Cancers of the Central Nervous System Flashcards by Haydar Sheikh

What % of all cancers are brain tumours?

2-5%

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What % of cancer deaths are caused by brain tumours?

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What is more common, primary brain tumours or mets to brain?

Mets

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Where do mets to the brain commonly arise from?

Lung
Breast
Skin (melanoma)
Kidney

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How can nasopharyngeal cancers spread to the brain?

They can extend directly through the foramina of the skull and involve the brain

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What might meningeal metastases occur from?

Leukaemia
Lymphoma
Breast cancer
Small-cell lung cancer
Local extension of medulloblastoma and ependymal gliomas

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What % of CNS tumours occur in the spinal cord?

Less than 20%

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Is the cause of most adult brain tumours known?

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What can be associated with brain tumours that tend to occur in children or young adults?

Inherited phakomatoses

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What inherited phakomatoses are associated with brain tumours in children and young adults?

Tuberous sclerosis
Li-Fraumeni syndrome
Turcot syndrome
Neurofibromatosis type I
von Hippel-Lindau disease
Gorlin’s basal naves syndrome

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What specific brain tumours are associat4ed with von Hippel-Lindau disease?

I’m only joking we obvs don’t need to know this lol got u

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What can the symptoms of glial tumours be divided into?

General

- Focal

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What causes the general symptoms of glial tumours?

Mass effects

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What can mass effects cause in glial tumours?

Increased ICP
Oedema
Midline shift and herniation

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What symptoms can be produced by midline shift in glial tumours?

Progressive altered mental state
Personality changes
Headaches
Seizures
Papilloedema

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What do focal symptoms of glial tumours depend on?

The site of the tumour

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What % of primary seizures are due to tumours?

Less than 10%

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What % of supratentorial tumours present with seizures?

20%

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How do meningiomas present?

Headache
Seizures
Motor and sensory disturbance
Cranial neuropathies (depending on site)

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Where do meningiomas cause characteristic changes?

Plain skull radiographs

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What are the characteristic changes on plain skull radiographs associated with meningiomas?

Bone erosion
Calcification
Hyperostosis

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Are meningiomas more common in men or women?

Women

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What is the frequency of tumour sites in the spinal cord?

70% thoracic
20% lumbosacral
10% cervical

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Where do spinal cord metastases most commonly occur from?

Breast
Lung
Prostate
Sarcoma
Lymphoma

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How do spinal axis tumours present?

- Sensorimotor dysfunction - Radicular symptoms - Syringomelia symptoms

What causes sensorimotor dysfunction in spinal axis tumours?

Cord compression

What causes radicular symptoms in spinal axis tumours?

Local extension of a tumour

What causes syringomyelia symptoms in spinal axis tumours?

Intra-medullary tumours causing central destruction

How do olfactory groove tumours present?

- Anosmia - Visual loss - Frontal lobe syndrome - Papilloedema

How do sella turcica tumours present?

Visual field loss

How do posterior fossa tumours present?

- Ataxic gait - Cranial neuropathies - Cerebellopontine angle - Suboccipital pain - Hydrocephalus - Ipsilateral arm and leg weakness

How do sphenoid wing tumours present?

- Exophthalmos and visual loss - Temporal bone swelling - Skull deformity - Cavernous sinus syndrome

What can the types of brain tumours be divided into?

- Glial tumours | - Non-gliomas

What are the types of glial tumours?

- Gliomas - Ependymomas - Oligodendrogliomas - Medulloblastomas

What % of brain tumours are gliomas?

50%

What can gliomas be graded as?

I-IV

What are ependyomas?

Cancers arising from ependymal cells lining the fourth ventricle

What are oligodendrogliomas?

Cancers arising from oligodendroglia

Who do medulloblastomas occur in?

Children

Where do medulloblastomas arise from?

Cerebellum

What might medulloblastomas be related to?

Neuroectodermal tumours elsewhere in CNS

Give 4 non-glial brain tumours

- Meningiomas - Primary cerebral non-Hodgkin's lymphoma - Craniopharyngiomas - Choroid plexus tumours

Give 4 types of primary spinal cord tumours

- Schwannomas - Extradural meningiomas - Intramedullary ependymomas - Astrocytomas

What is the imaging of choice in brain tumours?

MRI with gadolinium enhancement

What might PET be useful for in brain tumours?

To help differentiate tumour recurrence from radiation necrosis

What is required to confirm the diagnosis of brain tumour?

Biopsy

When might a biopsy not be used to confirm the diagnosis of brain tumour?

Diagnosis is sometimes made on clinical evidence is made if biopsy is hazardous

Why is staging not applicable to most primary brain tumours?

As they are locally invasive and do not spread to regional lymph nodes or distant organs

What treatment is required for curing the majority of gliomas?

Surgery, radiotherapy, and chemotherapy

How much of a glioma should be removed at surgery?

Removal should be complete as possible within the constraints of preserving neurological function

What is the role of radiotherapy in glioma management?

Can increase cure rate or prolong disease-free survival in high-grade gliomas May produce symptomatic improvement in patients with low-grade gliomas who relapse after initial therapy with surgery alone

What is the role of chemotherapy in glioma management?

May prolong disease-free survival in some types

What might limit the use of chemotherapy in gliomas?

Toxicity

What management do meningiomas require?

Surgical resection

What treatment is used for meningiomas that relapse after surgery?

Resect it again lol

What is the role of radiotherapy in meningiomas?

Reduces relapse rate

When should radiotherapy be considered in meningiomas?

- High-grade | - Incompletely resected

What are early complications of radiotherapy for brain tumours due to?

Reversible damage to myelin-producing oligodendrocytes

How long do oligodendrocytes damaged by radiotherapy take to recover?

3-6 months

What can radiotherapy induced damage to oligodendrocytes cause?

- Somnolence - Exacerbation of existing symptoms in brain - Lhermitte's sign

What is Lhermitte's sign?

Shooting numbness or parenthesis precipitated by neck flexion

When can radiotherapy cause Lhermitte's sign?

When you've zapped the spinal cord

What are the late complications of radiotherapy for brain tumours?

Irreversible radiation necrosis

What causes irreversible radiation necrosis?

Damage to blood vessels

What might radiation necrosis mimic?

Disease recurrence

What does radiation necrosis correlate with?

Radiation dose

What % of patients receiving radiotherapy for brain tumours get radiation necrosis?

15%

How many roentgens gives you radiation necrosis?

3. 6... not great, not terrible | p. s. this isn't a real card

What do the prognostic factors for brain tumours depend on?

- History - Grade and size of tumour - Age and performance status of patient - Duration of symptoms