Neurooncology Flashcards
In who are brain tumours most common?
Men under 45
Woman under 35
What is the prevalence of brain tumours
How many new cases each year
7 per 100,000
5000
1.6% of all cancers
How many types and groups of brain tumours are there?
150 types
7 main groups
Secondary brain tumours occur how?
Metastatic growth from a primary cancer ie lung breast, colorectal, testicular
What are gliomas?
Primary brain tumours of the glial cells
Describe the WHO Brain tumour scale
Malignancy scale 1-5
1 being least histologically malign and 5 being most
What are the known causes of primary brain tumours?
Mostly no cause is found
Ionising radiation
Family history 5%
Immunosuppressive (CNS Lymphoma)
What genetic syndromes are associated with brain tumours?
Neurofibromatosis,
tuberose sclerosis
Von hippel-landau disease
What are the the symptoms of brain tumours
Varied presentation dependant on tumour type, grade and site
Can include: Headache Seizures Focal neurological symptoms Other non focal symptoms
What qualities of headache are associated with seizures
Woken by headache
Worse in morning
Worse lying down
Exacerbated by coughing, sneezing, drowsiness
What percentage of patients experience headache as first symptom and what percent at presentation
24%
46%
What percentage of first seizures are consequently found to be a brain tumour
2-6%
What percent of brain tumours present with seizures?
21%
80% low grade gliomas
How do focal deficits present ?
Progressive over days-weeks Weakness Sensory loss Visual/speech disturbances Ataxia
Name three non focal symptoms
Personality change
Memory disturbances
Confusion
What is papillodema and what is it a sign of?
Optic disc swelling caused by increase intracranial pressure
Can be a sign of cancers such as gliomas
Name four focal neurological deficits common in brain tumours
Hemiparesis
Hemisensory loss
Visual field defect
Dysphasia
What are the red flags?
Headache (with increased intracranial pressure features)
Ie papillodema
New onset focal seizures
Rapidly progressive focal neurology (w/o headache)
Past history of other cancer
If there is a long history of isolated headache is a brain tumour likely or unlikely?
Unlikely
Describe the difference in presentation between low grade and high grade tumours
Low grade- Typically present with seizures (can be incidental finding)
High grade- rapidly progressive neurological deficit, symptoms of raised ICP
Investigations for brain tumours
CT (with contrast)
MRI
Brain biopsy
What would you find on the scan for a high grade tumour?
Irregular mass with vasogenic oedema. Enhancement often seen
What are the histologically markers for tumour ?
MGMT methylation
IDH-1 mutation
Chromosome 1p19q loss (in oligodendroglial tumours)
What treatments are available for high grade gliomas (HGG)
Depends on type, grade and site Steroids-reduce oedema Surgery-biopsy or resection Radiotherapy-mainstay. Radical vs palliative Chemotherapy - temozolamide, PCV
