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Brain Tumors
David A. Sun, M.D., Ph.D.
Neurosurgery
Disclosures
• I have no relevant personal financial
relationships
• I do not intend to discuss off-
label/investigational use of commercial
products/devices
Types of Tumors
Primary brain tumors
• Brain tissue origin
Secondary brain tumor
• Non-brain origin
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
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
Is this cancer?
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
Is this cancer?
Meningioma Glioma
Benign Malignant
Is this cancer?
Meningioma
Grade 1 2 3
92% 6% 2%
Benign Malignant
Is this cancer?
Meningioma
Grade 1 2 3
92% 6% 2%
Glioma
Grade 1 2 3 4
Benign Malignant
Is this cancer?
Meningioma
Grade 1 2 3
92% 6% 2%
Glioma
Grade 1 2 3 4
Benign Malignant
Pilocytic astroctyoma
(surgically curable)
Glioblastoma
(15 month
median survival)
How do brain tumors
cause problems?
• Mass effect
– Tumor pushes on normal brain
• Local invasion
– Tumors invade normal brain
• Microscopic
• Edema
– Swelling of normal brain
Presentation
• Generalized symptoms and 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
Presentation
• Focal symptoms and signs
→ site specific to location
Presentation
• Focal symptoms and signs
→ site specific to location;
Personality
Cognitition
Expressive
language
Receptive
language
Incoordination
Balance
Vision
Weakness
Incoordination
What are our options?
• Surveillance
– Serial MRI scans
What are our options?
• Surveillance
– Serial MRI scans – Watch it
What are our options?
• Surveillance
– Serial MRI scans
• Surgery
– Biopsy
• Diagnose the tumor
– Resection
• Diagnose the tumor
• Remove as much of tumor as possible
What are our options?
• 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
Surgery
Surgery
Surgery
• Where is the tumor?
• What bone is in the way?
• What brain is involved?
– What does that brain do?
• What arteries/veins are involved?
Surgery
• Where is the tumor?
• What bone is in the way?
• What brain is involved?
– What does that brain do?
• What arteries/veins are involved?
X
X
Transnasal
Trans-
sphenoidal
Primary
motor
cortex
X
Primary
motor
cortex
Awake
Crani
Biopsy
Surgical tools - Microscope
• Improves visualization
– Increased light
– Increased magnification
• Improves surgeon comfort
– Adjust scope angle,
instead of bending/twisting
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
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
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
Radiation Therapy
• No clean 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
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
Questions?

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brain tumors - KY cancer registry.pptx

  • 1. Brain Tumors David A. Sun, M.D., Ph.D. Neurosurgery
  • 2. Disclosures • I have no relevant personal financial relationships • I do not intend to discuss off- label/investigational use of commercial products/devices
  • 3. Types of Tumors Primary brain 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
  • 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? Meningioma Glioma Benign Malignant
  • 9. Is this cancer? Meningioma Grade 1 2 3 92% 6% 2% Benign Malignant
  • 10. Is this cancer? Meningioma Grade 1 2 3 92% 6% 2% Glioma Grade 1 2 3 4 Benign Malignant
  • 11. Is this cancer? Meningioma Grade 1 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 brain tumors cause problems? • Mass effect – Tumor pushes on normal brain • Local invasion – Tumors invade normal brain • Microscopic • Edema – Swelling of normal brain
  • 13. Presentation • Generalized symptoms and 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 symptoms and signs → site specific to location
  • 15. Presentation • Focal symptoms and signs → site specific to location; Personality Cognitition Expressive language Receptive language Incoordination Balance Vision Weakness Incoordination
  • 16.
  • 17.
  • 18. What are our options? • Surveillance – Serial MRI scans
  • 19. What are our options? • Surveillance – Serial MRI scans – Watch it
  • 20. What are our options? • Surveillance – Serial MRI scans • Surgery – Biopsy • Diagnose the tumor – Resection • Diagnose the tumor • Remove as much of tumor as possible
  • 21. What are our options? • 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
  • 24. Surgery • Where is the tumor? • What bone is in the way? • What brain is involved? – What does that brain do? • What arteries/veins are involved?
  • 25. Surgery • Where is the tumor? • What bone is in the way? • What brain is involved? – What does that brain do? • What arteries/veins are involved?
  • 26.
  • 27. X
  • 28. X
  • 29.
  • 30.
  • 31.
  • 33.
  • 34.
  • 37.
  • 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 • No clean 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

Editor's Notes

  1. over 100 different types of brain tumors
  2. Easily over 100 types of brain tumors
  3. I don’t consider a brain tumor to mean you have brain cancer
  4. You can’t really tell if someone where their tumor sits on this spectrum without looking at a piece of the tumor
  5. Tumors can cause trouble regardless of their grade or aggressiveness; Signs and symptoms depend on part of brain affected. Location, location, location