Neuro-Oncology

Question 1

What factors determine the presentation of an intracerebral space occupying neoplasm?

Answer 1

Rate of growth of tumour

Anatomical position

Question 2

What are the signs/sx of raised ICP?

Answer 2

Headache
N/V
Papilloedema

Question 3

Which neoplasms most commonly cause signs/sx of raised ICP?

Answer 3

Rapidly growing tumours (malignant glioma, metastatic deposits)

Question 4

What are the sx/signs of an intracerebral space occupying lesion?

Answer 4

Raised ICP
Epileptic seizures
Progressive neurological deterioration

Question 5

What are the sx/signs of progressive neurological deterioration?

Answer 5

Increasing weakness
Sensory loss
CN palsies
Dysphasia (if involving dominant hemisphere, typically L. hemisphere)

Question 6

What urgent investigations are required in pts presenting w/ sx/signs of an intracerebral space occupying lesion?

Answer 6

Early CT w/ contrast

MRI if no mass on CT

Question 7

What is the immediate management of a suspected intracerebral space occupying lesion?

Answer 7

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

Question 8

What is the paraneoplastic syndrome?

Answer 8

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

Question 9

How common is paraneoplastic syndrome?

Answer 9

10% of pts w/ advanced malignant disease

Question 10

What are the more common paraneoplastic syndromes involving the nervous syndromes?

Answer 10

Myasethenia Gravis
Lambert-Eaton-Myasthenic syndrome
Paraneoplastic sensory neuropathy
Paraneoplastic cerebellar degeneration

Question 11

What are the sx/signs of paraneoplastic cerebellar degeneration?

Answer 11

Classic cerebellar signs

• ataxic gait
• dizziness
• dysarthria

Question 12

What malignancies are associated w/ paraneoplastic cerebellar degeneration?

Answer 12

Hodgkin lymphoma
Breast cancer
SCC lung cancer
Ovarian cancer

Question 13

What are the three most common adult 1o brain tumours?

Answer 13

Malignant glioma
Meningioma
Astrocytoma

Question 14

Describe malignant gliomas (glioma multiforme/glioblastoma)

Answer 14

Most common adult 1o
Originates from astrocytes
Rapid growing, presents w/ raised ICP
Poor prognosis (death w/i 6mo dx)

Question 15

Describe meningiomas

Answer 15

Most common overall cerebral neoplasm
Arise from meninges
Generally benign/slow growing
Surgical excision/debulking to manage

Question 16

Describe astrocytomas

Answer 16

Benign/slow growing tumour occurring in young people

Can turn malignant in later life

Question 17

What other cerebral tumours are important to know?

Answer 17

Ependyomas
Pituitary Adenomas
Acoustic Neuroma (schwannoma)

Question 18

Describe ependyomas

Answer 18

Most common in young people/children
Originate from ependymal cells lining ventricles
Usually malignant, do not recur after removal

Question 19

Describe pituitary adenomas

Answer 19

10% of diagnosed intracranial neoplasms

10-15% of population have pituitary ‘incidentalomas’ on CT scanning –> do not require treatment

Question 20

Describe acoustic neuromas (schwannoma)

Answer 20

Most common in NF-2

Arise from Schwann cells of acoustic nn

Question 21

How do acoustic neuromas present?

Answer 21

Progressive, unilateral sensorineural deafness
Tinnitus
Vertigo
Facial nn palsy
Cerebellar sx/bulbar palsy

Question 22

What proportion of brain tumours are 2o mets?

Answer 22

30%

Question 23

What are the common 1o locations of somatic tumours that metastasise to the brain?

Answer 23

Bronchus
Breast
Kidney
Colon
Thyroid
Malignant melanoma

Question 24

What is the management of multiple metastases?

Answer 24

Usually inoperable

Question 25

What is the management of single metastases?

Answer 25

Remove to improve survival/palliation