Symposium 3: Tumours of the nervous system Flashcards Preview

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Flashcards in Symposium 3: Tumours of the nervous system Deck (32):
1

Name the members of the glial cell family.

Astrocytes (support and protect)
Oligodendroctyes (myelination)
Ependymal cells and choroid plexus cells (CSF)
Microglia (defense)

2

Which cells of the glial family do not give rise to neoplasia?

Microglia

3

What are the most common tumours of the nervous system?

Glioma and meningioma

4

What percentage of neoplasms do CNS tumours account for?

2%

5

What is the definition of Grade I CNS tumours?

Benign, no recurrence, no/very slow progression.

6

What is the definition of Grade II CNS tumours?

Malignant, low grade, progression (Astrocytoma 6-7y)

7

What is the definition of Grade III CNS tumours?

Malignant, high grade, faster progression (Astrocytoma 2-3y)

8

What is the definition of Grade IV CNS tumours?

Malignant, highly aggressive, (Glioblastoma 6-12m)

9

What histological features are used to grade CNS tumours?

- Cellular density and atypia
- Mitotic activity
- Necrosis
- Vascular proliferation

10

What cells are a schwannoma derived from?

Nerve sheath cells

11

What cells are neurocytomas derived from?

Neurones

12

What are the common microscopical features of astrocytic tumours?

- Fine fibrillary and microcystic background
- Increased cellular density
- Pleomorphism ( variation in size, shape and chromasia)

13

What are the common microscopical features of glioblastoma?

- High cellular density and mitoses
- Necrosis
- Vascular proliferation

14

What is the common presentation of a brain tumour?

- Raised intracranial pressure
- epilepsy
- neurological deficit
- endocrine dysfunction
- incidental

15

What are the symptoms of raised intracranial pressure?

- Headaches (early morning) (accumulation of CO2 overnight increases mass effect)
- vomiting
- blurred vision - swollen optic discs

16

What are the possible causes of raised ICP?

- Tumor mass
- surrounding edema
- obstructive hydrocephalus

17

What symptom are supratentorial tumours associated with?

Seizures

18

What kinds of neurological deficit might you see in brain tumours?

- cognitive
- visual
- cranial nerve
- motor
- sensory

19

What investigations might you do?

- Haematological
- Tumor markers- aFP,Bhcg,PSA
- Hormonal assay
- Visual fields
- Chest X ray

20

How can tumours be medically managed?

- steroids
- anti-convulsants
- hormonal replacement

21

How might tumours be surgically managed?

- Biopsy
- Stereotactic
- Neuro-navigation
- endoscopic
- Free hand
- excision
- total
- partial

22

What are the main indications for oncology in brain tumours?

- High grade glioma (esp GLIOBLASTOMA)
- Low grade glioma
- Benign tumours (eg meningiomas, pituitary adenomas, schwannomas)
- Paediatric (eg medulloblastoma, germ cell, ependymoma)

23

A 40 year old right handed plumber presents to A & E after a fit and has a 2 week history of gradually increasing numbness and weakness of right side.

Where is the lesion?

Left fronto-parietal region (ie both sides of central sulcus)

24

A 30 year old mother can’t make her children understand what she is trying to say. She seems to understand what is said to her. She is right handed.

Where is the lesion?

Left temporo-frontal region

25

A 50 year old company director becomes withdrawn, apathetic and bad-tempered - then develops headaches and vomiting.

Where is the lesion?

Frontal region

26

A 55 year old window dresser can’t dress herself properly, has numbness down one side and develops headaches

Which lobe of the brain is likely to be affected?

Parietal lobe: sensory loss, dyspraxia, inattention

27

What are the acute side effects of radiotherapy?

1. Cerebral oedema causing raised ICP & exacerbation of pre-RT neurological symptoms
2. Hair loss
3. Scalp / ear erythema

28

What are the intermediate side effects of radiotherapy?

Somnolence syndrome (severe tiredness) & exacerbation of existing neurological symptoms

29

What are the late effects of radiotherapy?

Damage to sensitive structures (shield these
from the radiation as much as possible)
eg; lens (cataracts)
pituitary (hypopituitarism)
cerebral hemispheres (memory loss)

30

When is radiotherapy for high grade gliomas not recommended?

If elderly or poor performance status may die of brain tumour within 3/12s, before recovered from the side-effects of RT

31

For which tumours can treatment be curative?

certain rare CNS tumours eg
germ cell tumours
medulloblastomas

32

For what reason is chemotherapy used in brain tumours?

Generally palliative
Can also be used to enhance the effectiveness of radiotherapy