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Control & Movement > Control CS7 intracranial tumours > Flashcards

Control CS7 intracranial tumours Flashcards

1
Q

What is an example of a cranial tumour that has high lethality?

A

High grade gliomas/glioblastimas

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2
Q

What age group is brain tumours one of the commonest causes of cancer deaths?

A

In young people

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3
Q

What are some benign brain tumours?

A

Meningiomas
Pituitary adenomas
Schwannomas

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4
Q

What are some common paediatric brain tumours?

A

Medulloblastoma
Germ cell tumours
Ependymoma

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5
Q

How will patients with brain tumours commonly present?

A

Headache
Confusion
Nausea and vomiting
Reduced consciousness
Seizures
Focal symptoms related to location of the tumour like progressive weakness of one side or dysphasia

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6
Q

When do you decide to do a scan to check for a brain tumour?

A

If a patient presents with a headache AND at least one other neuro symptom/sign

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7
Q

Which hemisphere of the brain is classed as the dominant hemisphere?

A

the half of the brain where the language centre resides - usually left hemisphere (right in 30% of left handed people)

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8
Q

A 40 year old right handed plumber presents to A & E after a fit and has a 2 week history of gradually increasing numbness and weakness of the right side. Where is the lesion?

A

In the left hemisphere in fronto-parietal region around the central sulcus affecting both motor and sensory cortexes

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9
Q

A 30 year old mother can’t make her children understand what she is trying to say. She seems to understand what is said to her. She is right handed. Where is the lesion?

A

In Broca’s area around the lateral sulcus in the left hemisphere in the temporo-frontal region

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10
Q

A 50 year old company director becomes withdrawn, apathetic and bad-tempered - then develops headaches and vomiting. Where is the lesion?

A

In the frontal lobe

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11
Q

A 55 year old lady can’t dress herself properly (dyspraxia), has numbness down one side (sensory loss) and develops headaches. Which lobe of the brain is likely to be affected?

A

The parietal lobe

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12
Q

What are common treatments for brain tumours?

A

Steroids
Anti-epileptics
Surgery
Radiotherapy
Chemotherapy

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13
Q

What are some side effects of steroids?

A

Proximal myopathy
Weight gain especially round face and stomach
Problems sleeping
Psychiatric problems/mood disturbances

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14
Q

What is radiotherapy?

A

The use of x-rays to treat tumours using carefully controlled high energy x-ray beams focused on the tumour. Is painless and invisible.

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15
Q

How do radiotherapy and chemotherapy differ in how they target cancer?

A

Localised treatment where as chemotherapy affects the whole body.

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16
Q

What is an advantage of proton therapy vs photon?

A

Protons may spare more of the brain’s normal tissue from exposure compared to photons so especially good in children to spare developing brain

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17
Q

What are some side effects of cranial radiotherapy?

A

Cerebral oedema increasing ICP and exacerbating neurological symptoms
Hair loss
Scalp/ear erythema
Somnolence syndrome
Late effects due to sensitive structures being damaged e.g. lens of eye causing cataracts, pituitary gland damage causing hypopituitarism, damage to cerebral hemispheres causing memory loss

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18
Q

Who is not given radiotherapy for high grade gliomas?

A

The elderly or those with a poor prognosis if they may die of the tumour within 3 months or before they have recovered from side effects of radiotherapy

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19
Q

What is the median survival rates for different grade gliomas?

A

Grade 1 - many years and cured if resection
Grade 2 - 5-12 years depending on type
Grade 3 - 2-4 years depending on type
Grade 4 - 6-18 months dependent on prognostic factors

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20
Q

What brain tumours can treatment be curative for?

A

Germ cell tumours
Medulloblastomas

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21
Q

What are some treatments for palliative brain metastases?

A

Whole brain radiotherapy
If primary tumour is chemo sensitive like small cell lung cancer, can use chemotherapy
If low volume disease with good performance status and reasonable prognosis can use gamma knife

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22
Q

What is the role of chemotherapy in the treatment of brain tumours?

A

To be used in palliative care
Enhance the effectiveness of radiotherapy

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23
Q

What symptoms can be indicative of raised intracranial pressure (ICP)?

A

Headache - usually early in the morning
Vomiting
Blurred vision

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24
Q

What may a patient present with which is actually a brain tumour?

A

Raised ICP
Epilepsy
Neurological deficit
Endocrine dysfunction

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25
Q

What can cause raised ICP?

A

Tumour mass
Cranial oedema
Obstructive hydrocephalus

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26
Q

What tumours are a common cause of seizures?

A

Supratentorial tumours

27
Q

What examination should you do when querying a brain tumour?

A

Examine higher mental function
Cranial nerve exam to identify any abnormalities
Check motor/sensory function
Look for cerebellar signs

28
Q

What investigations should be done for a query brain tumour?

A

Haematological tests e.g. FBC
Test for tumour markers e.g. aFP, Bhcg, PSA
Hormonal assay
Visual fields test
Chest/abdominal CT for other tumours/abnormalities

29
Q

What are some scans you can do to investigate a brain tumour?

A

CT
MRI
Cerebral angiography

30
Q

Which scan can help you identify Broca’s area?

A

fMRI

31
Q

Which investigation can help you identify corticospinal tracts in the brain?

A

DTI

32
Q

What is another scan used to identify brain tumours using PPM?

A

MRS

33
Q

What is the role of surgery for brain tumours?

A

To help diagnostics
Remove mass effect and alleviate symptoms
Treat complications of the tumour

34
Q

What are the different types of biopsy used for brain tumours?

A

Stereotactic
Neuro-navigation
Endoscopic
Free hand

35
Q

What are the two types of surgical excisions used for brain tumours?

A

total excision
Partial excision

36
Q

How do pathologists section a brain tumour?

A

With frozen section

37
Q

What fluorescent dye can be given to a patient to help identify the tumour in surgery?

A

5-ALA

38
Q

What is an example of a local chemotherapy agent?

A

Gliadal (carmustine) wafers

39
Q

How can hydrocephalus as a complication of brain surgery be treated?

A

With third ventriculostomy
With a ventriculo-peritoneal shunt

40
Q

What stain is used when looking at white matter of the brain/CNS?

A

H&E stain

41
Q

What stain is used to look at astrocytes?

A

GFAP stain

42
Q

What stain is used to look at neuropils in the brain?

A

NFP stain

43
Q

What are three types of glioma tumours?

A

Astrocytoma
Oligodendroglioma
Ependymoma

44
Q

What nervous tissue do gliomas derive from?

A

Glia tissue

45
Q

What nervous tissue do meningioma tumours develop from?

A

Meningeal tissue

46
Q

What nervous tissue do gangliocytoma tumours develop from?

A

Neuronal tissue

47
Q

What nervous tissue do medulloblastoma tumours develop from?

A

Primitive tissue

48
Q

What nervous tissue do schwannoma tumours develop from?

A

Nerve sheath

49
Q

What features of intracranial tumours are used in the WHO grading system?

A

Mitoses
Vascular endothelial proliferation
Necrosis

50
Q

What are the 4 grades of cancer set out by the WHO?

A

I - benign with no/slow progression
II - low grade with progression
III - high grade with rapid progression
IV - aggressive

51
Q

What are some genes where mutations are related to development of brain tumours?

A

IDH1/2
TERT
ARTX
BRAF
1p/19q co-deletion
EGFR
MGMT methylation
H3 K27
CDKN2A/B

52
Q

What test can be done for genetic mutations that lead to brain tumours?

A

IHC
FISH
NGS
Methylation PCR

53
Q

What mutation is associated with asteocytomas?

A

IDH1-mutant or IDH2-mutant

54
Q

What mutations are associated with oligodenodrogliomas?

A

IDH-mutant AND 1p/19q co-deleted (have to occur together for this tumour to form)

55
Q

What mutations are associated with glioblastomas?

A

IDH-wildtype AND H3-wildtype AND one or more of the following:
Micro vascular proliferation
Necrosis
TERT pro motor mutation
EGFR gene amplication
+7/-10 chromosome copy number

56
Q

Who is most likely to have a pilocytic astrocytoma?

A

Children

57
Q

Where is a pilocytic astrocytoma found and what are its features?

A

Found in cerebellum
Well-defined cystic tumour with pilocytes, rosethal fibres and vascular proliferation

58
Q

Where are Ependymoma tumours found and what are it’s features?

A

Found in the ventricles
Is a well-defined tumour with pseudorosettes and round small uniform cells

59
Q

Who is most likely to have a meningioma?

A

Female adults

60
Q

Where are meningiomas found and what are it’s features?

A

In the dura,
Is a well defined extra-axialt tumour with whorls and psammoma bodies

61
Q

Who is most likely to be affected by a meduoblasroma?

A

Children

62
Q

Where are medullablastomas found and what are the features of this tumour?

A

Found in cerebellum
Very high cellular density tumour with a anaplastic hyperchromatic cells with a rosette formation. Frequent apoptosis and mitoses.

63
Q

What are the three types of nerve sheath tumours?

A

Spindle-cell tumours
Shwannoma
Neurofibroma (nerve sheath tumour of the spinal cord)

64
Q

What cranial nerve are shwannomas usually found on?

A

Cranial nerve VIII

Control & Movement (36 decks)

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