Brain and spinal cord tumours (CNS tumours, CTs)

Notes
  • The most common cause of CTs in adults are secondary tumour that arise from metastasis of other tumours (mainly melanoma, lung, renal and breast cancers) to the brain.
  • Statistics: Brain tumours are more prevalent in the developed world; affect Caucasians more than Africans and Asians; estimated global incidence of primary malignant brain tumours is 28 - 58 per million in males and 20 - 41 per million in females; brain tumours are more common in children than in adults and it is the 2nd most common cancer in children after leukemia.
  • The most common primary CNS tumour in adults is glioblastoma mutiforme (Grade 4 astrocytoma) followed by meningioma (pia, dura and arachnoid) and accoustic neuroma.
  • The most common CNS tumours in children are: pilocytic astrocytoma, medulloblastoma and ependymomas (in that order).

##Pilocytic astrocytoma

  • It is the most common CNS cancer in children.
  • It affects astrocytes, mainly in cerebellum)
  • It has solid part, cystic part and protruding nodules
  • Histological examination of tumour reveals Rosenthal fibres and pilocytic astrocytes.

##Medulloblastoma

  • It is the 2nd most common tumour in children
  • Generally it causes malignant tumours
  • Histological examination of tumour reveals solid tumour and sheets of small blue cells with scanty cytoplasm.

## Ependymomas

  • It is the 3rd most common tumour in children
  • It affects ependymal cells which are the cells that line the ventricles (where CSF is produced in choroid plexus) hence the common symptom of this tumour is hydrocephalus.

##Meningioma

  • It arises mainly from the arachnoid layer of meninges
  • Histological examination of tumour reveals psammoma bodies (that are caused by dystrophic calcification). Other cancers that manifest with psammoma bodies are papillary cancer of thyroid, serous/adenocarcinoma of ovary and m

##Astrocytoma

  • Astrocytes are star-shaped cells that are found in the brain and spinal cord.
  • Astrocytoma is classified into glioma, ependymal tumour and oligodendroglioma.
  • Glioma (or optic nerve glioma) affects optic nerves occasionally causing monocular blindness (blindness in one eye).
  • Oligodendroglioma (in CNS) is known as Swannoma when it occurs in the peripheral nervous system. It is characterized by whirling myelination.

##Glioblastoma mutiforme (GBM)

  • This highly malignant tumour is common in men between 40 to 70 yrs of age
  • It has a grave prognosis
  • It displays a butterfly-distribution pattern between the two lobes of the brain.
  • Necrosis and hemorrhage are the key evident features of the tumour.
  • Histological examination reveals characteristic pseudoparasiding necrosis (necrotic areas surrounded by tumour cells), new blood vessels and giant cells
Symptoms
  • Headaches (worse in the morning) due pressure of the tumor on the brain. Unfortunately, they are manifested in the late stage of the tumour.
  • Ataxia (tumor in the cerebellum)
  • Drowsiness (pressure of the tumor on the brain)
  • Altered menstrual periods (pituitary tumor)
  • Changes in personality or memory
  • Confusion with left and right sides of the body (tumor in the frontal or parietal lobe of the cerebrum)
  • Fatigue
  • Growth in hands and feet in adults (pituitary tumor)
  • Inability to look upward (caused by a pineal gland tumor).
  • Lactation (pituitary tumor)
  • Nausea/vomiting
  • Seizures/convulsions (pressure of the tumor on the brain or spinal cord)
  • Speech coordination challenges
  • Vision changes such as loss of part of the vision or double vision (tumor in the temporal lobe, occipital lobe, or brain stem).
  • Paresis (muscular weakness and partial paralysis) of arms and/or legs
Diagnosis
  • MRI (is the diagnostic of choice)
  • CT Scan
  • Biopsy and histology
  • Immunohistochemistry (IHC)
Differential
  • Acute Subdural Hematoma
  • Encephalitis
  • Epilepsy
  • Epidural Hematoma
  • Hemorrhagic Stroke
  • Ischemic Stroke
  • Metastatic tumours
  • Ophthalmic illness
  • Psychopathic states
Prevention

To avoid exposure to carcinogenic agents

Management
  • Surgery
  • Adjuvant radiotherapy after surgery
  • Radiotherapy without surgery

##Chemotherapy;

  • Chemotherapy can be delivered through the following routes: intravenous, intra-arterial; interstitial (using Gliadel wafers soaked with antineoplatic agent); convection-enhanced delivery(where catheters are placed on the tumour or near the tumour for delivery of drug) and intrathecal.
  • MTOR inhibitors (everolimus, siroliumus and tacrolimus) are used for treatment of glioblastoma multiforme and astrocytoma.
  • Bevacizumab: treatment of glioblastoma that is resistant to the common chemotherapy and radiation
  • Carmustine: For treatment of glioblastoma, medulloblastoma, and astrocytoma
  • Temozolomide: For adults with anaplastic astrocytoma that is resistant to other treatments and as adjuvant therapy in treatment of glioblastoma multiforme.
  • Combination therapy of procarbazine, lomustine and vincristine (PCV regime) for treatment of oligodendrogliomas and mixed oligoastrocytomas.
  • Cisplatin or carboplatin for treatment of glioma, medulloblastoma, and other types of brain tumors.
  • Other useful drugs include: TKIs (erlotinib and imatinib); tamoxifen, paclitaxel, topotecan, and irinotecan.
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us