Brain Tumours – what should I know?

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: AnaplasticAstrocytoma /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

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