Brain Tumours Flashcards
What are examples of CNS tumours?
- Tumours of neuroepitheal tissue
- Tumours of meninges
- Tumours of cranial and spinal nerves
- Haematopoitic neoplasms
- Germ cell tumours
- Cysts and tumour like lesions
- Tumours of the sellar region
- Local extensions from regional tumours
- Metastatic tumours
What are some common primary brain tumours?
What are some common secondary brain tumours?
Renal cell carcnoma
Lung carcinoma
Breast carcinoma
Malignant melanoma
GI tract
What is the most common brain tumour seen clinically?
Metastases
What are gliomas?
Cancer of astrocytes
What is the function of astrocytes?
Astrocytes give structural and nutritional support to nerve cells
How are gliomas staged?
WHO grades from I to IV, with IV being the most common:
- Most aggressive
- Glioblastoma multiforme (GBM)
- Spread by tracking through white mater and CSF pathway
- Very rarely spread systematically
What are meningiomas?
Cancer of meninges
What are the characteristics of meningiomas?
- Slow growing
- Extra-axial
- Usually benign
- Arise from arachnoid
- Frequently occur along falx, convexity or sphenoid bone
- Usually cured if completely removed
Are meningiomas slow or fast growing?
Slow growing
Are meningiomas usually benign or malignant?
Benign
What do meningiomas arise from?
Arachnoid tissue
What is the most common pituitary tumour?
Adenoma
Are pituitary tumours usually benign or malignant?
Benign, only 1% are malignant
What is the clinical presentation of pituitary tumours?
- Visual disturbance
- Due to compression of optic chiasm
- Hormone imbalance
- Raised ICP
- Mass effect
- Focal neurological deficit
- Epileptic fits
- CSF obstruction
What are symptoms of raised ICP?
- Headache
- Typically morning headache
- Nausea/vomiting
- Visual disturbance
- Diplopia
- Somnolence
- Cognitive impairment
- Altered consciousness
When does the headache due to raised ICP usually occur?
Morning
What are signs of raised ICP?
- Papilleodema
- 6th nerve palsy
- Cognitive impairment
- Altered consciousness
- 3rd nerve palsy
What is the typical CSF production in a day?
400-450cc
What is hydrocephalus caused by?
Caused by tumours in or close to CSF pathways, especially posterior fossa tumours (pituitary)
What is done to diagnose hydrocephalus?
- History and examination
- Think sources of secondary tumours (such as chest x-ray)
- CT scan
- MRI scan
- Biopsy
What is focal neurological deficit?
Problem with nerve, spinal cord, or brain function, affecting a specific location such as part of tongue or side of face
What is the clinical presentation of focal neurological deficit?
- Hemiparesis
- Dysphagia
- Hemianopia
- Cognitive impairment (memory, sense of direction)
- Cranial nerve palsy
- Endocrine disorders
What is hemianopia?
Blindness over half the field of vision
What is ataxia?
Term for group of disorders that affect co-ordination, balance and speech
What does in-coordination mean?
Harmonious functioning of parts for effective results
What is the medical term for loss of ability to perform simple calculations?
Acalculia
What is the medical term for loss of ability to communicate through writing?
Agraphia
What is the medical term for inability to interpret sensations and hence recognise things?
Agosia
What are the 2 kinds of epilepsy?
- Focal epilepsy
- Generalised epilepsy
Epilepsy only occurs in lesions above where>?
Tentorium
What investigations are done for brain tumours?
Adequate cerebral imaging:
- CT
- MRI
- PET
- Angiography
If suspected metastases:
- CT chest/abdomen/pelvis
- Mammography
- Biopsy skin lesions/lymph nodes
What are the managent goals for a brain tumour?
- Accurate tissue diagnosis
- Improve quality of life
- Decreasing mass effect
- Improve neurological deficit
- Aid effect of adjuvant therapy
- Prolong life expectancy
What does the management of a brain tumour involve?
- Corticosteroids
- Dexamethasone
- Treat epilepsy
- Anticonvulsant drugs
- Analgesics/antimetics
- Counselling
- Surgery
- Radiotherapy
- Chemotherapy
- Endocrine replacement
What are the management options for a brain tumour?
What is the prognosis of meningioma?
- Commonly cured by surgery, may required anticonvulsants
What is the prognosis of low grade astrocytomas?
Long life expectancy
What is the prognosis of high grade astrocytoma/GBM?
Average 1 year survival
What is the prognosis of metastases in the brain?
- Frequently good medium term remission
When should a LP never be performed?
Remember, DO NOT perform a lumbar puncture when there are signs and symptoms to suggest an intracranial mass lesion, this is because you might:
- Cause meningitis
- Cause a herniation syndrome and the patient could die
- Cause an air embolism
- Make the patient’s headache worse
Why should a lumbar puncture never be performed when there are signs/symptoms to suggest an intracranial mass lesion?
Because you might:
- Cause meningitis
- Cause a herniation syndrome and the patient could die
- Cause an air embolism
- Make the patient’s headache worse
