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Brain Tumours – what should I know?

Brain Tumours – what should I know?. Dr Hannah Lord Consultant Clinical Oncologist. Causes of brain tumours. Causes:. DNA damage Radiation Genetics NF- 1 (acoustic neuromas) Li Fraumeni syndrome Tuberous sclerosis ( astrocytomas)

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Brain Tumours – what should I know?

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  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?

  5. 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

  6. Investigations • What would you do?

  7. Ix? • CT brain • MRI brain/spine – to exclude multiple metastaic deposits; to better characterise tumour

  8. How would you classify brain tumours?

  9. Types of Brain Tumours • Primary: benign or malignant (rare) • Secondary: malignant (majority)

  10. Primary brain tumour

  11. Primary brain tumour

  12. Radiology - brain mets

  13. Questions: • Where do brain metastases come from?

  14. Secondary Brain Tumours • Lung • Breast • GI • Any primary potentially

  15. Questions: • How will you initially treat brain secondaries?

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

  17. 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#)

  18. Primary brain tumours • Types of primary brain tumours? • BENIGN

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

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

  21. Primary brain tumours • Types of primary brain tumours? • MALIGNANT

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

  23. Primary Brain Tumours • GLIOMA

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

  25. GBM – radiology

  26. Treatment of gliomata • Observation – low grade Surgery

  27. 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)

  28. Benefits of Temozolamide

  29. Survival with TMZ

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

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

  32. Primary CNS Tumours • Ependymoma

  33. Ependymoma

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

  35. Primary CNS Lymphoma

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

  37. Primary CNS Lymphoma

  38. Pathology Blue cells B Cells Perivascular cuffing

  39. 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

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

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

  42. ??

  43. Research

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