Brain Tumours

Question 1

What area of the brain may be affected if patient is demonstrating problems with balance and coordination?

Answer 1

Cerebellum

Question 2

Where might the tumour be if the patient is showing behavioural changes, abnormal emotional responses, and problems with their hearing and vision?

Answer 2

Temporal Lobe

Question 3

What lobe is implicated when the patient is showing problems with their thought, reasoning, behaviour, smell, memory and movement.?

Answer 3

Frontal lobe

Question 4

What lobe is involved if patient demonstrates symptoms involving their hearing, sensation, reasoning, intellect, thought and memory?

Answer 4

Parietal Lobe

Question 5

What area of the brain could be affected if patient is showing abnormal speech, motor and sensory functions along with vision problems?

Answer 5

Left occipital lobe

Question 6

What area of the brain could be affected if patient is demonstrating abstract concept problems and vision problems?

Answer 6

Right occipital lobe

Question 7

What cells are found in astrocytic tumours?

Answer 7

Glial cells

Oligodendrocytes

Question 8

How are astrocytic tumours graded?

Answer 8

Using the WHO grading

Question 9

What is a grade 1 astrocytoma?

Answer 9

Benign slow growing astrocytoma with 97% 5 year survival rate?

Question 10

What category of patients are grade 1 astrocytoma’s commonest in?

Answer 10

Children and young adults

Question 11

What is the treatment for a grade 1 astrocytoma?

Answer 11

Surgery = curative

Question 12

Do grade 1 astrocytoma’s have malignant potential?

Answer 12

Yes
Slowly may progress into malignancy if left untreated
Progression accompanied by increased neurological symptoms

Question 13

What are some negative prognostic factors in grade 1 astrocytoma’s?

Answer 13

>50y/o
Focal deficits
Altered consciousness
Sudden onset/short duration of symptoms
Increased ICP

Question 14

What is the main presenting symptom in low grade astrocytoma?

Answer 14

Seizures

Question 15

What are the treatments for grade 2 astrocytoma?

Answer 15

Surgery +/-
Chemo and radiotherapy
Depends on morphology

Question 16

What are some negative prognostic factors in grade 2 astrocytoma’s?

Answer 16

>45 y/o
>6cm diameter
incomplete resection during surgery
Tumour crosses midline 
Low performance score

Question 17

What re grade 3 astrocytoma’s referred to as?

Answer 17

Anaplastic Astrocytoma’s

Question 18

What is the median survival rate for anaplastic astrocytoma’s?

Answer 18

2 years

Question 19

Surgery is curative in anaplastic astrocytoma - True/False

Answer 19

False

Can provide symptomatic relief

Question 20

What is the most common primary brain tumour?

Answer 20

glioblastoma multiforme

Question 21

What is the median survival rate for a glioblastoma multiforme?

Answer 21

<1 year

Question 22

In malignant astrocytoma’s, what type of tumour has a better prognosis?

Answer 22

MGMT methylated tumour

Question 23

Where are oligodendroglia tumours mainly found?

Answer 23

Frontal lobe

Question 24

What age group is most commonly affected by oligodendroglial tumours?

Answer 24

25-45 y/o

Question 25

What is the main presentation of oligodendroglia tumours?

Answer 25

Seizures

Question 26

What is the appearance of an oligodendroglial tumour?

Answer 26

solid Grey-pink in colour Toothpaste consistency Look for calcification and cysts

Question 27

What % of glial tumours are oligodendroglial tumours?

Answer 27

20%

Question 28

How do we treat oligodendroglial tumours?

Answer 28

Chemotherapy - procarbazine, vincristine Radiotherapy - decreases seizures Surgery (only in lower grade)

Question 29

What is the median survival for (low grade) oligodendroglial tumours ?

Answer 29

10 years

Question 30

What are warning/red flag signs in children with potential brain tumours?

Answer 30

Tiptoeing Ataxia Vomiting with headache

Question 31

What is the most common type of extra-axial tumour?

Answer 31

Meningioma

Question 32

What do patients normally present with?

Answer 32

Most are asymptomatic Headaches - at skull base Regional anatomical disturbances

Question 33

Meningiomas are more common in Males/Females?

Answer 33

Females

Question 34

Meningioma's are associated with what other type of cancer?

Answer 34

Breast cancer

Question 35

What chromosome s considered to be associated with meningiomas/breast cancer?

Answer 35

22q

Question 36

Meningioma's are benign. True/false

Answer 36

True | In 90% of cases they are benign and slow growing

Question 37

List some types of aggressive meningiomas:

Answer 37

Clear cell Choroid Rhabdoid Papillary

Question 38

What can occur in children who have previously suffered from leukaemia?

Answer 38

Radiation-induced meningiomas | Commonly found in the midline

Question 39

What treatment options are there for meningiomas?

Answer 39

Pre-op embolization Surgery Radiotherapy

Question 40

What is the median survival of meningiomas?

Answer 40

90% survival at 5 years

Question 41

What investigations are done for meningioma?

Answer 41

CT MRI Angiography - if planning embolization

Question 42

List a few examples of nerve sheath tumours:

Answer 42

Neurofibromas Schwannomas Malignant peripheral nerve sheath tumour (MPST)

Question 43

What condition is an acoustic neuroma associated with?

Answer 43

Neurofibromatosis II

Question 44

What are the symptoms of an acoustic neuroma?

Answer 44

Hearing loss tinnitus Disequilibrium

Question 45

What is an acoustic neuroma?

Answer 45

A schwannoma of the 8th cranial nerve

Question 46

Are acoustic neuroma's benign?

Answer 46

Yes | Malignant transformation is extremely rare

Question 47

How are acoustic neuromas treated?

Answer 47

25% managed medically 50% surgically Radiation, gamma knife etc

Question 48

What are some post op complications of acoustic neuroma surgery?

Answer 48

Facial palsy Corneal reflex Nystagmus Abnormal eye movement

Question 49

What is a complication of gamma knife treatment in acoustic neuroma?

Answer 49

Gradual decline in hearing over the years | Vestibular function decreases in first months then stabilises

Question 50

What is the common group affected by germ cell tumours?

Answer 50

<20 years old Peak age range 10-12 Males more than females

Question 51

What is the most common type of CNS germ cell tumour?

Answer 51

germinomas

Question 52

What is the survival rate of germinomas?

Answer 52

5 years 65-95% survival

Question 53

What therapy are germinoma's particularly sensitive to?

Answer 53

Radiotherapy

Question 54

Where do roughly 11% of germinoma's metastasize to?

Answer 54

Spine

Question 55

List some non-germinomatous germ cell tumours:

Answer 55

Teratoma Yolk sac tumour Choriocarcinoma Embryonal carcinoma

Question 56

What tumour markers must you test for in a child with a midline brain tumour?

Answer 56

AFP HCG LDH These detect different germ cell tumours

Question 57

What can be used to treat hydrocephalus?

Answer 57

A ventriculoperitoneal shunt

Question 58

How do you treat non-germinomatous germ cell tumours?

Answer 58

If benign operate Radiotherapy 1st line (if >3y/o) Chemotherapy 2nd line

Question 59

What is the survival rate for non-germinomatous germ cell tumours?

Answer 59

17-38% 5 year survival

Question 60

List the common presenting complaint in a person with a pituitary tumour?

Answer 60

Bitemporal hemianopia Headache Endocrine abnormalities e.g. galactorrhoea

Question 61

What condition would you suspect in a patient with pallor, yellowing skin, no axillary hair, puffy face and fine wrinkles but expressionless?

Answer 61

Panhypopituitarism

Question 62

What tests can be done to diagnose panhypopituitarism?

Answer 62

GH is the first hormone to decrease Then LH and FSH TSH, prolactin and ACTH will be the last hormones to decrease so test in that order