Neuro-Oncology Flashcards
What factors determine the presentation of an intracerebral space occupying neoplasm?
Rate of growth of tumour
Anatomical position
What are the signs/sx of raised ICP?
Headache
N/V
Papilloedema
Which neoplasms most commonly cause signs/sx of raised ICP?
Rapidly growing tumours (malignant glioma, metastatic deposits)
What are the sx/signs of an intracerebral space occupying lesion?
Raised ICP
Epileptic seizures
Progressive neurological deterioration
What are the sx/signs of progressive neurological deterioration?
Increasing weakness
Sensory loss
CN palsies
Dysphasia (if involving dominant hemisphere, typically L. hemisphere)
What urgent investigations are required in pts presenting w/ sx/signs of an intracerebral space occupying lesion?
Early CT w/ contrast
MRI if no mass on CT
What is the immediate management of a suspected intracerebral space occupying lesion?
Dexamethasone 4-6mg QDS (if any neurological deterioration/drowsiness)
Anticonvulsants (if presenting w/ epilepsy)
Refer to neuro-oncology MDT
-neurosurgical intervention if accessible
-adjuvant radiotherapy
What is the paraneoplastic syndrome?
Sx occuring in pts w/ cancer that cannot be explained by the tumour, mets or hormones normally secreted by the 1o tissue from which the tumour arose
How common is paraneoplastic syndrome?
10% of pts w/ advanced malignant disease
What are the more common paraneoplastic syndromes involving the nervous syndromes?
Myasethenia Gravis
Lambert-Eaton-Myasthenic syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration
What are the sx/signs of paraneoplastic cerebellar degeneration?
Classic cerebellar signs
- ataxic gait
- dizziness
- dysarthria
What malignancies are associated w/ paraneoplastic cerebellar degeneration?
Hodgkin lymphoma
Breast cancer
SCC lung cancer
Ovarian cancer
What are the three most common adult 1o brain tumours?
Malignant glioma
Meningioma
Astrocytoma
Describe malignant gliomas (glioma multiforme/glioblastoma)
Most common adult 1o
Originates from astrocytes
Rapid growing, presents w/ raised ICP
Poor prognosis (death w/i 6mo dx)
Describe meningiomas
Most common overall cerebral neoplasm
Arise from meninges
Generally benign/slow growing
Surgical excision/debulking to manage
Describe astrocytomas
Benign/slow growing tumour occurring in young people
Can turn malignant in later life
What other cerebral tumours are important to know?
Ependyomas
Pituitary Adenomas
Acoustic Neuroma (schwannoma)
Describe ependyomas
Most common in young people/children
Originate from ependymal cells lining ventricles
Usually malignant, do not recur after removal
Describe pituitary adenomas
10% of diagnosed intracranial neoplasms
10-15% of population have pituitary ‘incidentalomas’ on CT scanning –> do not require treatment
Describe acoustic neuromas (schwannoma)
Most common in NF-2
Arise from Schwann cells of acoustic nn
How do acoustic neuromas present?
Progressive, unilateral sensorineural deafness Tinnitus Vertigo Facial nn palsy Cerebellar sx/bulbar palsy
What proportion of brain tumours are 2o mets?
30%
What are the common 1o locations of somatic tumours that metastasise to the brain?
Bronchus Breast Kidney Colon Thyroid Malignant melanoma
What is the management of multiple metastases?
Usually inoperable
