Brain Tumours

Question 1

brain tumours are more primary or secondary in origin

Answer 1

secondary

Question 2

what are common sites for tumours to metastasise to the brain

Answer 2

lung - esp small cell carcinoma 
breast 
thyroid
colon
renal
malignant melanoma

Question 3

in children brain tumours are usually supratentorial or infratentorial

Answer 3

infratentorial

Question 4

what is the general presentation of brain tumours

Answer 4

headache - wakes patient up 
papilloedema 
focal neurology
vomiting
seizures 
ataxia 
personality change

Question 5

what are the 3 symptoms to be aware of in children that is suggestive of a brain tumour

Answer 5

vomiting with headache
ataxia
tip toeing
VAT

Question 6

what imagine is useful for diagnosing brain tumours

Answer 6

CT first line

MRI useful to characterise the tumour

Question 7

what drug is given to manage cerebral oedema with a brain tumour

Answer 7

dexamethasone - can also reduce nausea by reducing oedema

Question 8

what drug is given to manage seizures with a brain tumour

Answer 8

anti epileptics

Question 9

what is the most common type of brain tumour

Answer 9

glioma

Question 10

which two subtypes of tumours are classified as a glioma

Answer 10

astrocytomas

oligodendrocytomas

Question 11

what is the only known risk factor for gliomas

Answer 11

exposure to ionising radiation

Question 12

what are the names of the types of astrocytomas grades I-IV

Answer 12

pilocytic astrocytoma
diffuse astrocytoma
anaplastic astrocytoma
glioblastoma multiforme

Question 13

describe a pilocytic astrocytoma

Answer 13

benign - limited potential to proliferate and no infiltration
surgery is curative
common in children and young adults

Question 14

describe a diffuse astrocytoma

Answer 14

infiltrative but low level of proliferative activity
surgery then chemo and radiotherapy
average survival is 4 years

Question 15

describe an anaplastic astrocytoma

Answer 15

some malignant activity, nuclear atypic, increased mitotic activity and cellular anaplasia
average survival is 2 years

Question 16

describe a glioblastoma

Answer 16

malignant activity, high nuclear atypia, mitotic activity and necrosis

Question 17

what are the 2 ways a glioblastoma can arise

Answer 17

primary - de novo with no preceding tumour, usually older patients or p53 mutation
secondary - progression from low grade astrocytoma, usually in younger patients

Question 18

describe the imaging appearance of GBM

Answer 18

solitary
heterogenous with necrotic centre
ring enhancing
oedema/midline shift

Question 19

how is GBM managed

Answer 19

not curative management, more to improve functional status
maximal debunking surgery to reduce mass effect
radiotherapy
chemotherapy - oral temozolomide

Question 20

where in the brain are oligodendromas commonly seen

Answer 20

commonly frontal lobe with invasion to subarachnoid space

Question 21

subarachnoid invasion of an oligodendroma shows what morphology

Answer 21

toothpaste morphology

Question 22

what is a very common clinical feature of an oligodendroma

Answer 22

seizures

Question 23

what are some histological features that differentiate an oligodendroma from an astrocytoma

Answer 23

oligodendromas also have calcification, cysts and haemorrhage around the tumour

Question 24

how are oligodendromas managed

Answer 24

surgery

chemotherapy - very chemosensitive

Question 25

which chemotherapy agents are used for oligodendromas

Answer 25

PCV - procarbazine, lomustine and vincristine

Question 26

medulloblastomas are almost exclusively seen in which age group

Answer 26

children - second most common brain tumour in children after astrocytoma

Question 27

what causes a medulloblastoma to arise

Answer 27

embryonal tumour - poorly differentiated and occurs in the midline of the cerebellum

Question 28

describe the appearance of medulloblastomas

Answer 28

crumbly, chalky appearance and form drop down metastases down the spinal cord

Question 29

how does a medulloblastoma present

Answer 29

raised ICP symptoms | cerebellar signs

Question 30

medulloblastomas are particularly sensitive to which treatment

Answer 30

radiotherapy - however contraindicated in under 3s due to neurocognitive impairment

Question 31

what is a meningioma

Answer 31

extra-axial tumour of arachnoid cap cells | either benign or malignant, majority are benign

Question 32

how is a meningioma managed

Answer 32

watch and wait if patient asymptomatic surgical resection radiotherapy

Question 33

what is the prognosis of meningioma

Answer 33

good - 90% survival at 5 years

Question 34

what is a vestibular schwannoma

Answer 34

rare benign tumour arising from the internal auditory meatus affects the vestibular portion of CN VIII

Question 35

if a vestibular schwannoma is bilateral and in a young person, what condition should you think of

Answer 35

neurofibromatosis 2

Question 36

what are the clinical features of vestibular schwannoma

Answer 36

unilateral SN hearing loss tinnitus progressive imbalance absent corneal reflex