Oncological Presentations - Space Occupying Lesions

Question 1

Presentation

Answer 1

New headache with features of raised ICP

• papillodema
• vomiting
• posture related headache
• headache waking patient from sleep

Unexplained severe headache
Especially in those diagnosed with past cancer/HIV

Neurological symptoms

• seizure
• confusion
• personality/memory change
• blackout
• ataxia

Question 2

Investigations

Answer 2

Routine bloods
-low Na = SIADH

Imaging
-CT head with contrast

Question 3

What would you do to differentiate between primary and secondary brain tumours

Answer 3

If mets = from lung, breast, colon, melanoma, testicular

• reassess for scars, melanoma, testicular masses
• CXR
• CT CAP
• MRI head with gadolinium

Brain tumours do not normally mets

• most likely - astrocytoma
• menigioma

Question 4

Differential diagnoses

Answer 4

Malignancy

• primary - glioma, meningioma, schwannoma, pituitary, PNET
• secondary - brain mets

Trauma
-subdural, extradural hematoma

Infection

• TB granuloma
• abscess

Vascular
-aneurysm, AVM, CVA

Cysts

Question 5

Pathophysiology of SOL

Answer 5

Increased ICP - mass effect, CSF obstruction

• headaches, N+V
• behaviour changes

Cerebral irritation
-seizures

Interruption of pathways (vascular supply interrupted)
-focal neuro deficit

Question 6

Management

Answer 6

Dexamethasone
-not needed if small with no edema, asymptomatic

Monitor BG (brain tumours affect BG control)

• antiemetic, analgesia
• antiepileptics for seizures

Supportive
RT, CT, combination
Surgery