brain tumour
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brain tumour
A neoplasm affecting the brain, which may be primary (arising in the brain or meninges) or secondary (i.e., metastatic to the brain).Epidemiology
Brain tumours are the 3rd most common malignancy in ages 15–34; 35,000 occur annually in the US. 1st-degree relatives of children with brain tumours have a 5-fold increased risk of CNS tumours, leukaemia and other childhood tumours in the affected family.
Clinical findings
Seizures, vision or hearing loss, hemiparesis, double vision, headache, bizarre behaviour, nausea, vomiting, memory loss.
Imaging
Mass lesion by all modalities—CT, MRI, PET, ultrasound.
Management
Surgery, gamma knife radiotherapy may be effective; chemotherapy and immunotherapy are less so.
Prognosis
Generally poor, but depends on histological grading; malignant gliomas account for 2.5% of all cancer-related deaths.
Brain tumours/masses
Primary
• Non-neoplastic—craniopharyngioma, colloid cysts.
• Primary, benign—meningioma, pituitary adenoma, acoustic neuroma, epidermoid tumours, choroid plexus papilloma.
• Primary, low grade—pilocytic astrocytoma, astrocytoma, hemangioblastoma, oligodendroglioma, ganglioglioma.
• Primary, malignant—anaplastic astrocytoma, glioblastoma multiforme, ependymoma, lymphoma, medulloblastoma, primitive neuroectodermal tumour, germ cell tumour, pineal cell tumour, chordoma, choroid plexus carcinoma.
Metastatic
Carcinoma, meningeal carcinomatosis.
Location-specific symptoms of brain cancer
• Brainstem—vomiting, incoordination, difficulty with swallowing and speech, unilateral facial muscle weakness (e.g., crooked smile, drooping eyelid), crossed eyes, poor vision, morning headache, drowsiness, hearing loss, head tilt, hemiparesis, personality changes.
• Frontal lobe—seizures, impaired judgment and memory, changed personality or mental capacity, hemiparalysis, loss of sense of smell, impaired vision, swollen optic nerve or papilledema; if both hemispheres are involved, changed mental state or personality, uncoordinated gait.
• Parietal lobe—loss of ability to write; if tumour is in the left hemisphere, speech disturbances and seizures, loss of recognition of body parts, spatial disorders.
• Occipital lobe—directional blindness, seizures.
• Temporal lobe—may be asymptomatic; occasionally speech defects, seizures.
• Ependyma—hydrocephalus, ± neck stiffness, head tilt, multiple cranial nerve palsies.
• Meninges—symptoms specific to the region being compressed; metastatic brain tumours cause oedema resulting in headache, vomiting and nausea, as well as location-specific symptoms.