Radiotherapy & Chemotherapy for CNS Tumours Flashcards
What type of brain tumour has the highest lethality?
high-grade gliomas
they are one of the commonest causes of cancer deaths in the young
What are the predisposing factors to gliomas?
there are few known aetiological factors
prior radiation exposure can lead to a brain tumour a decade or so later
How do high grade gliomas usually present?
high grade glimoas present almost exclusively as emergency cases with short history and new neurological signs
How do brain tumours affect patients’ lives?
- loss of job, driving license and independence
- strain on relationships - anxiety, personality change, memory loss, need for care
- financial worries
- seizures and the uncertaintly about when they will occur
What are the 4 main categories of brain tumours with examples?
high grade glioma:
- especially glioblastoma
low grade glioma:
- often exists for many years and changes very little
- has very subtle impacts on the patient and their cognitive ability
- can transform into high grade glioma
benign tumours:
- meningiomas
- pituitary adenomas
- schwannomas
paediatric:
- medulloblastoma
- germ cell
- ependyoma
What are the main implications of benign tumours?
there is a fixed volume within the skull
growth of benign tumours can start to compress and interfere with the function of the normal brain
they are usually treated surgically
What is a glioma?
a type of tumour that starts in the glial cells of the brain or spinal cord
How do brain tumours usually present?
pressure symptoms:
- headache (50%)
- nausea and vomiting
- confusion
- reduced conscious level
seizures:
- in 50% of cases
focal symptoms due to location:
- e.g. weakness, dysphasia
- presentation varies a lot between patients as focal symptoms depend on the area of the brain affected by the tumour
When should someone be referred for a head scan by a GP?
if they present with BOTH a headache and another neurological sign/symptom
What are the different treatments available for brain tumours?
- steroids
- anti-epileptics
- surgery
- radiotherapy
- chemotherapy
Why are steroids used to treat brain tumours?
What are the drawbacks of using steroids?
they are used to reduce the swelling in the brain
it improves condition in the short-term, but long-term use can lead to adverse effects
can cause diabetes, high blood pressure, muscle weakness, etc.
the patient should be given the lowest dose of steroids that is appropriate
What is usually the first symptom of brain tumour?
headache
By the time they have presented to hospital, what symptoms does a brain tumour patient often present with?
- headache
- seizures
- unilateral weakness
- dysphasia
- confusion
- personality change
How can raised intracranial pressure affect the brain?
it leads to global neurological deficits
Why is it important to know where the central and lateral sulci are present?
they divide the brain into 4 lobes
presentation relates to whereabouts in the brain the tumour is present
Which area is usually concerned with language?
the dominant hemisphere - which is usually the left
What would indicate a brain lesion rather than a spinal cord lesion?
if symptoms e.g. weakness affected the whole of one side, rather than just part of it
If a patient had a brain lesion either side of the central sulcus of in the left hemisphere, what would you expect?
this affects both motor and sensory functions as it is in the left fronto-parietal region
unilateral (right side) numbness and weakness
What may make you suspect a brain tumour rather than a stroke?
if there is a gradually progressive history
a stroke or vascular disorder would present more suddenly
What would happen if someone had a brain lesion in the left temporo-frontal region?
they would present with expressive aphasia
the patient can understand everything that is being said to them, but no one else can understand what they are trying to say
What types of symptoms would someone present with if they had a brain lesion in the frontal region?
they tend to develop subtle symptoms involving an altered personality
frontal regions are involved in higher order functioning such as social skills, time keeping and planning
the patient becomes very passive, withdrawn and apathetic
What type of brain lesion involves sensory problems?
lesions in the parietal lobe
this leads to loss of sensation and dyspraxia
this is a condition affecting physical coordination
What is radiotherapy?
the use of X-rays to treat tumours
carefully controlled high energy X-ray beams are focused on the tumour
the beams travel through the skin to the tumour so are painless and invisible
What are the benefits to using radiotherapy?
- non-invasive
- no anaesthetic is required
- can be given to patients with multiple comorbidities in which surgery would not be possible
- can treat hidden areas that would not be accessible to surgery
When is radiotherapy indicated to improve survival in high-grade (grade 3 and 4) gliomas?
it is proven to increase survival by 6-12 months dependent on grade of tumour, age and performance status (PS) of each patient
may improve PS in 1/3 of patients
What is the main benefit of using protons over photons (radiotherapy)?
protons will go to a certain depth inside the paitent and then they largely stop
the dose of protons can be aimed and delivered in a concentrated way
there is minimal effects on other structures outside of the target site
What is a supratentorial tumour?
a tumour that is present above the tentorium cerebelli
What is shown here?
a type of neurological deficit resulting in visual problems
What is shown here?
IIIrd ventricular tumour
What is shown in this image?
endonasal resection craniopharyngioma
