Neuro-oncology

Question 1

Describe the clinical presentation of a neoplastic intercerebral SOL?

Answer 1

Very varied presentation

Rapidly growing tumours or those that block the ventricles are more likely to present with signs of raised ICP*

Many intracerebral SOL present with epilepsy. Any adult with a new onset seizure requires a CT scan to rule out SOL.

May present with a focal neurological deficit depending on where the lesion is located e.g. weakness, sensory loss, CN lesions and dyspahgia.

*Headache associated with nausea and vomiting classically worse in the morning +/- papilloedema

Question 2

Explain the the term paraneoplastic syndrome?

Answer 2

A paraneoplastic syndrome is a clinical syndrome involving nonmetastatic systemic effects accompanying an underlying malignancy.

It is thought to be caused by an immune mediated response to a neoplasm.

Question 3

Describe the 2 most common neurological paraneoplastic syndromes?

Answer 3

Lambert-Eaton myasthenic syndrome:

• Presents with proximal muscle weakness usually in the lower limb with gait abnormalaties.
• May also cause a ptosis.
• Can present similarly to myasthenia gravis.

Limbic encephalitis:

• An autoimmune mediated encephalitis
• Sub acute short term memory deficit
• Other features such as: headache, irritability, hallucinations, seizures

Question 4

List the three most common adult primary brain tumours and there prognosis?

Answer 4

Glioma (Glioma multiforme) highly malignant may only live 6 months after diagnosis

Astrocytoma: very benign slow growing tumours found predominantly in younger people however in later life may become malignant

Ependyoma: arise from the ependymal cells which line the ventricles. Usually malignant but have a good prognosis if removed.

Meningioma: not technically a brain tumour they are usually benign and slow growing tumours. Usually monitored and only removed if getting too large.

Question 5

List the tumours which commonly metastasise to the brain?

Answer 5

Thyroid
Lung (particularly bronchial)
Breast
GI cancers
Renal 
Malignant melanoma

However many have the potential to spread to the CNS e.g lymphoma

Question 6

Which cancer is very unlikely to metastasise to the brain?

Answer 6

Prostate