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Causes of brain tumours
Causes:
DNA damage Radiation Genetics
NF- 1 (acoustic neuromas)Li Fraumeni syndromeTuberous sclerosis ( astrocytomas)multiple endocrine neoplasia type 1(pituitary macroadenoma)
InfectionHIV
What makes you suspect a brain tumour in patient?
Morning headache, n+v, confusion New onset of seizures Motor deficit Sensory deficit Personality change Dyshasia Ataxia
Ix?
CT brain
MRI brain/spine – to exclude multiple metastaic deposits; to better characterise tumour
Types of Brain Tumours
Primary: benign or malignant (rare)
Secondary: malignant (majority)
Radiology - brain mets
Secondary Brain Tumours
Lung
Breast
GI
Any primary potentially
How to treat - secondaries
Depends on Primary cancer and its extent / control
Depends on patient fitness and wishes
Can occasionally debulk and give post op XRT, or XRT alone (20Gy in 5#)
Primary brain tumours
Types of primary brain tumours?
BENIGN
Primary brain tumours
I Benign
Pituitary – adenoma, cranio-pharyngioma Meningioma Acoustic neuroma Dermoid tumour
Benign brain tumours
Treatment?
Observation Surgery Radiotherapy BSC
Can behave in a malignant fashion due to location and recurrent nature
Primary brain tumours
Types of primary brain tumours?
MALIGNANT
Malignant brain tumours
II Malignant:
Glioma Primary Cerebral Lymphoma Germinoma Pineoblastoma Medulloblastoma
Malignant: Gliomata
Glioma Commonest Primary Brain Tumours
WHO Grades:
I: Fibrillary astrocytomaII: Astroctytoma or OligodendrogliomaIII: Anaplastic Astrocytoma /oligodendrgliomaIV: Glioblastoma multiforme
GBM – radiology
Treatment of gliomata
Observation – low grade Surgery
Treatment of gliomata
Radiotherapy 60Gy in 30# over 6 weeks +/- Temozolamide chemotherapy(25% alive at 2 years)
Or 30Gy in 6# over 2 weeks (months)
Gliadel wafers
Or BSC ( weeks)
Gliadel Wafers
Gliadel wafers at time of surgery (carmustine soaked) in completely resected high grade glioma (3 or 4)
Pathology - GBM
High Ki 67NecrosisPleomorphismAbnormal vasculatureGFAP +ve
Ependymoma
Grade I- III
Location?
Treatment?
Surgery +/- radiotherapy 54Gy in 30# over 6 weeks
Primary Cerebral Lymphoma
Primary cerebral lymphoma – HIV related Steroids Chemo (methotrexate based)+/- XRT Cognitive impairment Poor outcomes
Pathology
Blue cellsB CellsPerivascular cuffing
Effects on patient and family
Loss of autonomy Can not drive Neurological deficit Confusion and personality change Family lose the person they knew Financial loss Social loss
Effects on patient and family
Effects of treatment – steroids, anti epileptics, surgery and XRT
Invasion of space by supportive teams Death Genetic consequences
Multidisciplinary teams
Need GP, neurosurgeon, oncologist, endocrinologist, neurologist, specialist CNS nurse, palliative care team, pathologist, radiologist
Community Macmillan, DNs Social work, OT, physiotherapy input