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Similar to brain tumors - KY cancer registry.pptx
brain tumors - KY cancer registry.pptx
- 1. Brain Tumors David A.Sun, M.D., Ph.D. Neurosurgery
- 2. Disclosures • I haveno relevant personal financial relationships • I do not intend to discuss off- label/investigational use of commercial products/devices
- 3. Types of Tumors Primarybrain tumors • Brain tissue origin Secondary brain tumor • Non-brain origin
- 4. Secondary brain tumors •Non-brain origin = Cancer metastasis – Most common – 25-45% of cancer patients • Lung: >50% of all; most common in men • Breast: Most common in women • Melanoma: Highest propensity for brain – 50% of melanoma patients develop brain mets; Multiple • Renal Cell • Colorectal • Any primary can metastasize to the brain
- 5. Primary brain tumors •Meningioma (35%) • Glioma (30%) – Astrocytoma • Glioblastoma – Oligodendroglioma – Oligoastrocytoma – Ependymoma • Pituitary Adenoma (13%) – Within skull – Beneath brain Skin Skull Meninges Brain Neuron Astrocyte Oligodendrocyte Ependyma
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- 7. Is this cancer? Benign •Slow growing • Non-invasive • Does not spread • Less likely to recur Malignant • Fast growing • Aggressively invasive • May spread distantly • More likely to recur
- 8. Is this cancer? MeningiomaGlioma Benign Malignant
- 9. Is this cancer? Meningioma Grade1 2 3 92% 6% 2% Benign Malignant
- 10. Is this cancer? Meningioma Grade1 2 3 92% 6% 2% Glioma Grade 1 2 3 4 Benign Malignant
- 11. Is this cancer? Meningioma Grade1 2 3 92% 6% 2% Glioma Grade 1 2 3 4 Benign Malignant Pilocytic astroctyoma (surgically curable) Glioblastoma (15 month median survival)
- 12. How do braintumors cause problems? • Mass effect – Tumor pushes on normal brain • Local invasion – Tumors invade normal brain • Microscopic • Edema – Swelling of normal brain
- 13. Presentation • Generalized symptomsand signs → Elevated intracranial pressure • Headaches (50%) – New or different – Worsening over time – Worse on awakening, them improve – Other symptoms • Seizures (30%) • Cognitive change (30%) • Personality change (25%) • Nausea/vomiting (15%) • Blurred vision/papilledema • Lethargy
- 14. Presentation • Focal symptomsand signs → site specific to location
- 15. Presentation • Focal symptomsand signs → site specific to location; Personality Cognitition Expressive language Receptive language Incoordination Balance Vision Weakness Incoordination
- 18. What are ouroptions? • Surveillance – Serial MRI scans
- 19. What are ouroptions? • Surveillance – Serial MRI scans – Watch it
- 20. What are ouroptions? • Surveillance – Serial MRI scans • Surgery – Biopsy • Diagnose the tumor – Resection • Diagnose the tumor • Remove as much of tumor as possible
- 21. What are ouroptions? • Surveillance – Serial MRI scans • Surgery – Biopsy – Pick a few weeds out • Diagnose the tumor – Resection – Pull as many weeds as possible • Diagnose the tumor • Remove as much of tumor as possible
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- 24. Surgery • Where isthe tumor? • What bone is in the way? • What brain is involved? – What does that brain do? • What arteries/veins are involved?
- 25. Surgery • Where isthe tumor? • What bone is in the way? • What brain is involved? – What does that brain do? • What arteries/veins are involved?
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- 39. Surgical tools -Microscope • Improves visualization – Increased light – Increased magnification • Improves surgeon comfort – Adjust scope angle, instead of bending/twisting
- 40. Surgical tools -Navigation • GPS system for the OR – Pre-plan surgical approach – Confirm anatomic position • Brings radiology data into the OR • Functional MRI • White mater tracks
- 41. Surgical tools -Robotics • Navigation systems with built in surgical assistant – Pre-plan surgical approach – Utilize the robot to align the instruments • Minimally invasive – Single stitch incision – Maximizing precision
- 42. Surgical tools –Laser Ablation • Minimally invasive – Single stitch incision • Pass a probe into the tumor – Reduced risk to normal brain • Utilize heat to destroy tumor cells Pre-op 1 year post-op
- 43. Radiation Therapy • Noclean margins • Can never pull every single weed • Whole brain radiation – Multiple small doses to entire brain • Stereotactic radiosurgery (SRS) – High dose to a small area – Limits exposure to normal brain SRS
- 44. Team Approach • Neuro-oncology •Radiation oncology • Behavioral oncology • Neurosurgery • Neuro-radiology • Neuro-psychology • Neuro-pathology • Nurse Navigator • Research Nurse • PT/OT/SLP • Support services • Make the diagnosis • Deliver individualized treatment • Provide clinical trials • Provide support for our patients and families • Maximize quality of life
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Editor's Notes
- #4 over 100 different types of brain tumors
- #5 Easily over 100 types of brain tumors
- #7 I don’t consider a brain tumor to mean you have brain cancer
- #8 You can’t really tell if someone where their tumor sits on this spectrum without looking at a piece of the tumor
- #13 Tumors can cause trouble regardless of their grade or aggressiveness; Signs and symptoms depend on part of brain affected. Location, location, location