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Brain Tumours Flashcards

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1
Q

What is a brain tumour?

A

A growth of cells

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2
Q

Outline the 4 most common ways that brain tumours present (in order of most to least common).

A

Progressive neurological deficit 68%.
Usually motor weakness 45%.
Headache 54%.
Seizures 26%.

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3
Q

What can raised ICP occur due to?

A

Contribution to mass within a ‘rigid closed box’

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4
Q

Give examples of things that cause raised ICP.

A

tumour mass
oedema
blockage of CSF flow ie. hydrocephalus
haemorrhage

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5
Q

What are the symptoms associated with raised ICP?

A

Headaches.
Vomiting.
Mental changes.
Seizures

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6
Q

When should you think about surgery for a brain tumour?

A

If >5mm tumour

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7
Q

When should you think about conservative management for a brain tumour?

A

If <5mm tumour

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8
Q

Headache can occur WITH/WITHOUT raised ICP

A

BOTH

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9
Q

Describe the features of a headache associated with a brain tumour.

A
  • Worse in the morning; wakes person up.
  • Worse with coughing or leaning forward (30%).
  • Might be associated with, and made a bit better by vomiting.
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10
Q

What may a headache associated with a brain tumour be similar to?

A

Tension headache or migraine

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11
Q

What cranial nerve has a torturous long course in the brain and is thus more likely to be affected by brain tumours?

A

CN VI

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12
Q

Why may someone with a brain tumour have a headache?

A

The tumour may compress on the dura, blood vessels or periosteum and cause pain

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13
Q

What is the investigation of choice in brain tumours?

A

MRI

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14
Q

Who should have an urgent suspicious cancer referral?

A
  • Focal neurological deficit
  • Change in behaviour
  • Seizure
  • Headache, vomiting or papilloedema
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15
Q

What are the 2 most common cell types from which neuroepithelial tumours arise?

A

Astrocytes

Oligodendroglial cells

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16
Q

Outline the WHO grading system for Astrocytic tumours.

A

I: Pilocytic, Pleomorphic xanthoastrocytoma, Subependymal giant cell.

II: Low grade astrocytoma.

III: Anaplastic astrocytoma.

IV: Glioblastoma multiforme

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17
Q

Describe 2 key features of Grade 1 Astrocytomas.

A
  • Truly benign

* Slow growing

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18
Q

Who is most commonly affected by Grade 1 Astrocytomas.

A

Children

Young adults

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19
Q

Where do Pilocytic astrocytomas tend to affect?

A

Optic nerve.
Hypothalamic gliomas.
Cerebellum.
Brainstem

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20
Q

What is the treatment of choice for Pilocytic astrocytomas?

A

Surgery

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21
Q

How do Pilocytic astrocytomas appear on imaging?

A

Well circumscribed, uniformly strongly enhanced lesions

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22
Q

How do children with Grade 1 Astrocytomas present?

A

Tend to begin walking on tiptoes.
Go back on developmental milestones.
Begin vomiting

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23
Q

What are the typical cellular features of ‘low grade, grade II astrocytomas’?

A

Hypercellularity.
Pleomorphism.
Vascular proliferation.
Necrosis.

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24
Q

What areas of the brain do grade II astrocytomas usually appear in?

A

Temporal lobe.
Posterior frontal lobe.
Anterior parietal lobe

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25
How do grade II astrocytomas usually present?
SEIZURES
26
What is the treatment of grade II astrocytomas?
Surgery | + chemo +/- radiotherapy
27
What is a grade II astrocytoma also known as?
Glioblastoma
28
What is surgery in grade II astrocytomas used for?
Seizure control. Tx of herniation. Relief of CSF obstruction. Cytoreduction
29
What grades of astrocytic tumours are malignant?
III - IV
30
Anaplastic astrocytomas can arise....
DE NOVO
31
What is the most common primary tumour?
Glioblastoma multiforme
32
What is the spread of glioblastoma multiforme like?
White matter tracking or CSF pathways
33
There is no curative treatment for malignant astrocytomas, but what can be done?
Surgery to improve survival quality
34
What does the surgery in malignant astrocytomas involve?
* cytoreduction. | * reducing mass effect
35
What is radiotherapy used for?
Malignant tumours post-op
36
When is radiotherapy used in low grade astrocytomas?
- Incomplete removal. | - Malignant degeneration (+/- surgery).
37
When is radiotherapy used in the treatment of benign astrocytomas?
Only if recurrence/progression is not amenable to surgery
38
What are the side effects of radiotherapy?
Drops IQ by 10 Skin damage Hair damage/change/loss Tiredness
39
Who is the side effects of radiotherapy not good in?
Children - drops IQ by 10
40
What lobe do oligodendroglial tumours occur in?
FRONTAL
41
What are the peak ages of oligodendroglial tumours?
Adults of 25-45 years. | Smaller peak in children of 6-12 years
42
What symptoms do people with oligodendroglial tumours present with?
SEIZURES
43
Oligodendroglial tumours often have subarachnoid granulations which can be said to look like?
Toothpaste
44
Peripherally, what do oligodendroglial tumours have?
Calcification
45
What are the 3 features that allow oligodendroglial tumours to be easily distinguished from astrocytomas?
* *Calcification – usually peripheral * * Cysts * * Peritumoral haemorrhage
46
What are 'collision' tumours?
Tumours where oligodendroglial cells co-exist with astrocytic cells in a neoplastic collision type of tumour
47
Are oligodendroglial tumours chen-sensitive?
YES
48
What is the gold standard treatment of oligodendroglial tumours?
SURGERY + CHEMOTHERAPY
49
Surgery is not great for 'high grade' oligodendroglial tumours
TRUE
50
What does radiotherapy do for oligodendroglial tumours?
Reduces seizures
51
IF SOMEONE WHO PRESENTS WITH HEADACHE THAT WAKES THEM IN THE MORNING + VOMITING
ALWAYS CHECK FOR A NEW NEUROLOGICAL DEFICIT
52
What do meningiomas arise from?
Arachnoid cap cells
53
Meningiomas are INTRAXIAL
FALSE - extraxial
54
The majority of intracranial neoplasms are ............
ASYMPTOMATIC
55
Who gets meningiomas more?
MEN
56
What other types of cancers are meningiomas associated with?
* Breast * Multiple meningiomas * Meningioma en plaque
57
Describe meningioma en plaque.
A morphological subgroup within the meningiomas, defined by a carpet or sheet-like lesion that infiltrates the dura and sometimes invades the bone.
58
To avoid the recurrence of meningiomas, what should be done?
All involved bone should be removed
59
What are the symptoms associated with meningiomas?
* Headaches * Cranial nerve neuropathies if affecting skull base * Regional anatomical disturbance
60
90% of meningiomas are ......
BENIGN
61
Meningiomas are FAST growing
FLASE - slow
62
When do meningiomas often grow?
These often grow during pregnancy due to elevated oestrogen levels
63
Who (+ where) in particular should you be aware of the possibility of radiation-induced meningiomas?
People who have had childhood leukaemia | typically occur in midline
64
What are the important features to be aware of on CT of someone with a meningioma?
* Homogenous, densely enhancing. * Oedema. * Hyperostosis/Skull ‘blistering.’
65
What are the important features of a meningioma on MRI?
* Dural tail. (+ beaking) | * Patency of dural sinuses
66
What 3 Ix's should always be done in someone with a suspected meningioma?
CT MRI Angiography/embolisation
67
Why is angiography/embolisation done in someone with a meningioma?
Because meningiomas are usually quite vascular, preoperative embolisation can ease complete tumor resection by diminishing operative time and intraoperative blood loss
68
What is used for embolisation in someone with a meningioma?
External carotid artery feeders OR Occlusion of sagittal sinus
69
How are small meningiomas managed?
'Watch and wait'
70
When is surgery done for a meningioma?
If tumour >3-4cm
71
Give 3 examples of nerve sheath tumours.
* Schwannomas (aka neuromas) - acoustic neuroma is most common * Neurofibromas * Malignant peripheral nerve sheath tumours (MPST)
72
What is an acoustic neuroma?
Vestibular schwannoma of 8th cranial nerve
73
What condition is acoustic neuroma associated with?
Neurofibromatosis II
74
List the symptoms associated with vestibular schwannoma.
* Hearing loss * tinnitus * Dysequilibrium
75
What may vestibular schwannoma lead to? Why?
Hydrocephalus – if get really big and press on the 4th ventricle
76
What investigation is needed for someone with acoustic neuroma?
Audiometry + Radiographic
77
If acoustic neuromas are small they are usually left alone. Why?
Due to risk of damage to facial nerve
78
What does medical management of acoustic neuromas usually involve?
1. Periodic neuro exam. 2. Hearing aid. 3. Periodic MRI
79
How are 50% of acoustic neuromas managed surgically?
'Hearing preserving surgery'
80
Give 4 (iatrogenic) problems that may arise after surgery for an acoustic neuroma.
Facial nerve palsy. Corneal reflex. Nystagmus. Abnormal eye movement
81
What is the peak incidence of pineal tumours?
10-12 years old
82
Who is more affected by pineal tumours?
MALES
83
How do pineal tumours appear on CT?
ISO or HYPER dense
84
What may pineal tumours metastasise via?
CSF
85
What is the most common CNS germ cell tumour?
Germinomas
86
How are germinomas treated?
RADIOTHERAPY | they are very radiosensitive
87
Give examples of germinomas.
Teratoma – mature, immature. Yolk sac tumour. Choriocarcinoma. Embryonal carcinoma
88
What are tumour markers highly specific for?
Germ cell tumours
89
Name 3 tumour markers.
``` Alpha Fetoprotein (AFP) Human Choriogonadotrophin (beta-HCG) Placental Alkaline Phosphatase (PLAP) ```
90
What is AFP synthesised by?
Yolk sac endoderm and embryonic intestinal epithelium
91
What tumours is AFP present in?
Yolk sac tumours (+ teratomas)
92
What is HCG synthesised by?
Syncytiotrophoblasts
93
What tumours is HCG present in?
Choriocarcinoma (+ germinoma)
94
What is PLAP synthesised by?
Primordial germ cells + syncytiotrophoblasts
95
What tumours is PLAP found in?
Germinoma (+ choriocarcinoma, yolk sac)
96
What is used to treat hydrocephalus?
VP shunt
97
What is the Stupp protocol and what is it used for?
Surgery + Radiotherapy + Chemo (TMZ) | Used in treatment of malignant astrocytomas
98
What does Stupp protocol do?
Increases mean survival to 14 months

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