neuro-oncology

Question 1

what is neuro-oncology?

Answer 1

cancer of the NS

Question 2

define cancer

Answer 2

a group of diseases caused when cells divide and grow in an uncontrolled manner

Question 3

what is a tumour?

Answer 3

a mass of cancerous cells

Question 4

how are intracranial tumours graded?

Answer 4

-histopathology
-grade
-site

Question 5

how are CNS classified briefly?

Answer 5

-neuroepithelial
-meninges
-nerve sheath cells
-blood vessels

Question 6

what is? supratenorial vs infratentorial?

Answer 6

supratentorial - in the cerebrum - adult brain tumours
infratentorial - around the cerebellum - more common in children

Question 7

what is a primary brain tumour?

Answer 7

mass of abnormal cells that arises from within the brain parenchyma

Question 8

what is a secondary brain tumour?

Answer 8

-spread of cancer cells from a primary tumour outside the brain

Question 9

what are intrinsic brain tumours?

Answer 9

tumour cells within the brain tissue

Question 10

what are extrinsic brain tumours?

Answer 10

tumour cells located outside the brain tissue eg meninges etc

Question 11

what is “mass effect”?

Answer 11

compression caused by increased ICP from a space occupying lesion

Question 12

what is a space occupying lesion?

Answer 12

describes a mass of unknown history on MRI - called this until we know what it is

Question 13

describe the clinical features of a brain tumour

Answer 13

-insidious, gradual onset
-exact presentation depends on site and tumour grade
-raised ICP - headache, papilloedema
-mass effect with brain shift - vomiting, deteriorating consciousness
-epilepsy in 30%
-neurological deficits depend on site

Question 14

what’s the pathway of “work-up” for brain tumours?

Answer 14

-imaging - CT, MRI,
-surgical interventions - biopsy +/- debunking/ decompression / excision
-histopathology - frozen section and histology
-medical or radio-oncology management depending on pathological classification

Question 15

how are brain tumours managed?

Answer 15

-steroid therapy - reduce swelling etc - dexamethasone
-surgery - craniotomy - patient may be awake
-radiotherapy - destruction of cancer cells with xray
-chemotherapy - temozolomide

Question 16

describe gliomas

Answer 16

-most common
-arise from glial cells - oligodendrocytes etc
-peak incidence 40-60 years
-equal incidence in frontal, temporal, parietal and thalamic regions
-graded 1-4 (4=most invasive)

Question 17

what typically can be q grade 4 for gliomas?

Answer 17

glioblastoma

Question 18

describe a meningioma

Answer 18

-arises from the arachnoid granulations
-tends to compress rather than invade tissue
-generally a low grade
-can also occur in the skull base, orbit and spinal canal
-can cause significant neurological deficit

Question 19

describe schwannoma tumours

Answer 19

-non invasive tumour
-slow growing
-usually occur in middle age 40-50 years
-more frequent in females

Question 20

describe haemangioblastomas

Answer 20

-vascular origin
-generally low grade lesion
-mainly occurs in middle aged people
-most common primary brain tumour of the cerebellum in adults
-70% association with presence of a cyst

Question 21

what kind of surgery can be seen with brain tumours?

Answer 21

-burrhole biopsy
-craniotomy
-craniectomy
-debulking or decompression

Question 22

how does radiotherapy work?

Answer 22

-uses high energy rays to target and destroy cancer cells
-beams conform with the shape of the tumour to minimise the adverse effects on normal tissue

Question 23

what are the adverse effects of radiotherapy?

Answer 23

-oedema
-fatigue
-cognitive impairment
-radiation induced tumours eg meningioma

Question 24

why is temozolomide used as chemotherapy?

Answer 24

as it can cross the blood brain barrier
-given orally

Question 25

how would we assess a brain tumour patient?

Answer 25

Question 26

in terms of physiotherapy management, what are important factors to consider?

Answer 26

-impact of ongoing treatment -steroid dependency -extent of surgical removal -discharge planning

Question 27

what are examples of neurological impairments seen in people with primary brain tumours?

Answer 27

-limb weakness -ataxia / co-ordination difficulties -sensory - perceptual deficit

Question 28

what are the different types of spinal tumours?

Answer 28

intra dural extra dural

Question 29

what is malignant spinal cord compression?

Answer 29

when secondary tumours grow in spine and compress spinal cord -5-10% of people with advanced cancer -particularly if they have a primary tumour in breast, prostate, lung, myeloma, renal etc