Brain tumour

Question 1

Astrocytic tumour classifications

Answer 1

I: pilocytic astrocytoma
II: astrocytoma
III anaplastic astrocytoma
IV: glioblastoma

Question 2

Oligodendricytic tumour classifications

Answer 2

II: oligodendroglioma

anaplastic oligodendroglioma

Question 3

Classes of brain tumours

Answer 3

I: in-situ/localized
II: diffuse
III: undefied
IV: malignant

Question 4

Neuron tumour classifications

Answer 4

I: gangliocytoma
II: neurocytoma

Question 5

Ependymal tumour classifications

Answer 5

I: subependymoma
II; ependymoma
III: anaplastic ependymoma

Question 6

Meningeal tumour classifications

Answer 6

I: meningioma
II: atypical meningioma
III: anaplastic meningioma

Question 7

Neurononal stem cell tumour classification

Answer 7

IV: neuroblastoma (PNET) - named by location
Medulloblastoma
Neuroblastoma
Retinoblastoma
Pineoblastoma

Question 8

Mixed brain tumour classification

Answer 8

I: ganglioglioma
II: mixed oligoastrocytoma
III: anaplastic oligoastrocytoma

Question 9

PSNS tumour classifications

Answer 9

I:Schwannoma/neurofibroma
IV: malignant peripheral nerve sheath tumour

Question 10

General principles of brain tumours

Answer 10

1/2 are “benign” but mass effect
cure rate for malignant brain tumours much lower than other cancers
lifetime risk: 1/200
leading cause of cancer deaths in children/teenagers
2nd leading cause of cancer deaths in males 20s-40s
40% primary CNS tumours: gliomas
80% of malignant CNS tumours: gliomas

Question 11

CNS tumour etiology

Answer 11

majority are unknown
Irradiation --> meningoma, glioma, nerve sheath tumours
Genetic
Immunosuppression: CNS lymphoma
Experimental: SV40
Occupation: some risk
Trauma, diet- no convincing data

Question 12

CNS tumour risk factors

Answer 12

Sex: gliomas Men. women
Meningiomas: women > men
Association with breast cancer and meningioma
Cell phone: of concern

Question 13

Clinical features of CNS tumours

Answer 13

epilepsy
headache
raised ICP
focal neurologic deficit
short history: more aggressive

Question 14

Intracranial CNS tumour distribution

Answer 14

adults: 70% supratentorial, 30% infra
children: 30% supra, 70% infra

Question 15

CNS tumours common among adults

Answer 15

glioblastoma
metastasis
malignant astrocytoma
meningioma
pilocytic
Schwannoma

Question 16

CNS tumours common among children

Answer 16

medulloblastoma
astrocytoma
ependymoma
craniopharyngioma
glioblastoma

Question 17

Glioblastoma 5 year survival

Answer 17

3-4%

Question 18

Anaplastic astrocytoma 5 year survival

Answer 18

30%

Question 19

Oligodendroglioma 5 year survival

Answer 19

60%

Question 20

Ependymoma 5 year survival

Answer 20

60%

Question 21

Medulloblastoma 5 year survival

Answer 21

60%

Question 22

Pilocytic astrocytoma 5 year survival

Answer 22

> 80%

Question 23

Meningioma 5 year survival

Answer 23

70-95%

Question 24

Pilocytic astrocytoma features

Answer 24

predominantly in childhood
usually cerebellum, optic tract, hypothalamus
others: more guarded prognosis
often cystic (esp cerebellum)
potentially curable by complete excision

Question 25

Pilocytic astrocytoma genetics

Answer 25

most common: gains on 7q34 Often associated with duplications of BRAF, HIPK2 genes - not associated with clinical outcome for cerebellar tumours - predict better clinical outcome for low grade gliomas in pediatric patients - activation of MAP kinase signalling pathway

Question 26

DIffuse gliomas

Answer 26

40% of all primary CNS tumours 78% of malignant CNS tumours >80% of high grade gliomas

Question 27

Tumour suppressor genes involved in CNS tumours

Answer 27

p53 Rb: retinoblastoma p16 p19

Question 28

Oncogenes involved in CNS tumours

Answer 28

Epidermal growth factor receptor: GBM | pltaelet-derived growth receptor alpha: low grade astrocytoma

Question 29

CNS tumour metastasis

Answer 29

``` Lung (50%) Breast (15%) Skin (melanoma - 10%) GI GU 80-90% are in the brain, 10-20% spinal ```

Question 30

CNS effects of cancer treatment

Answer 30

``` Radiotherapy: encephalopathy delayed myelopathy hypothalamic/pituitary disturbance oncogenesis ``` Chemo: encephalopathy/myelopathy cerebellar