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Causes:
DNA damage
Radiation Genetics
NF- 1 (acoustic neuromas) Li Fraumeni syndrome Tuberous sclerosis ( astrocytomas) multiple endocrine neoplasia type 1(pituitary macroadenoma)
Infection
HIV
Diagnosis
Morning headache, n+v, confusion New onset of seizures Motor deficit Sensory deficit Personality change Dyshasia Ataxia
Investigations
Ix?
CT brain
MRI brain/spine to exclude multiple metastaic deposits; to better characterise tumour
Questions:
Lung Breast
GI
Any primary potentially
Questions:
How to treat?
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#)
BENIGN
MALIGNANT
GLIOMA
Malignant: Gliomata
Glioma Commonest Primary Brain Tumours WHO Grades:
I: Fibrillary astrocytoma II: Astroctytoma or Oligodendroglioma III: Anaplastic Astrocytoma /oligodendrglioma IV: Glioblastoma multiforme
GBM radiology
Treatment of gliomata
Surgery
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)
Benefits of Temozolamide
2 3 4 5
Gliadel Wafers
Gliadel wafers at time of surgery (carmustine soaked) in completely resected high grade glioma (3 or 4)
Pathology - GBM
Ependymoma
Ependymoma
Ependymoma
Treatment?
Surgery +/- radiotherapy 54Gy in 30# over 6 weeks
Primary cerebral lymphoma HIV related Steroids Chemo (methotrexate based)+/- XRT Cognitive impairment Poor outcomes
Pathology
Loss of autonomy Can not drive Neurological deficit Confusion and personality change Family lose the person they knew Financial loss Social loss
Effects of treatment steroids, anti epileptics, surgery and XRT Invasion of space by supportive teams Death Genetic consequences
Multidisciplinary teams
Need GP, neurosurgeon, oncologist, endocrinologist, neurologist, specialist CNS nurse, palliative care team, pathologist, radiologist Community Macmillan, DNs Social work, OT, physiotherapy input
??
Research