Brain tumors

Question 1

How common is brain cancer

Answer 1

9th most common

Question 2

what are neuroepithelial split into

Answer 2

glial cells
neurones

Question 3

what are glial cells split into

Answer 3

• astrocytes
• ependymal cells
• oligodendrocytes
• microglial
• neurones

Question 4

acoustic neuroma affects what nerve

Answer 4

8th

Question 5

from what primary cancers metastsise to the brain

Answer 5

Lung
Breast
Colorectal
Testicular
Renal cell
Malignant melanoma

Question 6

how are brain tumors graded

Answer 6

according to how fast they grow and how likely they are togrow back after treatment.

Question 7

What system do we use and not use

Answer 7

NO- TNM TUMOR NODE METASTASIS
YES- WHO

Question 8

What is the most common primary brain tumor

Answer 8

glioma

Question 9

Grade 1 Brain tumour

Answer 9

Slow growing, non-malignant, and associated with long-term survival

Question 10

Grade 2 Brain tumour

Answer 10

Have cytological atypia. These tumours are slow growing but recur as higher-grade tumours.

Question 11

Grade 3 Brain tumour

Answer 11

Have anaplasia and mitotic activity. These tumours are malignant

Question 12

Grade 4 Brain tumour

Answer 12

• Anaplasia, mitotic activity with microvascular proliferation, and/or necrosis.
• These tumours reproduce rapidly and are very aggressive malignant tumours

Question 13

What are neuropeithelial cells??

Answer 13

stem cells that differentiate into neurons and glial cells.

Question 14

What are glial cells

Answer 14

• non-neuronal cells in the central nervous system (brain and spinal cord) and the peripheral nervous system that do not produce electrical impulses.
• They maintain homeostasis, form myelin, and provide support and protection for neurons.

Question 15

What are astrocytes

Answer 15

• supportive role - maintain brain homeostasis and neuronal metabolism.
• They provide neurons with mechanical support, control neuronal cell development, plasticity and synaptogenesis,
• release nutritional and energy like glucose and lactate and play a role in neurotransmission, vasomodulation and repair.
• Astrocytes also maintain and control the concentrations of ions, neurotransmitters and metabolites and regulate water movements.

Question 16

why can low grade gliomas not show any symtoms for up to 5 years

Answer 16

brain plasticity , as tumor grows the brain moves out of the way

Question 17

what is anaplasticity

Answer 17

A term used to describe cancer cells that divide rapidly and have little or no resemblance to normal cells

Question 18

What are oligodendrocytes

Answer 18

produce the myelin sheath insulating neuronal axons

Question 19

average survival rate of low grade gliomas

Answer 19

10 yrs
median age - 35 years

Question 20

Features of High Grade Gliomas - 3 and 4

Answer 20

• Most common type - 85% of all new cases of malignant primary brain tumour
• Either as primary tumour or from pre-existing low grade
• Survival time longer than de novo high grade glioma
• Median age onset 45 for III, 60 for IV
• Survival times III – 3-5 years IV – 12 months

Question 21

What are the Known causes of Brain Tumours?

Answer 21

• Majority no cause found
• Ionising radiation
• 5% family history
• Associated genetic syndromes: neurofibromatosis, tuberose sclerosis, Von Hippel-Lindau disease
• Immunosuppression (CNS lymphoma)
• No evidence to link mobile phone use

Question 22

symptoms of brain tumor

Answer 22

• Headache
• Seizures
• Focal neurological symptoms
• Other non-focal symptoms

Question 23

features of headache

Answer 23

• Woken by headache,
• worse in the morning,
• worse lying down,
• associated with N&V,
• exacerbated by coughing, sneezing, drowsiness

Question 24

focal symptoms

Answer 24

• Weakness
• Sensory loss
• Visual/speech disturbance
• Ataxia

Question 25

non focal symptoms

Answer 25

- Personality change/behaviour - Memory disturbance - Confusion

Question 26

reccurent de ja vu or memories would make you think

Answer 26

tumor in temporal lobe

Question 27

signs of brain tumor

Answer 27

Papilloedema Focal neurological deficit

Question 28

focal neurologial deficit could exhibit as ?

Answer 28

Hemiparesis Hemisensory loss Visual field defect Dysphasia

Question 29

presentation of low grade tumor

Answer 29

typically present with seizures (can be incidental finding).

Question 30

high grade tumors present as

Answer 30

- rapidly progressive neurological deficit. - Symptoms of raised intracranial pressure.

Question 31

red flags for tumor

Answer 31

- Headache with rasied intracranial pressure with focal neurology - check for focal defects

Question 32

for what reasons would you do an urgent referral

Answer 32

- New onset focal seizure - Rapidly progressive focal neurology (without headache) - Past history of other cancer

Question 33

investigations ?

Answer 33

- CT - with contrast - MRI - better for pituitary lesions - opthamologiacal

Question 34

Once you have found a tumor what do you do

Answer 34

- brain biopsy - surgery

Question 35

tx ?

Answer 35

- depends on grade, location - treatment is non- curative except for grade 1

Question 36

prognosis of brain tumor

Answer 36

5 year survival rate is 12 %

Question 37

treatment - ( HIGH GRADE GLIOMA)

Answer 37

- Steroids – reduce oedema - Surgery – biopsy or resection - For tissue diagnosis, relief of raised ICP, prolongation of survival - Radiotherapy – mainstay of treatment. - Radical vs palliative - Chemotherapy – Temozolamide, PCV

Question 38

Treatment for low grade gliomas

Answer 38

- Surgery – early resection - Radiotherapy and early chemotherapy = improves overall survival time from 7.8 years to 13.3 years

Question 39

Frontal lobe tumor may result in

Answer 39

- movement - problem solving - behavior or personality change -

Question 40

monroe kellie doctrine

Answer 40

The Monro-Kellie doctrine or hypothesis states that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant. An increase in one should cause a reciprocal decrease in either one or both of the remaining two