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Neurology > Brain tumours - clinical presentation > Flashcards

Brain tumours - clinical presentation Flashcards

1
Q

What percentage of brain tumours are malignant?

A

55%

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2
Q

Brain cancer is the 9th most common cancer, true or false?

A

True

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3
Q

Brain cancers are the commonest cause if cancer in men & women under what age?

A

men - <45

women - <35

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4
Q

What cancers can secondary brain tumours arise from?

A

Lung, breast, colorectal, testicular etc.

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5
Q

Do brain tumours use the TNM classification system?

A

No

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6
Q

What classification do brain tumours follow?

Describe the difference between grade I and-IV

A

WHO classification based on histology, molecular markers and genetic factors.

Grade is determined using morphology

  • I = most benign, slow growing, non-malignant, associated with long term survival
  • II - slow growing but eventually become higher grade
  • III - malignant but not as aggressive as IV
  • IV = most malignant, anaplastic, mitotic activity with microvascular proliferation and or necrosis. These tumours reproduce rapidly and are very aggressive and malignant.
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7
Q

What is the most common primary brain tumour?

A

Gliomas - tumour of glial cells (astrocytes, oligodendrocytes, ependymal cells)

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8
Q

Causes of brain tumours?

A
  • majority of the time, no cause is found
  • ionising radiation in childhood leukaemias for example
  • 5% family history
  • immunosuppression (CNS lymphoma)
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9
Q

Symptoms and signs of brain tumours

A

Headache
Seizures
Focal neurological symptoms
Other non-focal symptoms

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10
Q

What are the typical signs of headache due to brain tumour?

A

Worse in the morning
Worse lying down
Associated with nausea and vomiting
Exacerbating by coughing, sneezing and drowsiness - raised ICP features

24% first symptom is a headache

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11
Q

What are some red flag features of a headache?

A

Headache plus…

  • age >50
  • new or changed headache
  • previous history of cancer (low threshold for scanning)
  • focal neurology
  • features of raised ICP
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12
Q

Clinical features of primary brain tumours?

A
  • new-onset seizure!!
  • headache
  • motor loss
  • confusion
  • weakness
  • memory loss
  • visual disorder
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13
Q

What is the prefrontal area and frontal area (frontal lobe) responsible for?

A

Prefrontal area:

  • personality
  • inhibition

Frontal:

  • motor function
  • language production (Broca’s area)
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14
Q

Functions of the temporal lobe?

A
  • language comprehension
  • auditory processing
  • visual field pathway
  • memory
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15
Q

Functions of the cerebellum?

A
  • balance

- coordination

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16
Q

Functions of the occipital lobe?

A
  • visual processing
17
Q

Functions of the parietal lobe?

A
  • sensory processing
  • spatial oreintation
  • astereognosis
  • dysgraphaesthesia
  • visual field pathway
  • dyslexia, dyscalculia, dyspraxia, agnosia
18
Q

Investigations for brain cancer

A
  • MRI
  • CT scan with contrast might miss brain tumours
  • Brain biopsy or surgery needed to diagnose what type of cancer it is
    (MGMT methylation, IDH-1 mutation, chromosome 1p19q)
19
Q

Treatment for high grade brain cancer?

A
  • *Steroids**
  • Reduce oedema
  • *Surgery**
  • Biopsy or resection
  • For tissue diagnosis, relief of raised ICP, prolongation of survival
  • *Radiotherapy**
  • Mainstay of treatment
  • Radical vs palliative
  • 5 times a week for 6 weeks
  • *Chemotherapy**
  • Temozolamide, PCV
  • Prognosis: 6m no treatment and 18m with treatment
20
Q

Treatment for low grade brain cancer?

A
  • *Surgery**
  • Early resection
  • Awake craniotomy to reduce risks - brain is stimulated during surgery to assess effects on areas near the tumour before resection
  • Without mapping: 40% subtotal resection, mortality 2% and 17% permanent deficits
  • With mapping: 80% total or subtotal resection, mortality 0%, 0.5% permanent deficits + 80% of impact on epilepsy
  • *Radiotherapy and early chemotherapy**
  • Improves overall survival from 78yrs to 13.3yrs
  • Prognosis: median survival 10yrs

Neurology (17 decks)

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