Brain Tumours

Question 1

WHO classifications of CNS tumours

Answer 1

Tumours of neuroepithelial tissue 
Tumours of meninges 
Tumours of cranial and spinal nerves 
Haematopoietic neoplasma 
Germ cell tumours 
Cysts and tumour-like lesions 
Tumours of the sellar region 
Local extensions from regional tumours 
Metastatic tumours

Question 2

Common primary types of brain tumours

Answer 2

Neuroepithelial tissues - glioma
Meninges - meningioma
Pituitary - adenoma

Question 3

Commons secondary types of brain tumours (spread from)

Answer 3

Renal cell carcinoma 
Lung carcinoma 
Breast carcinoma 
Malignant melanoma 
GI tract carcinoma

Question 4

Pathological features of gliomas

Answer 4

Derived from astrocytes

WHO grade I - IV

Question 5

Pathological features of grade IV gliomas

Answer 5

Most common and most aggressive
Glioblastoma multiforme (GBM)
Spread by tracking through white matter and CSF pathway
Rarely spread systemically

Question 6

Features of meningiomas

Answer 6

Slow growing 
Extra-axial 
Usually benign 
Arise from arachnoid 
Frequently occur along the falx, convexity or sphenoid bone 
Usually cured if completely removed

Question 7

Features of pituitary tumours

Answer 7

Adenoma most common
Only 1% will be malignant
Presents with visual disturbance due to compression of optic chiasm, and hormone imbalance

Question 8

What percentage of cancer patients will develop cerebral metastases?

Answer 8

15-30%

Question 9

In what percentage of cancer patients is cerebral metastases the cause of the presenting symptom?

Answer 9

15%

Question 10

Clinical presentation of brain tumours

Answer 10

Raised ICP
Focal neurological deficit
Epileptic fits
CSF obstruction

Question 11

Raised ICP symptoms

Answer 11

Headache (typically in morning)
Nausea/vomiting
Visual disturbance 
Somnolence 
Cognitive impairment 
Altered consciousness

Question 12

Raised ICP signs

Answer 12

Papilloedema 
Sixth nerve palsy 
Cognitive impairment 
Altered consciousness 
Third nerve palsy

Question 13

In what tumours does hydrocephalus occur?

Answer 13

Tumours in or close to the CSF pathway, especially in posterior fossa tumours and in children

Question 14

How is hydrocephalus diagnosed?

Answer 14

History and examination 
CT 
MRI 
Biopsy 
Consider sources of secondary tumour

Question 15

Lesions in what part of the brain might result in epilepsy?

Answer 15

Only in lesions above the tentorium

Question 16

Investigations for brain tumours

Answer 16

CT
MRI
PET
Angiography

Question 17

Investigations if suspecting brain metastases

Answer 17

CT chest, abdomen and pelvis
Mammography
Biopsy skin lesion/lymph nodes

Question 18

Management goals of brain tumours

Answer 18

Accurate tissue diagnosis
Improve quality of life - decrease mass effect and improve neurological deficit
Aid effect of adjuvant therapy if required
Prolong life expectancy

Question 19

Possible managements of brain tumours

Answer 19

Corticosteroids e.g. dexamethasone 
Treat epilepsy - anticonvulsants 
Analgesics/antiemetics 
Counselling 
Surgery 
Radiotherapy 
Chemotherapy 
Endocrine replacement

Question 20

Management options for Glioblastoma multiforme

Answer 20

Complete surgical excision if possible - biopsy or debunk only
Medical - steroids, anticonvulsants
Radiotherapy
Chemotherapy - temazolamide

Question 21

Management options for brain metastases

Answer 21

Confirm diagnosis
Medical - steroids, anticonvulsants
Radiotherapy - whole brain, stereotactic
Surgery

Question 22

Prognosis of meningioma

Answer 22

Commonly cured by surgery, may require anticonvulsants

Question 23

Prognosis of astrocytomas low grade

Answer 23

Long life expectancy

Question 24

Prognosis of high grade astrocytomas/GBM

Answer 24

Average 1 year survival

Question 25

Prognosis of brain metastases

Answer 25

Frequently a good medium-term remission