Brain Tumours (clinical) Flashcards
What are the common metestatic sites for spread to the brain?
Lung
Breast
Kidney
GI
(previous lecture also included melanoma)
How do we classify brain tumours?
Tissue of origin
ocation
Primary or secondary
Grading
What percentage of cancer patients develop brain mets?
10-15%
What are the two most likely causes of neurological death?
- Stroke
- Brain tumour
How do we grade tumours?
Microscopic appearence
Growth rate
To grade differentiation:
oGX Grade cannot be assessed (Undetermined)
oG1 Well-differentiated (Low grade)
oG2 Moderately differentiated (Intermediate grade)
oG3 Poorly differentiated (High grade)
oG4 Undifferentiated (High grade)
What are the common presentations of brain tumour?
Neurological defecit: 68%
- 45% motor weakness
- Mental status changes
HA 54%
Seizures 26%
What are the genereal signs and symptoms of brain tumours?
oCerebral edema
oIncreased intracranial pressure
oFocal neurologic deficits
oObstruction of flow of CSF
oPituitary dysfunction
oPapilledema (if swelling around optic disk)
What are the signs and symptoms of cerebral tumours?
oHeadache
oVomiting unrelated to food intake
oChanges in visual fields and acuity
oHemiparesis or hemiplegia
oHypokinesia
oDecreased tactile discrimination
oSeizures
oChanges in personality or behavior
What are the signs and symptoms for brainstem tumours?
oHearing loss (acoustic neuroma)
oFacial pain and weakness
oDysphagia, decreased gag reflex
oNystagmus
oHoarseness
oAtaxia (loss of muscle coordination) and dysarthria (speech muscle disorder) (cerebellar tumours)
What are the signs and symptoms of cerebellar tumours?
Disturbances in coordination and equilibrium
What are the signs and symptoms of pituitary tumours?
Endocrine dysfunction
Visual defecits
Headache
What are the signs and symptsoms of frontal lobe tumours?
oInappropriate behavior
oPersonality changes
oInability to concentrate
oImpaired judgment
oMemory loss
oHeadache
oExpressive aphasia
oMotor dysfunctions
What are the signs and symptoms of parietal lobe tumour?
Sensory defecits:
- Paresthesia
- Loss of 2 point discrimination
- Visual field defecits
What are the signs and symptoms for temporal lobe tumours?
oPsychomotor seizures – temporal lobe-judgment, behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousness
What are the signs and symptoms of ocipital lobe tumours?
Visual disturbances
What is the name given to grade a) 1 and 2 b) 3 c) grade 4
Gliomas?
Grade 1 and 2 glioma - astrocytoma
Grade 3 - anaplastic astrocytoma
Grade 4 - Glioblastoma multiforme (also known as a glioblastoma)
What are the intraaxial tuomurs?
•Gliomas
oAstrocytoma (Grades I & II)
oAnaplastic Astrocytoma(III)
oGlioblastoma Multiforme(IV)
- Oligodendroglioma
- Ependymomas
- Medulloblastoma
- CNS Lymphoma
What are the extraaxial tumours?
- Meningioma
- Metastatic
- Acoustic neuromas (Schwannoma)
- Pituitary adenoma
- Neurofibroma
What are the most common brain tumours?
- Gliomas
- Meningioma
What age group is most commonly affected by meningiomas?
Usually age 40 - 70
Is meningioma usually invasive or non-invasive?
Usually non - invasive
Where are meningiomas usually located?
Parasaggital region
SPhenoid wing
Parasellar region
What is the presentation of a meningioma?
Asymptomatic
Symptomatic: Focal or generalised seizure or gradually worsening neurological defecit
What are the features of meningioma on CT?
Cearly demarcated contours
Frequently have areas of calcification
Isodense or hypodense
WHich demographic is affected by diffuse low grade astrocytomas?
Young adults
Where do you find astrocytoma?
Frontal region
Subcortical white matter
What is the presentation of astrocytoma?
Seizures
Headache
Slowly progressive neurological defecits
What are the findings of diffuse low grade astrocytoma on CT?
Well circumscribed
Hypodense or isodense
MRI is more sensitive than CT
What is the most common type of brain tumour in adults?
Glioblastoma
Where can glioblastomas arise from?
May arise de novo (from new) or may evolve from a low grade glioma
What does an astrocytoma resemble?
Can look like a butterfly lesion
What is the location of a glioblastoma?
Frontal and temporal lobe
Basal ganglia
What is the presentation of a glioblastoma?
Seizures
Headache
SLowly progressive neurological defecit
What are the findings of high grade astrocytoma on CT?
Hypodense or isodense
Central hypodense area of necrosis surrounded by a thick enhancing rim
Surrounding oedema
What is the typical appearance of an oligodendroglioma?
Characteristic fried egg appearance
Arises from myelin
What is the location of an oligodendroglioma?
FOund superficially in the frontal lobe
What is the presentation of oligodendroglioma?
Seizures most common
Headache
Slowly progressive neurologic deficits
What are the features of oligodendroglioma on CT?
Well circumscribed
Hypodense lesions with heavy calcification
Cystic degeneration is common
What are examples of haemorrhagic brain mets?
Melanoma
Renal cell
Choriocarcinoma
What are the diagnostic procedures of brain tumours?
•Radiological Imaging
oComputed Tomography scan (CT scan) with/without contrast
oMagnetic Resonance Imaging (MRI) with/without contrast
oPlain films
oMyelography
oPositron Emission Tomography scan (PET scan)
- LP/CSF analysis
- Pathology
Why would you use a CT and MRI?
CT - Diagnosis of brain tumours
MRI - Folow-up of brain tumours
What might a CT scan miss?
May miss small tumours
May miss tumours adjacent to the bone such as (pituitary adenomas, clival tumours and vestibular schwannoma)
May miss brainstem tumours
Low grade astrocytoma
What is a CT more sensitive to than an MRI scan?
More sensitive than MRI for detecting acute haemorrhage, calcification and bony involvement
What are the advantages of MRI over CT?
More sensitive than CT scans
Can detect small tumours
Provides much greater anatomic detail
Especially useful for visualizing skull base, brain stem and posterior fossa tumours
When are steroids used for brain tumour patients?
Pre-operatively
What is surgical treatment for brain tumours?
Resection
Biopsy
Craniotomy
Stereotaxis surgery
Transsphenoidal
Endoscopic
What are post - op complications?
- Increased ICP
- Hematoma
- Hypovolemic shock
- Hydrocephalus
- Atelectasis - partial collapse or incomplete inflation of the lung
- Pulmonary edema
- Meningitis
- Fluid and electrolyte imbalances (ADH)
- Wound infection
- Seizures
- CSF leak
- Edema
How does radiation therapy work?
Damages cells that rapidly divide - sensitive to these cells
Usually lasts 4 - 8 weeks
What is a common side effect of radiation therapy?
Skin burn and reddened skin from beam of radiation
How is cerebral oedema controlled before radiation therapy begins?
Corticosteroids are given beforehand
Why might surgery be indicated after radiation therapy?
Radiation necrosis may occur after treatment is completed
Give examples of chemotherapy drugs
How are chemotherapy drugs administered?
PO (means per os in latin - by mouth)
IV
Intrathecal (spinal injection)
What are the side effects of chemotherapy?
Bone marrow suppression
Fatigue
Hair loss
Nausea / vomitting
Anxiety
Peripheral neuropathy
What type of tumour causes hydrocephalus due to aqueduct stenosis and also overlies the tectum and midbrain?
Pineal germinoma
What tumour is usually benign
Most common in young children?
Low grade pilocytic astrocytomas
What tumour cases locked in syndrome?
Brainstem glioma
Which tumour is most commonly found in the 4th ventricle - median age at diagnosis is also 5?
Ependymoma
Whch tumour has abundant capillary blood vessels?
Haemangioblastoma
It is also associated with retinal lesions
