1. Brain Tumours – what should I know?
Dr Hannah Lord
Consultant Clinical Oncologist

2. Causes of brain tumours

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

4. Diagnosis
So – how do you suspect a brain tumour?

6. 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

7. Investigations
What would you do?

8. Ix?
CT brain
MRI brain/spine – to exclude multiple metastaic deposits; to better characterise tumour
If cerebral lymphoma – other Ix to exclude HIV and systemic disease – (where especially in men?)

9. Primary brain tumour

10. Primary brain tumour

11. Radiology - multiple brain mets

12. Outcomes
Depends on pathology– weeks to non life threatening

13. Types of Brain Tumours Primary (rare) benign or malignant
Secondary (majority) malignant

14. Secondary Brain Tumours
Lung
Breast GI
Any primary potentially

15. How to treat?
Oedema – steroids
Pain – analgaesia
Nausea - antiemetics

16. Investigations CT / MRI Brain If appropriate Solitary / multiple
Surgical candidate?
If appropriate
CT Chest Abdo Pelvis
Tumour markers
Neurosurgical Biopsy

17. How to treat Depends on Primary cancer and its extent / control
Depends on patient fitness and wishes
Can occasionally debulk and give post op XRT

18. Primary brain tumours
Types of primary brain tumours?

19. Primary brain tumours I Benign Pituitary – adenoma, cranio-pharyngioma
Meningioma
Acoustic neuroma
Dermoid tumour

20. Malignant brain tumours
II Malignant:
Glioma
Primary Cerebral Lymphoma
Germinoma
Pineoblastoma
Medulloblastoma

21. Benign brain tumours Treatment? Observation Surgery Radiotherapy BSC
Can behave in a malignant fashion due to location and recurrent nature

22. Malignant: Gliomata Commonest Primary Brain Tumours Grades:
I: Fibrillary astrocytoma
II: Astroctytoma or Oligodendroglioma
III: Anaplastic Astrocytoma / Oligodendroglioma
IV: Glioblastoma multiforme

23. GBM – radiology

24. Treatment of gliomata
Observation Surgery

25. 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)

26. Pathology - GBM High Ki 67 Necrosis Pleomorphism Abnormal vasculature
GFAP +ve

27. Ependymoma Grade I- III Location? Treatment? Surgery +/- radiotherapy
54Gy in 30# over 6 weeks

28. Imaging of ependymoma

29. Primary Cerebral Lymphoma
Primary cerebral lymphoma – HIV related
Steroids
Chemo (methotrexate based)+/- XRT
Cognitive impairment
Poor outcomes

30. Pathology
Blue cells
B Cells
Perivascular cuffing

31. 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

32. Effects on patient and family
Effects of treatment – steroids, anti epileptics, surgery and XRT
Invasion of space by supportive teams
Death
Genetic consequences

33. Multidisciplinary teams
Need GP, neurosurgeon, oncologist, endocrinologist, neurologist, specialist CNS nurse, palliative care team, patholgist, radiologist
Community Macmillan, DNs
Social work, OT, physiotherapy input

34. ??

35. Research