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Phase 3a - Neurology > Brain Tumours & Metastases > Flashcards

Brain Tumours & Metastases Flashcards

1
Q

Primary Brain Tumours

A

Primary brain tumours originate within the brain or surrounding structures, as opposed to metastatic tumours which spread from other sites.

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2
Q

Classification of Primary Brain Tumours is completed by ___

A

Histology

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3
Q

Name some examples of Gliomas

A

Gliomas (tumours of glial cells):
Astrocytomas (including glioblastoma multiforme).
Oligodendrogliomas.
Ependymomas.
Meningiomas (arise from meninges).
Medulloblastomas (common in children, cerebellum).
Pituitary tumours (e.g., prolactinomas).
Schwannomas (e.g., vestibular schwannomas).
Craniopharyngiomas (near the pituitary).

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4
Q

Meningiomas arise from __

A

Meninges

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5
Q

Epidemiology of Glioblastoma multiforme

A

Most common primary malignant brain tumour in adults.

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6
Q

Epidemiology of Meningiomas

A

Most common primary benign tumour in adults.

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7
Q

Epidemiology of Medulloblastomas

A

Most common malignant brain tumour in children.

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8
Q

Causes and risk factors of Primary Brain Tumours

A

Genetic syndromes: Neurofibromatosis type 1 and 2, Li-Fraumeni syndrome, tuberous sclerosis, and von Hippel-Lindau disease.
Ionising radiation.
Family history of brain tumours.

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9
Q

General Symptoms of Primary Brain Tumours

A

(due to raised intracranial pressure):

Headache (worse in the morning or with straining).
Nausea and vomiting.
Papilloedema (optic disc swelling).
Seizures.

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10
Q

Focal Neurological Symptoms of Primary Brain Tumours depend on what?

A

Depend on tumour location

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11
Q

Focal Neurological Symptoms: Frontal Lobe

A

Personality changes, poor decision-making, hemiparesis.

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12
Q

Focal Neurological Symptoms: Temporal Lobe

A

Seizures, memory impairment, language disturbances.

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13
Q

Focal Neurological Symptoms: Parietal Lobe

A

Sensory loss, visuospatial issues

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14
Q

Focal Neurological Symptoms: Occipital Lobe

A

Visual field defects.

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15
Q

Focal Neurological Symptoms: Cerebellum

A

Ataxia, balance issues.

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16
Q

Focal Neurological Symptoms: Brainstem

A

Cranial nerve palsies, ataxia.

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17
Q

Dx/ Ix for Primary Brain Tumours

A

Neuroimaging:

MRI (with contrast): Gold standard for characterising brain tumours.
CT scan: Quicker but less detailed.
Biopsy:

Essential for definitive diagnosis and histopathological classification.
Other Tests:

Blood tests: Check endocrine function if a pituitary tumour is suspected.
Lumbar puncture: Rarely used but may assist in medulloblastoma or other paediatric cases.

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18
Q

Name some examples of Primary Brain Tumours

A

Glioblastoma Multiforme (GBM), Meningiomas, Vestibular Schwannomas (Acoustic Neuromas), Medulloblastomas, Pituitary Tumours

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19
Q

Features of Glioblastoma Multiforme (GBM)

A

Highly aggressive, poor prognosis.

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20
Q

Imaging of Glioblastoma Multiforme (GBM)

A

“Ring-enhancing lesion” on contrast MRI.

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21
Q

Tx for Glioblastoma Multiforme (GBM)

A

Surgery, radiotherapy, temozolomide (chemotherapy).

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22
Q

Features of Meningiomas

A

Typically slow-growing and benign.

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23
Q

Sx for Meningiomas

A

Often incidental findings; may cause focal deficits.

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24
Q

Tx for Meningiomas

A

Surgical resection if symptomatic.

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25
Q

Features of Vestibular Schwannomas (Acoustic Neuromas)

A

Affects CN VIII, leading to hearing loss and tinnitus.

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26
Q

Symptoms of Vestibular Schwannomas (Acoustic Neuromas)

A

Balance problems, facial numbness (compression of CN VII).

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27
Q

Tx for Vestibular Schwannomas (Acoustic Neuromas)

A

Surgery or stereotactic radiosurgery.

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28
Q

Features of Medulloblastomas

A

Common in children; arises in the posterior fossa.

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29
Q

Sx for Medullablastomas

A

Ataxia, hydrocephalus.

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30
Q

Tx for Medulloblastomas

A

Surgery, craniospinal radiotherapy, and chemotherapy.

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31
Q

Features of Pituitary Tumours

A

Hormonal dysfunction (e.g., prolactinoma causing amenorrhoea, galactorrhoea).

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32
Q

Tx for Pituitary Tumours

A

Medical therapy (e.g., dopamine agonists for prolactinomas) or surgery.

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33
Q

Management for Primary Brain Tumours

A

Surgical Resection, Radiotherapy:
Post-surgery or for non-operable tumours.
Chemotherapy:
Typically adjunctive (e.g., temozolomide for GBM).
Symptom Control

34
Q

Surgical Resection is the primary tx for ____

A

Primary treatment for accessible tumours.

35
Q

What is used for symptom control in Primary Brain Tumours

A

Corticosteroids: To reduce cerebral oedema.
Antiepileptics: For seizure control.
Rehabilitation: Occupational and physiotherapy for functional impairments.

36
Q

Prognosis of a Primary Brain Tumours depends on ___

A

Dependent on tumour type, grade, and location.

37
Q

Prognosis of Glioblastomas

A

Poor prognosis (median survival ~12-18 months).

38
Q

Prognosis of Meningiomas

A

Excellent prognosis if benign and resectable.

39
Q

What are Brain Metastases?

A

Brain metastases refer to secondary tumours that have spread to the brain from a primary cancer elsewhere in the body. These are the most common type of brain tumour in adults.

40
Q

Name some common primary cancers (Brain Metastases)

A

Lung cancer (most common cause).
Breast cancer.
Melanoma (high propensity to metastasize to the brain).
Kidney cancer.
Colorectal cancer.

41
Q

Epidemiology of Brain Metastases

A

Occurs in approximately 10-30% of adult cancer patients.
Most common in patients with advanced or late-stage cancer.

42
Q

Pathophysiology of Brain Metastases

A

Tumour cells spread via the bloodstream or lymphatic system to the brain

43
Q

Common locations of Brain Metastases include:

A

Cerebral hemispheres (~80%).
Cerebellum (~15%).
Brainstem (~5%).

44
Q

Symptoms of Brain Metastases

A

Raised Intracranial Pressure:

Headaches (worse in the morning).
Nausea and vomiting.
Blurred vision due to papilloedema Memory impairment, confusion, or personality changes.

45
Q

Are seizures common in Brain Metastases

A

Common presentation in metastases involving the cerebral cortex.

46
Q

Dx/ Ix for Brain Metastases

A

Imaging:

MRI with contrast: Gold standard for identifying and characterizing brain metastases.
CT scan with contrast: Quicker, used in emergency settings.
2. Biopsy:

Rarely required but may be necessary if there is diagnostic uncertainty.

47
Q

Ix to identify a primary tumour

A

Chest X-ray or CT thorax, abdomen, and pelvis.
Mammography or breast MRI.
Colonoscopy if colorectal cancer is suspected.
PET-CT scan for metastatic workup.

48
Q

Differential Dx for Brain Metastases

A

Primary brain tumours (e.g., glioblastoma).
Abscesses or infections (e.g., toxoplasmosis in immunocompromised patients).
Stroke or haemorrhage.
Autoimmune conditions (e.g., multiple sclerosis).

49
Q

Symptomatic Tx for Brain Metastases

A

Corticosteroids (e.g., dexamethasone): Reduce cerebral oedema and pressure.
Antiepileptic drugs: For seizure control (e.g., levetiracetam).
Analgesics: For headache and pain relief.

50
Q

Definitive Tx for Brain Metastases

A

Surgical resection: For accessible and symptomatic metastases in selected patients.
Radiotherapy:
Whole brain radiotherapy (WBRT): For multiple metastases.
Stereotactic radiosurgery (SRS): For small, isolated lesions.
Systemic Therapy:
Chemotherapy, immunotherapy, or targeted therapy depending on the primary cancer type.

51
Q

Palliative care for Brain Metastases

A

For patients with poor prognosis or extensive disease.

52
Q

Prognosis of Brain Metastases

A

Poor overall prognosis, dependent on factors such as:
Number and size of metastases.
Control of primary tumour.
Performance status of the patient.

53
Q

Median survival for Brain Metastases without tx

A

~1 month.

54
Q

Median survival for Brain Metastases with tx

A

(e.g., surgery + radiotherapy): 3-12 months.

55
Q

What is Metastatic Disease ?

A

Metastatic disease refers to the spread of cancer cells from a primary tumour to distant sites in the body, forming secondary tumours.

56
Q

Common sites of Metastatic

A

Bone: Common in breast, prostate, and lung cancers.
Liver: Frequently seen in colorectal and pancreatic cancers.
Lung: Commonly affected in metastatic breast, colorectal, and kidney cancers.
Brain: Seen in melanoma, lung, and breast cancers.
Peritoneum: Often involved in ovarian and gastric cancers.

57
Q

Mechanism of Spread in Metastatic Disease

A

Hematogenous Spread: Via the bloodstream; common in sarcomas and carcinomas.
Lymphatic Spread: Via the lymphatic system; common in carcinomas.
Direct Invasion: Into surrounding tissues.
Transcoelomic Spread: Across body cavities (e.g., pleural or peritoneal).

58
Q

Symptoms of Bone Metastases

A

Bone pain (worse at night).
Pathological fractures.
Hypercalcaemia (confusion, constipation, polyuria).

59
Q

Symptoms of Liver Metastases

A

Jaundice.
Hepatomegaly.
Right upper quadrant pain.
Elevated liver enzymes.

60
Q

Symptoms of Lung Metastases

A

Cough, haemoptysis.
Dyspnoea.
Chest pain.

61
Q

Symptoms of Brain Metastases

A

Headaches, seizures.
Focal neurological deficits.
Cognitive and personality changes.

62
Q

Symptoms of Peritoneal Metastases

A

Ascites (fluid accumulation in the abdomen).
Abdominal pain and bloating.

63
Q

Ix for Metastatic Disease

A

General Workup:

Full blood count.
Liver function tests.
Tumour markers (e.g., CA-125 for ovarian cancer, PSA for prostate cancer).
Imaging:

CT scan of the chest, abdomen, and pelvis: Commonly used for staging.
MRI: Particularly for brain and spinal metastases.
Bone scan: For suspected bone metastases.
PET-CT: Highly sensitive for detecting metastases across the body.
Biopsy:

Required to confirm the metastatic nature of the disease and often to identify the primary tumour if unknown.

64
Q

Differential Dx for Metastatic Disease

A

Primary tumours at the site of metastasis.
Benign conditions (e.g., cysts, abscesses).
Inflammatory or autoimmune diseases (e.g., sarcoidosis).

65
Q

Management of Metastatic Disease

A

Systemic Therapy:

Chemotherapy: Targets rapidly dividing cells across the body.
Hormonal Therapy: For hormone-sensitive cancers (e.g., tamoxifen for breast cancer).
Targeted Therapy: Focuses on specific molecular pathways (e.g., trastuzumab for HER2-positive breast cancer).
Immunotherapy: Enhances the immune response to cancer cells (e.g., checkpoint inhibitors like pembrolizumab).
2. Local Treatments:

Surgery: For resectable metastases (e.g., liver metastases in colorectal cancer).
Radiotherapy: To control symptoms like pain or prevent complications (e.g., spinal cord compression).
3. Supportive and Palliative Care:

Symptom Management: Pain relief, antiemetics, bisphosphonates for bone metastases.
Psychological Support: Counselling and therapy for patients and families.
End-of-Life Care: Ensuring comfort and dignity in advanced stages.

66
Q

Prognosis of Metastatic Disease

A

Heavily dependent on:
Type and aggressiveness of the primary tumour.
Extent of metastatic spread.
Patient’s overall health and response to treatment.

67
Q

Median Survival for Metastatic Disease

A

Varies widely; for example:
Brain metastases: ~6-12 months with treatment.
Bone metastases: Prognosis depends on cancer type (e.g., prostate cancer metastases can be indolent).

68
Q

What is an Acoustic Neuroma?

A

(Vestibular Schwannoma):
A benign, slow-growing tumour arising from the Schwann cells of the vestibulocochlear nerve (cranial nerve VIII).

69
Q

Epidemiology of Acoustic Neuroma

A

Typically occurs in adults aged 40-60 years.
Accounts for 8% of all intracranial tumours and 90% of cerebellopontine angle tumours

70
Q

Neurofibromatosis Type 2 (NF2) is associated with ___

A

bilateral acoustic neuromas.

71
Q

Acoustic Neuroma originates from ___

A

the vestibular division of cranial nerve VIII

72
Q

What does an Acoustic Neuroma compress?

A

Compresses adjacent structures:
Cochlear nerve: Hearing impairment.
Facial nerve: Facial weakness or paresthesia.
Trigeminal nerve: Sensory loss in the face.
Brainstem and cerebellum: Ataxia and other neurological symptoms in advanced cases.

73
Q

Early symptoms of Acoustic Neuroma

A

Unilateral hearing loss: The most common presenting feature, typically sensorineural.
Tinnitus: Persistent ringing in one ear.
Vertigo or imbalance.

74
Q

Later symptoms of Acoustic Neuroma

A

from nerve/brainstem compression):

Facial numbness or weakness (trigeminal or facial nerve involvement).
Ataxia: Due to cerebellar involvement.
Headaches and papilledema: From raised intracranial pressure in large tumours.

75
Q

Bilateral tumours are indicative of ___

A

NF2.

76
Q

Dx for Acoustic Neuroma

A

Audiometry:

Shows sensorineural hearing loss.
2. Imaging:

MRI with contrast: Gold standard for detecting tumours in the cerebellopontine angle.
CT scan: May be used if MRI is unavailable.
3. Vestibular Testing:

May show impaired vestibular function.
4. Genetic Testing:

For NF2 if bilateral tumours or family history are present.

77
Q

Differential Dx for Acoustic Neuroma

A

Ménière’s disease.
Presbycusis (age-related hearing loss).
Chronic otitis media.
Brainstem tumours.
Multiple sclerosis (if presenting with vertigo or sensory symptoms).

78
Q

Conservative managment for Acoustic Neuroma

A

Observation and serial MRIs: For small, asymptomatic tumours or elderly patients.

79
Q

Surgical resection of Acoustic Neuroma

A

Recommended for large tumours or significant symptoms.
Risks include damage to the facial nerve, resulting in permanent weakness.

80
Q

Stereotactic Radiosurgery for Acoustic Neuroma

A

(e.g., Gamma Knife):

Used for small to medium-sized tumours.
Aims to halt growth while preserving function.

81
Q

Complications of Acoustic Neuroma

A

Facial nerve damage:

Can occur during surgery, leading to weakness or paralysis.
Hearing loss:

Permanent hearing loss may result from tumour or treatment.
Hydrocephalus:

From compression of the brainstem or blockage of cerebrospinal fluid flow.
Cerebellar dysfunction:

Imbalance and ataxia.

82
Q

Prognosis for Acoustic Neuroma

A

Excellent prognosis with early detection and treatment.
Growth rate is usually slow, allowing for careful monitoring in many cases.

Phase 3a - Neurology (18 decks)

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