🩺 MedAtlax

Brain Tumor

6 min read

Brain Tumor

Dr.Safdar Malik MD FCPS

img-0.jpegimg-1.jpegimg-2.jpeg

Background

  • The incidence of CNS tumors ≈ 1% of all cancers.
  • Third leading cause of cancer deaths in people 15 to 34 years of age.
  • Second leading cause of cancer deaths in children.

Risk Factors

  • Radiation therapy.
    • can cause
    • and can change grading of tumors
    • neurofibromatosis type 1 and 2
  • Genetics; e.g: NF, Tuberous sclerosis, Von Hippel-Lindau synd., Li-Fraumeni syndrome, and Turcot syndrome.
  • Lymphomas that begin in the brain.
  • Male gender (except meningioma, more in females).

Key

  • Intra Axial the tumor arise from Center eg: Brain Cells tumor < Astrosite - astrocytoma glial cells
  • Extra Axial arise from meninges
    • Tumors In Adult
    • Tumors In Children

Origin

  • Glial Tissue from brain cells (Glioma, Astrocytoma)
  • MENENGIES meningioma not very common
  • Ependymal Layer Cells which cover Ventricles
  • Choroid plexus Production of CSF it’s in all brain except (Lateral Ventricle) ⇒ Papilloma
  • Bone
  • PNET
  • Glands Brain glands < pituitary adenoma
  • Others

Location

  • In Pediatric most of tumors is in posterior fossa

  • In adult more in supratentorial

  • Supra Tentorial

  • Infra Tentorial

  • Intra Axial

  • Extra Axial

  • Sellar & Supra Sellar

  • Pineal region

  • Intra Ventricular

  • Cp angle

The brain metastasis locally specically meniggemia can involve skull bone not to other organs

WHO Classification & Grading of CNS Tumours

Brain has no lymph nodes so no mel’s in Brain → we don’t use TAM staging system

IIIIIIIVIs there’s only one metastasis called DGP met, IIIIIIIV
Astrocytic tumours
Subependymal giant cell astrocytomabenign↓highly gradedCentral neurocytoma•
Pilocytic astrocytomawe can remove it•completely and no needDr. BalshawayExtraventricular neurocytoma•
Pilomyxoid astrocytoma•Cerebellar liponeurocytoma•
Diffuse astrocytoma•Paraganglioma of the spinal cord•
Pleomorphic xanthoastrocytoma•Papillary glioneuronal tumour•
Anaplastic astrocytoma•Rosette-forming glioneuronal tumour of the fourth ventricle•
Glioblastoma always in Adult•Pineal tumours
Giant cell glioblastoma•Pineocytoma•
Gliosarcoma•Pineal parenchymal tumour of intermediate differentiation••
Oligodendroglial tumoursPineoblastoma in Pediatric•
Oligodendroglioma•Papillary tumour of the pineal region••
Anaplastic oligodendroglioma•Embryonal tumours
Oligoastrocytic tumoursMedulloblastoma•
Oligoastrocytoma•CNS primitive neuroectodermal tumour (PNET)•
Anaplastic oligoastrocytoma•Atypical teratoid / rhabdoid tumour•
Ependymal tumoursTumours of the cranial and paraspinal nerves
Subependymoma•Schwannoma•
Myxopapillary ependymoma•Neurofibroma•
Ependymoma•Perineurioma•••
Anaplastic ependymoma•Malignant peripheral nerve sheath tumour (MPNST)••
Choroid plexus tumoursMeningeal tumours
Choroid plexus papilloma•Meningioma•
Atypical choroid plexus papilloma•Atypical meningioma•
Choroid plexus carcinoma•Anaplastic / malignant meningioma•
Other neuroepithelial tumoursHaemangiopericytoma•
Angiocentric glioma•Anaplastic haemangiopericytoma•
Chordoid glioma of the third ventricle•Haemangioblastoma•
Neuronal and mixed neuronal-glial tumoursTumours of the sellar region
Gangliocytoma•Craniopharyngioma•
Ganglioglioma•Granular cell tumour of the neurohypophysis•
Anaplastic ganglioglioma•Pituicytoma•
Desmoplastic infantile astrocytoma and ganglioglioma•Spindle cell oncocytoma of the adenohypophysis•
Hyperobscoplastic neuroepithelial tumour•7

CBTRUS Statistical Report

img-3.jpeg

Gliomas account for 29% of all tumors and 80% of malignant tumors

Common Primary Neoplasms

Common 1° neoplasms:

  • Gliomas #1 (50%)
  • Meningiomas #2 (25%)

Among children:

80-90% IN POSTERIOR FOSSA

  • Astrocytomas benign
  • Medulloblastoma
  • Ependymoma

Signs & Symptoms

Symptoms & Signs Due to Raised ICP

  • Recurring, persistent, deep, dull headaches.
  • Vomiting.
  • Dizziness.
  • Seizures.
  • Papilledema.
  • Bradycardia.
  • Hypertension.

Symptoms Due to Origin of Tumor

  • SYMPTOMS DUE TO ORIGION OF TUMOR

  • Seizures

    • epilipsy for first time do CT scan

  • Weakness or paralysis, part of the body.

  • Changes in sensory perceptions, such as vision, hearing, touch, taste and smell.

  • Changes in personality and/or thought processes.

  • Cerebellar .

  • Pituitary hormonal imbalance

Functions of the Cerebral Lobes

Different lobes of the cerebrum carry out specific tasks.

  • The frontal lobe is generally where “higher functions” of thought, memory, judgment and movement originate.
  • The parietal lobe processes sensory information and is involved in orientation and recognition.
  • The occipital lobe processes visual information.
  • The temporal lobe is involved in hearing, language, expression and memory.

Glioma

Characteristics

  • Poorly defined
  • Highly agressive in adult
  • Occurs in the white matter of cerebral hémisphères so can occure any site of brain.
  • Spread extremely rapidly

Average Age of Onset

  • Fifth decade

General Name for Several Tumors that Arise from Glial Cells

  • Astrocytes (Glioblastoma multiforme is the most common)
  • Ependymal
  • Oligodendrocytes

Symptoms Between the Hemispheres

  • Between the hemispheres:
    • ✓ Seizures, lower extremity weakness, headache, personality changes, dementia, increasing apathy, flattening of affect, unsteadiness, tremor

img-4.jpeg

Intra-Axial Imaging

img-5.jpegimg-6.jpeg

intra-axial

Meningioma (Extra-Axial)

Characteristics

Tumors that arise from meninges: arachnoid

  • grow on the surface of the brain (or spinal cord), and therefore push the brain away
  • Most are considered “benign”
  • slow-growing
  • low potential to spread

meningioma (Extra - acid)

img-7.jpeg

Sphenoid Wing

Sphenoid Wing :

  • Eye-bulging
  • decreased vision
  • paralysis of eye movement
  • seizures
  • memory difficulty
  • personality change
  • headache

img-8.jpeg

Symptoms According to Location: Surface of the Brain

Symptoms according to location:

  • Seizures
  • headache
  • extremity weakness
  • difficulty speaking
  • visual field deficit

img-9.jpeg

Olfactory Groove and Sella

Olfactory Groove and sella :

  • Anosmia
  • subtle personality changes
  • mild difficulty with memory
  • euphoria
  • diminished concentration
  • urinary incontinence
  • visual impairment

img-10.jpeg

CP Angle (Cerebellopontine Angle)

Tumour Types — All Benign

  • Schawanoma 8th cr nerve, 5th cr nerve and sometimes 7th vestibuloculture
  • Meningioma
  • Arachnoid Cyst
  • Haemangioblastoma

Imaging

img-11.jpegimg-12.jpeg

Cerebellopontine Angle: Symptoms

Cerebellopontine angle:

  • Loss of hearing, = 8th
  • Facial muscle weakness, = 7th, 8th
  • dizziness, unsteadiness, incoordination, hydrocephalus, voice and swallowing difficulties.

img-13.jpeg

Pituitary Tumors

  • → when it increase in size it press on optic chiasma so pit can’t see temporal side

  • → has 2 types: Hypersecretion of hormone, remove tumor by Nasal-endoscopic resection

  • Hypersecretion of hormone: symptom depend on which hormone

  • Pituitary Adenomas

  • Pituitary Carcinomas

  • Sarcomas

  • Meningioma

  • Chardomas

  • Haemangiblastoma

  • Cyst

  • Rathkes Cleft cyst, Arachnoid cyst & Mucoceles. Dermoid & Epidermoid

  • Craniopharangioma.

  • Astrocytoma.

img-14.jpeg

Imaging

img-15.jpeg

Post Fossa Sol

  • DUE TO ↑ ICP
  • HYDROCEPHALOUS because of obstruction
  • ATAXIA/IMBALANCE
  • CEREBELLER SIGNS

img-16.jpeg

PFT

img-17.jpegimg-18.jpeg

Diagnosis & Treatment Planning

Confirm the Diagnosis by Histopathology

First you have to confirm the diagnosis by Histopathology

img-19.jpeg

Factors Influencing the Treatment Plan

  • Location of tumor.
  • Radiological appearance of tumor.
  • Size of tumour
  • The risks and potential benefits of available treatment options
  • General health & comorbidities.
  • Age
  • The type of healthcare services available / your ability to travel

Options

The most common treatment are:

  • Surgery
  • Drug therapy (chemotherapy, immunotherapy, gene therapy) steroid
  • Radiotherapy
  • Combined chemo/radiotherapy
  • Best supportive care
  • Watch and wait

Radical vs Palliative Intent

  • Radical: In some cancers the intent is to cure. For brain tumours the aim is to stabilize the disease with best standard treatment which currently is a combination of radiotherapy and oral chemotherapy.
  • Palliative: The intent here is to relieve the symptoms when a cure is not possible. Sometimes it is better to look after the symptoms because to deal with the cause may be too damaging.

Scenario

img-21.jpeg

Broca’s area located around pars opercularis (44) and pars triangularis (45)

img-22.jpeg

affect the sperm area

Gliomas

img-23.jpegimg-24.jpeg

img-25.jpegimg-26.jpeg

img-27.jpeg

Differential Diagnosis: Meningioma vs Metastasis vs Glioma

Not the same!

  • Meningioma
  • Metastasis
  • Glioma

img-28.jpegimg-29.jpegimg-30.jpeg

Graph View

Backlinks