Hi - Neuro-Oncology

Question 1

Classifications of tumours in brain

Answer 1

Primary - CNS derived
Secondary - mets

Extra-axial - coverings eg bone, skin, meninges, nerves
Intra-axial - glia, neurones, neuroendocrine cells, lymphomas and germ cell tumours

Question 2

Which types of CNS tumours are benign / malignant?

Answer 2

Intra-axial = benign
Extra - axial and secondary = malignant

Question 3

Aetiology of brain cancers?

Answer 3

Unknown
Prev H+N radiotherapy
Some familial eg neurofibromatosis

Question 4

What % of:
- adult brain cancers are primary tumours ?
- childrens brain cancers are primary tumours?

What is the comparative freq of secondary vs primary ?

Answer 4

Primary tumours are 1% of all adult cancers and 25% childrens
Secondary 10x freq primary

Question 5

Functions of neuroimaging in neuro oncology

Answer 5

Assess tumour type
Guide biopsy / resection
Post surgery / Tx response
Follow up / recurrence / progression

Question 6

3 Mx options for neuro onc

Answer 6

Surgery - resection with minimal damage to normal tissues
Radio - gliomas, mets
Chemo - high grade gliomas and some lymphomas

Question 7

WHO grading for neuro tumours

Answer 7

ABOUT SURVIVAL
1 = Benign
2 = > 5 years
3 = < 5 years
4 = < 1 years

Question 8

Give features of diffuse gliomas, including age group and usual grade

Answer 8

Perivascular spread and supratentorial
In adults mainly
Grade 2+

Question 9

How does the IDH mutant affect glioma prognosis?

Answer 9

IDH+ = increased prognosis and response to Tx

Question 10

Who gets circumscribed gliomas?

Answer 10

Kids

Question 11

What is the most common brain tumour in children?

Answer 11

Pilocytic astrocytoma

Question 12

MRI features of Pilocytic astrocytoma
where are they found?

Answer 12

well circumscribed, cystic, enhacning lesion
In cerebellum / brainstem / optic hypothalamus

Question 13

Histology of Pilocytic astrocytoma

Answer 13

BRAF+ in 70%
Hairy on histology - rosenthal fibres
Piloid cells
Slow growing, low mitotic activity

Question 14

Grade of Pilocytic astrocytoma

Answer 14

1

Question 15

Features of astrocytoma (age range, histology, prognosis)

Answer 15

20-40 year old
Low or normal mitotic activity with no vascular proliferation/necrosis.
Progresses to higher grade over time

Question 16

What is the worst brain tumour?

Answer 16

Glioblastoma multiforme

Question 17

Grade of GBM & prognosis

Answer 17

4 - under 8 months

Question 18

Mutations in GBM

Answer 18

IDH1 wildtype (NO mutation)
TERT / PTEN / EGFR

Question 19

GBM histology

Answer 19

Very cellular, no clear margins
Neoangiogenesis
Necrosis

Question 20

Grades and % of meningiomas

Answer 20

G1-3
80% G1
20% G2 (25-50% recur)
1% G3 (50-90% recur)

Question 21

Markers of meningiomas

Answer 21

TERT or metholome

Question 22

Epidemiology of meningioma

Answer 22

38% of CNS tumours
Rare under 40 years old, increase with age

Question 23

MRI apperance of meningiomas

Answer 23

Well circumscribed, non invasive

Question 24

Grading of Ki67 mitotic activity

Answer 24

G1 = <4
G2 = 4-20
G3 = 20+

Question 25

Describe appearance of CNS mets and location

Answer 25

Often multiple
At grey/white matter junctions or leptomeningeal

Question 26

Which Ca are most likely to met to brain?

Answer 26

Lung, breast, melanoma, renal Ca

Question 27

Who gets medulloblastomas?

Answer 27

RARE
2nd most common brain cancer in KIDS tho

Question 28

Where are medulloblastomas from?

Answer 28

Embryonal cells

Question 29

Histology of medulloblastomas

Answer 29

Poor differentiation
Synaophysin
GFAP
Ki67 markers are HIGH

Question 30

What is the purpose of the methylome profile?

Answer 30

Reflects tumour cell origin in poorly differentiated tumours when compared to reference ranges