Brain Tumors

Dr. Sohail Sajjad

 What is a brain tumor?

 A collection of abnormal
cells that grows in the brain
or central spine canal.
 Types
Benign Malignant

 Slow growing  Fast growing

 Non-invasive  Aggressively invasive
 Does not spread  May spread distantly
 Less likely to recur  More likely to recur
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
→ normal ICP 7–15 mmHg for a supine adult.

 Headaches (50%)
 New or different
 Worsening over time
 Worse on awakening increases with any activity that increases ICP
 Other symptoms
 Seizures (30%)
 Cognitive change (30%)
 Personality change (25%)
 Nausea/vomiting (15%)
 Blurred vision
 Due to compression of abducens VI (LR VI)
 Papilledema (70-75%)
 Edema of optic disc
 Increased CSF pressure perioptic pressure impedes venous
drainage.
 Leads to :enlarged blind spot, diplopia etc.

 Lethargy
 Presentation
 Focal symptoms and signs
→ site specific to location;

Weakness
Incoordination
Personality
Cognition
Expressive
language
Vision

Incoordination
Receptive Balance
language
Symptoms – correspond to tumor
location and size & type of tumor
 Types of Tumors
Primary brain tumors Secondary brain tumor
 Brain tissue origin  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
Specific Primary brain tumors
 Glioma (30%)
 Astrocytoma
 Benign Grade I, II
 Malignant Grade III, IV
 Oligodendroglioma
 Ependymoma
 Medulloblastoma
 Tumors arising from supporting structures
 Meningioma
 Pituitary Adenoma
 Neuroma
 …….
Glial cells Glioma
 Astrocytes Astrocytoma
 Anchor neurons to blood supply
 Regulate chemical environment
 May regulate vasoconstriction
 Oligodendrocytes Oligodendroglioma
 Coats axons in CNS - myelin
 Insulation
 Propagation of electrical signals
 Ependymal cells ependymoma
 Walls of ventricles – CSF
Photographic representation:
 Is this cancer?
Benign Malignant
Meningioma
Grade I II III
92% 6%
2%
Glioma
Grade I II III IV
Astrocytoma
 Many categories are recognized, most common are:
1. Pilocytic astrocytoma
2. Fibrillary astrocytoma

 Based on the degree of differentiation they are classified as:

1. Astrocytoma (Grade I, II )
2. Anaplastic astrocytoma (Grade III)
3. Glioblastoma multiforme(Grade IV)
Benign – malignant (flowchart)
 Benign
Grade I, II 1. Astrocytoma
• Low grade • Well-differentiated
• Well differentiated • Symptoms are slow growing
• Survival 5 years
Grade III 2. Anaplastic astrocytoma
• High grade • WHO grade III type
• Poorly differentiated • Rare
3. Glioblastoma multiforme
• Very aggressive
Grade IV
• Prognosis is poor
• Anaplastic
• Maximum 10 months
 Malignant
 Anaplastic Astrocytoma

 Grade III astrocytoma

 Diffusely infiltrative invade cerebral parenchyma
 Arise in frontal and temporal lobes
 Old age disease (5th-6th decade)

High grade tumor, pre-treatment

(Left is right, right is left)

http://radiopaedia.org/cases/anaplastic-
astrocytoma-who-grade-iii
 Glioblastoma multiforme

• Grade IV
• Invade white matter of cerebral hemispheres
• Primarily occurs in grey matter
• GBM is aggressive, rapidly growing and infiltrative.
• Invades both hemispheres through corpus callosum
• Arise in frontal and temporal lobes
 Oligodendroglioma
 Incidence:
 2%-3% of total gliomas
 Most common in young and middle age.
 Pathogenesis
 Slow growing, solid calcified tumor
 Either grade II or III
 Most common in cerebral hemispheres (frontal lobe)
 Clinical manifestations
 Partial or generalized seizures
 Bleed and may present as “stroke-like syndrome”
 Prognosis
 Median overall survival is 17 years.
 Recur as a more aggressive tumor.
Ependymoma
 Incidence
 Low incidence 2% total gliomas
 Common in children
 Pathogenesis
 Derived from ependymal cell lining of the
ventricular system.
 Graded from I-IV on degree of anaplasia
 Clinical manifestations
 More common in 4th ventricle
 Detected early due to rise in ICP
 In posterior fossa
 Prognosis
 5 years survival 80%
 Next lecture

 Tumors arising from supporting structures in the brain

 Diagnosis of primary brain tumors
 Medical management