Brain Tumours

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Brain Tumours what should I know?

• Dr Hannah Lord
• Consultant Clinical Oncologist

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Causes of brain tumours
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Causes

• DNA damage
• Radiation
• Genetics
• NF- 1 (acoustic neuromas)
• Li Fraumeni syndrome
• Tuberous sclerosis ( astrocytomas)
• multiple endocrine neoplasia type 1(pituitary
  macroadenoma)
• Infection
• HIV

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Diagnosis

• So how do you suspect a brain tumour?

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What makes you suspect a brain tumour in patient?

• Morning headache, nv, confusion
• New onset of seizures
• Motor deficit
• Sensory deficit
• Personality change
• Dyshasia
• Ataxia

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Investigations

• What would you do?

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Ix?

• CT brain
• MRI brain/spine to exclude multiple metastaic
  deposits to better characterise tumour

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• How would you classify brain tumours?

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Types of Brain Tumours

• Primary benign or malignant (rare)
• Secondary malignant (majority)

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Primary brain tumour
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Primary brain tumour
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Radiology - brain mets
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Questions

• Where do brain metastases come from?

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Secondary Brain Tumours

• Lung
• Breast
• GI
• Any primary potentially

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Questions

• How will you initially treat brain secondaries?

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How to treat?

• Oedema steroids
• Pain analgaesia
• Nausea - antiemetics

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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)

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Primary brain tumours

• Types of primary brain tumours?
• BENIGN

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Primary brain tumours

• I Benign
• Pituitary adenoma, cranio-pharyngioma
• Meningioma
• Acoustic neuroma
• Dermoid tumour

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Benign brain tumours

• Treatment?
• Observation
• Surgery
• Radiotherapy
• BSC
• Can behave in a malignant fashion due to location
  and recurrent nature

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Primary brain tumours

• Types of primary brain tumours?
• MALIGNANT

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Malignant brain tumours

• II Malignant
• Glioma
• Primary Cerebral Lymphoma
• Germinoma
• Pineoblastoma
• Medulloblastoma

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Primary Brain Tumours

• GLIOMA

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Malignant Gliomata

• Glioma Commonest Primary Brain Tumours
• WHO Grades
• I Fibrillary astrocytoma
• II Astroctytoma or Oligodendroglioma
• III Anaplastic Astrocytoma /oligodendrglioma
• IV Glioblastoma multiforme

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GBM radiology
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Treatment of gliomata

• Observation low grade Surgery

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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)

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Benefits of Temozolamide
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Survival with TMZ
OS (Years) TMZ XRT XRT
2 27.2 10.9
3 16.0 4.4
4 12.1 3.0
5 9.8 1.9
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Gliadel Wafers

• Gliadel wafers at time of surgery (carmustine
  soaked) in completely resected high grade glioma
  (3 or 4)

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Pathology - GBM
High Ki 67 Necrosis Pleomorphism Abnormal
vasculature GFAP ve
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Primary CNS Tumours

• Ependymoma

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Ependymoma
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Ependymoma

• Grade I- III
• Location?
• Treatment?
• Surgery /- radiotherapy 54Gy in 30 over 6
  weeks

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• Primary CNS Lymphoma

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Primary Cerebral Lymphoma

• Primary cerebral lymphoma HIV related
• Steroids
• Chemo (methotrexate based)/- XRT
• Cognitive impairment
• Poor outcomes

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Primary CNS Lymphoma
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Pathology
Blue cells B Cells Perivascular cuffing
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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

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Effects on patient and family

• Effects of treatment steroids, anti epileptics,
  surgery and XRT
• Invasion of space by supportive teams
• Death
• Genetic consequences

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Multidisciplinary teams

• Need GP, neurosurgeon, oncologist,
  endocrinologist, neurologist, specialist CNS
  nurse, palliative care team, pathologist,
  radiologist
• Community Macmillan, DNs
• Social work, OT, physiotherapy input

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Research