitarism

A 
Pallor
Fine wrinkling of skin
Absent axillary hair 
Face puffy 
Expressionless

Tx; GS first, then LF/FSH, then TSH, then ACTH then prolactin

34
Q

What is decorin?

A

Inhibits primary breast cancer growth and distant mets in a mouse model

Shrinks tumour in animal models of GBM

BMSc - Neuropharmacology and Behaviour (27 decks)

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