Brain Tumours Flashcards
What is included in the WHO classifications of brain tumours?
- Tumours of Neuroepitheal tissue
- Tumours of meninges
- Tumours of cranial and spinal nerves
- Haematopoietic neoplasms
- Germ cell Tumours
- Cysts and tumour like lesions
- Tumours of the sellar region
- Local extensions from regional tumours
- Metastatic tumours
What are the common primary brain tumours?
Neuroepitheal tissue
-Glioma (Glioblastoma Multiform)
Meninges:
-Meningioma
Pituitary
-Adenoma
What are the common types of secondary brain tumour?
Commonest tumours that spread to the brain are:
- Renal cell carcinoma
- Lung Carcinoma
- Breast carcinoma
- Malignant Melanoma
- GI tract
What may help you distinguish between primary and secondary brain tumours on a scan?
Primary is usually 1 lesion
Secondary is more likely to be multiple
What is the most comon brain tumour seen clinically?
Metastases (secondary tumour)
15-30% patients with cancer will get cerebral metastases
15% cerebral metastasis is presenting symptom as primary tumour will have given no symptoms
9% cerebral met is only detectable site of spread
Increasing incidence
What are gliomas derived from?
What do these cells do?
Astrocytes
-Structural and nutritional support to nerve cells
How are gliomas graded?
What is the most serious grade?
WHO grade I-IV
Grade IV
- Most common
- Most aggressive
- Glioblastoma multiforme (GBM)
- Spread by tracking through white matter and CSF pathway
- Very rarely spread systemically
What are the characteristics of meningiomas?
- Slow growing
- Extra-axial
- Usually benign
- Arise from arachnoid
- Frequently occur along falx, convexity, or sphenoid bone
- Usually cured if completely removed
Describe pituitary tumours
Adenoma most common
Only 1% malignant
Presentation:
- Visual disturbance (compression of optic chiasma)
- Hormone imbalance
What is the clinical presentation of brain tumours?
- Raised ICP (mass effect)
- Focal neurological deficit
- Epileptic fits
- CSF obstruction
What are the symptoms of raised ICP?
- Headache (typically morning headache)
- Nausea/ vomiting
- Visual disturbance (diplopia, blurred vision)
- Cognitive impairment
- Altered consciousness
What are the signs for ICP?
- Papilloedema
- 6th nerve palsy
- Cognitive impairment
- Altered consciousness
- 3rd nerve palsy
How do tumours result in hydrocephalus?
Tumours in or close to csf pathways
Especially posterior fossa tumours
Especially in children
How do you diagnose brain tumours?
- History and examination
- Think of sources of secondary tumours (e.g. CXR)
- CT scan
- MRI scan
- Biopsy
What focal neurological deficits may present in brain tumours?
- Hemiparesis
- Dysphasia
- Cognitive impairment (memory, sense of direction)
- Cranial nerve palsy
- Endocrine disorders
