Primary CNS tumors account for 2% of cancers in adults in the US, with over 18,000 new cases diagnosed each year resulting in more than 12,000 deaths. The most common type is glioblastoma, which has a poor prognosis. Risk factors include high dose radiation exposure and certain genetic syndromes. Symptoms vary based on location but often include headaches, cognitive changes, and seizures. Diagnosis involves imaging, typically MRI with contrast, followed by histopathology. Treatment options include surgery, radiation therapy, and chemotherapy, with the standard of care for high grade gliomas being radiation plus temozolomide.

1. Primary CNS Tumors in
Adults

2. Statistics
■ Account fo 2% of all cancers in U.S. adults
■ 18,000 new diagnoses each year
■ Result in >12,000 deaths/year
■ Incidence higher in men than women
■ Lifetime risk: .65% in men and .5% in women
■ Incidence peaks at 65-79 y/o
■ 2 x incidence of GBM in Caucasions compared to
African-Americans

3. Risk Factors: Environmental
■ PROVEN:
■ High Dose Ionizing Radiation
■ UNPROVEN:
■ ETOH/Tobacco use
■ Cell Phones
■ Chemical Agents: Hair dye, pesticides
■ Head trauma
■ Infections: Toxoplasma gondii
■ Nitrosamine consumption
■ Occupational exposures: petroleum, vinyl chloride

4. Risk Factors: Genetic
■ LiFraumeni Syndrome (p53 mutation)
■ MEN Type 1
■ Neurofibromatosis 1 and 2
■ Neval Basal Cell CA Syndrome
■ Tuberous Sclerosis
■ Turcot’s Syndrome
■ Von Hippel-Lindau Syndrome

5. Types of Brain Neoplasms
■ Classified based on cellular origin and histologic
classification.
■ Neuroglial Tumors: 80% of all Brain Tumors
■ Divided into 4 Grades:
• Low Grade:I,II High Grade: III, IV
■ Astrocytes
■ Oligodendrocytes
■ Ependymal cells
■ GBM: Grade IV Astrocytoma
• Most common glioma and most common 1 brain tumor.
• Poor prognosis
• Found in Cerebral Hemispheres, can cross corpus callosum

6. Butterfly Glioma

7. Types
■ Oligodendroglioma
■ Rare, slow growing, Often found in Frontal
lobes.
■ Oligodendrocytes: often calcified in
oligodendroglioma, fried-egg appearance

8. Oligodendroglioma

9. Types
■ Schwannoma
■ 3rd most common Primary Brain Tumor
■ Often localized to 8th nerve: Acoustic
Schwannoma
■ Resectable
■ B/L Schwannoma associated with
Neurofibromatosis Type 2

10. Types
■ Meningiomas: 20% of all Primary Brain Tumors
■ Most often occurs in convexities of hemispheres and
parasagittal region
■ Arises from arachnoid cells external to brain
■ Resectable
■ Lymphomas
■ Incidence increasing in U.S.
■ Occurs in patients with Immunodeficiency Syndromes

11. Meningioma

12. Clinical Presentation
Sign or symptom/Percentage with the sign or sx
Headache 56
Memory loss 35
Cognitive changes 34
Motor deficit 33
Language deficit 32
Seizures 32

13. Clinical Presentation
Personality change 23
Visual problems 22
Changes in consciousness 16
Nausea or vomiting 13
Sensory deficit 13
Papilledema 5

14. Clinical Presentation
Tumor location & Signs and symptoms
■ Frontal lobe
■ Dementia, personality change, gait disturbance,
expressive aphasia, seizure
■ Parietal lobe
■ Sensory loss, hemianopia, spatial disorientation
■ Temporal lobe
■ Complex partial or generalized seizure; behavior
change, including symptoms of autism, memory loss,
and quadrantanopia
■ Occipital lobe
■ Contralateral hemianopia

15. Clinical Presentation
■ Thalamus
■ Contralateral sensory loss, behavior change, language
disorder
■ Cerebellum
■ Ataxia, dysmetria, nystagmus
■ Brain stem
■ Cranial nerve dysfunction, ataxia, pupillary
abnormalities, nystagmus, hemiparesis, autonomic
dysfunction

16. Diagnosis
■ H&P, Neuro Exam
■ Fundoscopic Exam
■ Imaging: MRI with Contrast in the preferred
study for initial evaluation of brain tumor
■ Follow with Histopathology to confirm the dx

17. Staging
■ No standard system of staging for
Primary Brain Tumors.

18. Treatment
■ Surgery
■ Radiation Therapy
■ Chemotherapy

19. Surgery
■ Obtain tissue for dx or Resection
■ Often curative for Pituitary Adenomas,
Meningioma, Schwannoma
■ The decision to perform a complete resection is
based on the location and extent of the tumor,
histopathology, and comorbid conditions

20. Radiation Tx
■ Postsurgical radiation is the standard treatment
for high-grade gliomas
■ Its role in the treatment of low-grade gliomas is
controversial

21. Chemotherapy
■ High Grade Gliomas:
■ Temozolomide and Radiation
■ GBM:
■ Silencing the MGMT gene: methyl guanine, methyl
transferase gene results in resistance to Alkylating and
Methylating agents.
■ Recurrent Malignant Gliomas:
■ Camptosar, Avastin, Gleevec, Tarceva