Brain Cancers

Question 1

How to know if you have a brain tumour:

Answer 1

Symptoms vary from person to person- depend on tumour location, inflammation, spread, size
Inflammation can be up to 70% of brain tumour size NB
3 overall categories: caused by intracranial hypertension, dysfunction of nervous tissue, inflammation
Headaches
Worse when waking up- and during exercise as CSF flows and moves
May occur during sleep
Vomiting, confusion, weakness
Changes in person’s mental function and personality
Alertness
Memory loss
Seizures
Weakness or sensory loss in one part of the body
Eye problems, abnormal sensation of motion, difficulty swallowing

Question 2

Confirmation Of brain tumour

Answer 2

CT scan of the head (good for dense tissues)
MRI of the head (good for softer tissues- indicate extent of inflammation)
EEG (good for initial diagnosis from seizures)
Examination of the CSF for circulating tumour cells
Categorisation occurs after- very complex

Question 3

Risk factors for Brain Tumours

Answer 3

Exposure to ionizing radiations
Exposure to some aromatic substances (petroleum derivatives), reactive dipolar substances (vinyl chloride) and heavy metals (lead, mercury, arsenic)
Some inherited conditions increase the risk of developing brain tumors
But for less than 5% of brain tumours
Neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome (p53 mutations)
Congenital or acquired immunodeficiency
Primary central nervous system lymphomas (EBV, HIV infections)

Question 4

Meningioma

Answer 4

Most common non-malignant growth of the brain
Arise from arachnoidal cells
Arachnoid mater of the brain begins to lose control of division, become undifferentiated
Majority attached to dura mater
2:1 female:male
Seizures (40% of cases)
Raised intracranial pressure (tumour size and oedema)

Question 5

Grading of Meningiomas

Answer 5

Grade I- low risk of recurrence, little chance of aggressive growth
Ie fibroblastic meningioma
Grade II- higher risk of recurrence and aggressive growth
Atypical meningioma
Grade III- high risk of recurrence and aggressive growth present, may have escaped CT and began mixing with the nervous tissue
Rhabdoid meningioma

Question 6

Glioma

Answer 6

Most common malignant brain tumour
Arises from glial cells
50% of all intracranial tumors
30% of CNS tumors but 80% of malignant tumors
More frequent in males
Can occur in various location
Supratentorial – more frequent in adulthood
Infratentorial – more frequent in childhood
Above or below tentorial membrane separating brainstem/ cerebellum from cerebrum
Gliomas metastasise through CSF
Symptoms depend on location of growth!
Brain
Seizures
Loss of function
Nausea, Headaches
Raised intracranial pressure (tumor size and edema)
Spinal cord glioma
Numbness, weakness, pain
Optic nerve
Visual loss

Question 7

Treatment options for Glioblastoma

Answer 7

Observation- wait and see, determine grade
Resection, chemotherapy, radiotherapy
Delivery issues w chemotherapy in the brain
BBB
Intracranial/intra-tumoral pressure (high, difficult to get drugs in there)
Needs to enter liver before the brain → peripheral inactivation of the drug
Trying new ways of delivering the drug, and targeting the tumour specifically