Primary Malignant Brain Tumors
Men > Women
More frequent in children
Risk Factors for Brain Tumors
Genetic mutation
Neurofibromatosis
Exposure to high dose ionizing radiation
High Dose Ionizing Radiation Possibilities
Radiation therapy
Atomic bomb survivors
CT scans
Dental xrays
Classification of CNS Neoplasm
Grade 1: benign
Grade 2: malignant
Grade 3: malignant tissue that has cells that are actively growing
Grade 4: malignant tissue has cells that look most abnormal and tend to grow quickly
Tumor Classifications
Neuroglial (Glioma)
Meningioma
Schwannoma
Neuroglial (Glioma) Subtypes
Astrocytoma
Oligodendroglioma
Ependymoma
Schwannoma Subtype
Acoustic neuroma
Astrocytic Tumor Subtypes
Glioblastomas
Astrocytomas
Astrocytic Tumor Grading
Grade 1: benign (almost always diagnosed in childhood)
Grade 2: slow growing and invade surrounding tissue
Grade 3: rare and require aggressive treatment due to tentacle like growth are hard to resect
Grade 4: aggressive fast growing cancer (Glioblastoma)
Glioblastoma
Highly malignant 60-75% of all astrocytomas Difficult to remove Survival 2 years Treatment: surgery, radiation, and chemotherapy
Oligodendroglioma
Can be grade II-III
Frontal, temporal lobe
Slow growing
Main Presenting Symptom of Oligodendroglioma
Seizure
Frontal Lobe Oligodendroglioma
Weakness on one side of the body
Personality changes
Behavior changes
Difficulty with short term memory
Treatment of Oligodendroglioma
Surgery
Radiation
Chemotherapy
Prognosis of Oligodendroglioma
Survival 4-10 years
Ependymal Cells
Cells line the ventricles of the brain and center of the spinal cord
Ependymoma
More common in children
Peak at age 5-6 and 20-30
Intracranial Ependymoma
Most common in kids
Poor prognosis
Symptoms of increased ICP: hydrocephalus, headache, N/V, ataxia, strabismus, irritability, altered mental status
Spinal Cord Ependymoma
Most common in adults
Better prognosis
May cause cord compression symptoms
Most common spinal cord tumor
Meningioma
20-30% of primary brain tumors
Most common primary brain tumor
Meningioma Facts
More common in women
Benign
Usually grow inward putting pressure on brain and spinal cord
Can grow outward and cause thickening of the skull
Treatment of Meningioma
Surgery
Radiation
Meningioma Prognosis
5 year survival rate: 73-94%
Meningioma Symptoms
Irritation: seizures
Compression: HA, focal weakness, dysphagia, apathy, somnolence
Stereotypic: CN deficits, change in mentation, visual changes, anosmia, exopthalmos, tongue atrophy
Vascular: compression of cerebral arteries
Misc: hydrocephalus, panhypopituitarism
Tumors of the Cranial and Paraspinal Nerves
Schwannoma
Neurofibroma
Perineurioma
Malignant Peripheral Nerve Sheath Tumor
Schwannomas
Nerve sheath tumor
Relatively slow growing
Mostly benign
Acoustic neuromas are the most common
Acoustic Neuroma
Arises from 8th cranial nerve
Benign
Slow growing
Can cause serious complications
Acoustic Neuroma Symptoms
Unilateral hearing loss Tinnitus Occasional dizziness Difficulty swallowing Impaired eye movement Taste disturbance Unsteadiness
Treatment of Acoustic Neuroma
Surgical excision
Stereotactic radiation surgery
Followed by observation fro growth
Outcome and Prognosis Neuroma
Tinnitus- up to 60% relieved
Recurrence- less that 5% (observe for 10 years)
Hearing- preserved in 80%
Facial Nerve Dysfunction: variable
Primary CNS Lymphoma
Common in immunodeficiency syndromes
Derived from B lymphocytes
Occurs in the cerebral hemispheres
Treatment of CNS Lymphoma
Steroids to decrease brain edema
Chemotherapy
Radiation
Metastatic Tumors
Most common brain tumor
Most Common Cancers to Metastasize to the Brain
Lung (16-20%) Renal Cell Cancer (7-10%) Malignant Melanoma (7%) Breast (5%) Colon (1-2%)
Treatment of Metastatic Tumors
Radiation
Chemotherapy
Neurologic Presentation of Generalized Tumors
Headaches Seizures N/V Depressed LOC Nerocognitive Dysfunction
Neurologic Presentation of Focal Tumors
Seizures Weakness Sensory loss Aphasia Visual spatial dysfunction
Symptoms of CNS Tumors
Headache Seizure Syncope N/V Numbness, tingling, weakness Balance issues Cognitive dysfunction
Cognitive Dysfunction Symptoms
Personality changes Changes in memory, attention Altered language ability Problems with executive functioning Change in daily patterns of eating and sleeping
Tumor Headaches in CNS Tumors
Dull, constant Bilateral, not throbbing Occipital/frontal lobes Increased coughing or straining Worse with change in body position Worse at night N/V Change in pattern from usual headache
Most common symptoms of gliomas and cerebral metastases
Seizures
Medical Management of Symptoms
Headache/brain edema- steroids
Seizures- anticonvulsants
Imaging in Primary Care for CNS Tumors
MRI with gadolinium
Neurosurgical Workup of CNS tumors
+/- lumbar puncture to examine cells
+/- cerebral angiogram
Biopsy
Treatment of CNS Tumors
Surgical resection
Chemotherapy
Radiation