Primary and secondary brain tumours Flashcards
(49 cards)
Incidence of all brain tumours
~20:100,000
16th most common registered adult cancer
2nd most common paediatric cancer
Incidence of primary tumour
~8:100,000
Presentation of a brain tumour - 3 cardinal presenting symptoms
Symptoms of raised ICP (headache, reduced conscious level, nausea and vomiting)
Progressive neurological deficit
Epilepsy
Causes of raised ICP (intracranial pressure)
Headache
Drowsiness
Vomiting
Features of raised ICP headache
Worst on waking from sleep in morning
Increased by coughing, straining and bending forwards
Sometimes relieved by vomiting
Cardinal physical sign of raised ICP and its cause
Papilloedema Due to obstruction of venous return from the retina Loss of crisp optic nerve head margins Venous engorgement Retinal oedema Haemorrhages
What is papilloedema
optic disc swelling that is caused by increased intracranial pressure
Focal neurological deficits
Motor deficit (this includes ataxia) Sensory deficit Speech deficit Visual deficit Deafness Deteriorating memory Personality change
Features of epilepsy as a result of brain tumour
Sinister when of recent onset
Focal seizures more common with tumours:
Motor, Sensory, Temporal lobe pattern
(olfactory aura or ‘deja vue’)
Types of brain tumours
Primary
Secondary
Are primary or secondary tumours more common
Secondary
Aetiology of secondary tumours
Non small cell LUNG 24%
Small cell LUNG 15%
Breast 17% Melanoma 11% Renal cell 6% GI 6% Unknown primary 5%
Secondary brain tumour treatment options
Surgery
Radiotherapy
Chemotherapy
Best supportive care
When is surgery considered as an option for brain cancer patients
Absent or controlled 1st degree disease i.e. survival >1/4
Age <75
Good performance status
Median survival from surgery
13.4 months
(1 yr survival 56%)
(5yr survival 15%)
Surgical failure rate for brain tumour
52% of radiation group had brain recurrence
28% of surgery and radiation group had recurrence
What cell type are majority of primary brain tumours from
Glial cells
Types of primary brain tumours
Astrocytoma (85-90%)
Oligodendroglioma (~5%)
Others: medulloblastoma, central neurocytoma etc
WHO Grading of Gliomas
Grade I - Paediatric tumour/pilocytic astrocytoma
Grade II - Premalignant tumour (benign)
Grade III - Anaplastic astrocytoma (cancer)
Grade IV - Glioblastoma multiforme (GBM) - Most common phenotypes
True or False:
Given enough time all gliomas will progress inexorably to become GBM (glioblastoma multiforme)
True
Pathophysiology to malignant glioma
2 ways:
1. (More Common) Initial genetic error is of glucose glycolysis:
Mutation of isocitrate dehydrogenase 1 (IDH-1). Results in excessive build up of 2-Hydroxyglutarate. Which triggers genetic instability in glial cells and subsequent inappropriate mitosis.
2. No IDH mutation:
Catastrophic genetic mutation. Very poor prognosis even for ‘low grade’ tumours.
Survival of glioblastoma
At present under 20% survive of patients with GBM survive more than 18 months from diagnosis even with ‘aggressive therapy’
Good prognostic factors of glioblastoma patient
Age under 45-50 years
Aggressive surgical therapy
Good performance post surgery
Tumour that has transformed from a previous low grade tumour (secondary GBM)
MGMT mutant – which means they should respond chemoRx
Poor prognostic factors of glioblastoma patient
> 50 years
Post-surgery: Poor neurological function - drowsy, headache, focal neurology
Non radical surgical treatment
De novo disease: Primary GBM
MGMT ‘wild type’ - no predicted response chemoRx
