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Flashcards in Neuro Deck (588)
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1

How common are brain tumours?

16th most common adult cancer, and 2nd most common children cancer

20/100000

2

Presentation of a brain tumour?

symptoms of raise ICP: headache, reduced conscious level, nausea and vomiting

progressive neurological deficit and epilepsy

3

Features of a raised ICP headache?

worst on waking from sleep, increased by coughing, straining and bending forwards, can be relieved by vomiting

4

What is the cardinal physical sign or a brain tumour?

papilloedema

5

What causes papilloedema?

obstruction of venous return from the retina

caused by loss of crisp optic nerve head margins, venous engorgement, retinal oedema, haemorrhages, raise ICP, intraneuronal ischemic damagee

6

What types of focal neurological deficits are there?

motor, sensory, speech, visual, deafness, deteriorating memory, personality change

7

What type of tumours are focal siezures more common in?

motor, sensory and temporal lobe

8

Are primary or secondary brain tumours more common?

secondary

9

Treatment of secondary brain tumours?

surgery, radiotherapy, chemotherapy, best supportive care

10

When would surgery be considered for a brain tumour?

absent or controlled primary disease, younger than 75, good performance status

11

Where is the main origin for primary brain tumours to occur from?

glial cells

12

What is the main type of primary brain tumour?

astrocytoma (85-90%)
oligondendroglioma (5%)

13

What is WHOs grading for gliomas?

1 - pilocytic astrocytoma (paediatric tumour)
2 - benign premalignant tumour
3 - anaplastic astrocytoma
4 - glioblastoma multiforme (THE MOST COMMON PHENOTYPE)

14

If given enough time, what will all gliomas progress to?

glioblastoma multiforme (GBM) with the exception of pilocytic astrocytoma

15

What is the common pathway to a malignant glioma?

initial genetic error in glucose glycolysis, mutation of isocitrate dehydrogenase 1 (IDH1), resulting in excessive build up of 2-hydroxyglutarate, triggering genetic instability in glial cells and subsequent inappropriate mitosis

16

What is the less common pathway to a malignant glioma?

no IDH mutation, catastrophic genetic mutation, poor prognosis

17

Survival of GBM?

20% survive more than 18 months, even with aggressive therapy

18

Good prognostic factors for a glioblastoma?

under 50, aggressive surgical therapy, good performance post surgery, secondary GBM, MGMT mutatnt (as they means they should respond to chemo)

19

Bad prognostic factors for a glioblastoma?

over 50, poor neurological function post surgery, non radical surgery treatment, primary GBM, MGMT wild type as means they wont respond to chemo

20

Traditional vs updated glioblastoma therapy?

debulking surgery, radiotherapy

respective surgery, adjuvant chemo with temozolomide with RT, 6 cycles of teozolomide chemo

21

How does temozolomide chemo treat brain tumours?

a prodrug, activated by HCl, crosses the blood brain barrier and then methylates guanine in DNA to make replication impossible at the base site

22

Which tumour is resistant to Temozolomide?

MGMT, by reversing guanine methylation

23

When does Temozolomide treatment work best?

any age, if debulk first, if performance status if low, no wild type MGMT

24

What is WHOs performance status for any cancer patient?

1 - capable of light work
2 - self caring >50% of day
3 - limited self care

25

How does avastin treat brain tumours?

it Is an anti angiogenic agent which shuts down the tumours blood supply

26

Side effects of avastin?

hypertension, GI haemorrhage, expensive

27

How does gene therapy treat brain tumours?

inoculation of tumour with replication deficient HSV-1 retrovirus so wild type HSV-1 replicates exponentially and causes encephalitis

modified HSV-1 fails to replicate in normal brain but replicates rapidly in GBM, causing oncolysis and release of progeny virus

tumour cells killed and normal brain cells unaffected

28

How does dexamethasone treat brain tumours?

powerful synthetic steroid, given orally, improving brain performance, reduces tumour inflammation and oedema

29

In who is a benign glioma commonly seen?

in the young, rare over 45

30

What is the first symptoms of a benign glioma?

siezures