Brain tumors

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

5. 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

9.  How would you classify brain
tumours?

10. Types of Brain Tumours
 Primary: benign or malignant (rare)
 Secondary: malignant (majority)

11. Primary brain tumour

12. Primary brain tumour

13. Radiology - brain mets

14. Questions:
 Where do brain metastases come
from?

15. Secondary Brain Tumours
 Lung
 Breast
 GI
 Any primary potentially

16. Questions:
 How will you initially treat brain
secondaries?

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

18. 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#)

19. Primary brain tumours
 Types of primary brain tumours?
 BENIGN

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

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

22. Primary brain tumours
 Types of primary brain tumours?
 MALIGNANT

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

24. Primary Brain Tumours
 GLIOMA

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

26. GBM – radiology

27. Treatment of gliomata
 Observation – low grade Surgery

28. 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)

29. Benefits of Temozolamide

30. 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%

31. Gliadel Wafers
 Gliadel wafers at time of surgery (carmustine
soaked) in completely resected high grade
glioma (3 or 4)

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

33. Primary CNS Tumours
 Ependymoma

34. Ependymoma

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

36.  Primary CNS Lymphoma

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

38. Primary CNS Lymphoma

39. Pathology
Blue cells
B Cells
Perivascular cuffing

40. 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

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

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

43. ??

44. Research