Brain Tumors

Group 1

Anatomy of brain

Anatomy of brain

• Meninges :Dura mater. (hard mother ). Arachnoid mater. Pia mater.

Epidemiology•Incidence & prevalence:

•Between January 1997 and December 1998 there are 1.9 case per 100,000 people in Saudi Arabia

•Brain tumors are developing in approximately 8.1 per 100,000 people in the United Kingdom each year.

•More common in age groups between (3-12)years old and (40-70)years old

Risk Factors

BenignMalignant

And absence of

+

Risk Factor or not??

Clinical Presentation

The symptoms depend on the tumor's size,location, how far it has spread.

Symptoms can be divided in 3 main categories:

1- Consequences of intracranial hypertension

2- Dysfunction3-Irritation

1- Consequences of intracranial hypertension:

• Headaches are the most common symptom in braintumor patients.

• Nausea and vomiting : present at the initialencounter with at least 40% of patients.

• Syncope: must be distinguished from seizure.

• Papilledema.

2-Dysfunction .

• Cognitive decline.

• Hemiplegia .

• Numbness or tingling in the arms or legs.

• Aphasia.

• Ataxia.

• Dizziness.

2-Dysfunction (cont):

• Visual field impairment , double vision, bitemporal

hemianopia.

• Impaired sense of smell.

• Impaired hearing.

• Cranial nerve palsies.

• Endocrine dysfunction.

3-Irritation

• Seizures: 25% to 50% of all patients with brain tumors experience seizures at some point in their disease course.

• Fatigue.

• Weariness.

• Tremors.

Types & causes •Brain tumors can be benign or malignant:

• Benign brain tumors do not contain cancer cells:

Usually, benign tumors can be removed, and they seldom grow back.

The border or edge of a benign brain tumor can be clearly seen. Cells from benign tumors do not invade tissues around them or spread to other parts of the body. However, benign tumors can press on sensitive areas of the brain and cause serious health problems.

Unlike benign tumors in most other parts of the body, benign brain tumors are sometimes life threatening.

Malignant brain tumors contain cancer cells: Malignant brain tumors are generally more serious and often are life threatening.

They are likely to grow rapidly and crowd or invade the surrounding healthy brain tissue.

Very rarely, cancer cells may break away from a malignant brain tumor and spread to other parts of the brain, to the spinal cord, or even to other parts of the body. The spread of cancer is called metastasis.

Sometimes, a malignant tumor does not extend into healthy tissue. The tumor may be contained within a layer of tissue. Or the bones of the skull or another structure in the head may confine it. This kind of tumor is called encapsulated.

Tumor Grade: Grade I: The tissue is benign. The cells look nearly like normal brain cells, and cell growth is slow.

Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a grade I tumor.

Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing. These abnormal-appearing cells are termed anaplastic.

Grade IV: The malignant tissue has cells that look most abnormal and tend to grow very fast.

Tumor type : 1 .Primary brain tumor :

Tumors that begin in brain tissue are known as primary tumors of the brain.

Primary brain tumors are named according to the type of cells or the part of the brain in which they begin.

The most common primary brain tumors are gliomas. They begin in glial cells. There are many types of gliomas:

Astrocytoma - The tumor arises from star-shaped glial cells called astrocytes. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum and the cerebellum. A grade III astrocytoma is sometimes called an anaplastic astrocytoma. A grade IV astrocytoma is usually called a glioblastoma multiforme.

Brain stem glioma - The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and middle-aged adults.

Ependymoma - The tumor arises from cells that line the ventricles or the central canal of the spinal cord. They are most commonly found in children and young adults.

Oligodendroglioma - This rare tumor arises from cells that make the fatty substance that covers and protects nerves. These tumors usually occur in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. They are most common in middle-aged adults.

Some types of brain tumors do not begin in glial cells. The most common of these are:

Medulloblastoma - This tumor usually arises in the cerebellum. It is the most common brain tumor in children. It is sometimes called aprimitive neuroectodermal tumor.

Meningioma - This tumor arises in the meninges. It usually grows slowly.

Schwannoma - A tumor that arises from a Schwann cell. These cells line the nerve that controls balance and hearing. This nerve is in the inner ear. The tumor is also called an acoustic neuroma. It occurs most often in adults.

Craniopharyngioma - The tumor grows at the base of the brain, near the pituitary gland. This type of tumor most often occurs in children.

Germ cell tumor of the brain - The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger than 30. The most common type of germ cell tumor of the brain is agerminoma.

Pineal region tumor - This rare brain tumor arises in or near the pineal gland. The pineal gland is located between the cerebrum and the cerebellum.

2. Secondary brain tumor (metastatic) : Metastatic brain tumors are made of cancerous cells that

spread through the bloodstream from a tumor located elsewhere in the body (e.g. lung, breast and kidney).

Metastatic brain tumors are the most common type of tumor found in the brain and are much more common than primary brain tumors.

Metastatic tumors are usually named after the type of tissue from which the original cancer cells arose (for example, metastatic lung or metastatic breast cancer).

Causes No one knows the exact causes of brain tumors.

Research has shown that people with certain risk factors are more likely than others to develop a brain tumor.

The following risk factors are associated with an increased chance of developing a primary brain tumor:

I. Being male - In general, brain tumors are more common in males than females. However, meningiomas are more common in females.

II. Race - Brain tumors occur more often among white people than among people of other races.

III. Age - Most brain tumors are detected in people who are 70 years old or older. However, brain tumors are the second most common cancer in children. Brain tumors are more common in children younger than 8 years old than in older children.

IV. Family history - People with family members who have gliomas may be more likely to develop this disease.

V. Being exposed to radiation or certain chemicals at work (e.g. Formaldehyde, Vinyl chloride)

reference : http://www.medicinenet.com/brain_tumor/

• The Common Brain Tumor in Child :1- Astrocytoma2-neuroblastoma3-Medulloblastoma 4-ependymoma

• Which one of this tumor is not a gliomas : 1- Ependymoma 2- Germ cell tumor 3- Astrocytoma 4-Brain stem

1-Diagnosis2- Treatment

3 -Prognosis

Seif el eslam Wael Bedir

Work upIncrease Intracranial pressure

Neurological symptoms

History examination Investigation

meningitis

Space occupying lesion

vitals

fundoscope

Complete neurological examination

EEC

Spinal fluid analysis

Radiological work up

Diagnosis• computed tomography (CT)-scans• magnetic resonance imaging (MRI).

• Neoplasms will often show as differently colored masses (also referred to as processes) in CT or MRI results.

Benign brain tumors often show up as hypodense (darker than brain tissue) mass lesions on cranial CT-scans.

On MRI, they appear either hypo- (darker than brain tissue) or isointense (same intensity as brain tissue) on T1-weighted scans, or hyperintense (brighter than brain tissue) on T2-weighted MRI, although the appearance is variable.

• Contrast agent uptake, sometimes in characteristic patterns, can be demonstrated on either CT or MRI-scans in most malignant primary and metastatic brain tumors.• Perifocal edema

The definitive diagnosis of brain tumor can only be confirmed by:

• histological examination of tumor tissue samples obtained either by means of brain biopsy or open surgery.

• This examination, performed by a pathologist, typically has three stages:

• interoperative examination of fresh tissue,• preliminary microscopic examination of prepared

tissues, • Follow up examination of prepared tissues after

immuno histochemical staining or genetic analysis.

Treatment

Overview These various types of treatment are available depending on

neoplasm type and location and may be combined to give the best chances of survival:

• surgery: complete or partial ressection of the tumor with the objective of removing as many tumor cells as possible

• radiotherapy• Chemotherapy: with the aim of killing as many as possible of

cancerous cells left behind after surgery and of putting remaining tumor cells into a non dividing, sleeping state for as long as possible

A)Surgery

• The primary and most desired course of action described in medical literature is surgical removal (resection) via craniotomy.

• The prime remediating objective of surgery is to remove as many tumor cells as possible, with complete removal being the best outcome and cytoreduction ("debulking") of the tumor otherwise.

• In some cases access to the tumor is impossible and impedes or prohibits surgery.

• Any person undergoing brain surgery may suffer from epileptic seizures. Medication is prescribed and administered to minimize or eliminate the occurrence of seizures.

B) Radiation therapy

• The goal of radiation therapy is to selectively kill tumor cells while leaving normal brain tissue unharmed.

• Radiotherapy is the most common treatment for secondary brain tumors.

• The amount of radiotherapy depends on the size of the area of the brain affected by cancer.

• Conventional external beam 1-'whole brain radiotherapy treatment' (WBRT)

or 'whole brain irradiation‘ may be suggested if there is a risk that other

secondary tumors will develop in the future 2- Stereotactic radiotherapy is usually

recommended in cases involving fewer than three small secondary brain tumors.

C) Chemotherapy

• Patients undergoing chemotherapy are administered drugs designed to kill tumor cells. Although chemotherapy may improve overall survival in patients with the most malignant primary brain tumors, it does so in only about 20 percent of patients.

• Chemotherapy is often used in young children instead of radiation, as radiation may have negative effects on the developing brain.

• The decision to prescribe this treatment is based on a patient’s overall health, type of tumor, and extent of the cancer. The toxicity and many side effects of the drugs, and the uncertain outcome of chemotherapy in brain tumors puts this treatment further down the line of treatment options with surgery and radiation therapy preferred.

conclusionprognosis Treatment Type90% deis with treatment Surgical debulking

radiationGlioma

Preoperative embolisation & surgical resection

meningioma

90% exceed 5 years survival rate

Surgical resection Cerebellar astrocytoma

50% exceed 5 years survival rate

Surgical removal Radio Chemotherapy

Medulloblastoma

Other

• A shunt is used not as a cure but to relieve symptoms by reducing hydrocephalus caused by blockage of cerebrospinal fluid.

• Researchers are presently investigating a number of promising new treatments including gene therapy, highly focused radiation therapy, immunotherapy and novel chemotherapies.

Prognosis

• The prognosis of brain cancer varies based on the type of cancer.• Medulloblastoma has a good prognosis with chemotherapy, radiotherapy, and surgical resection while• glioblastoma multiforme has a median survival of only 12 months even with

aggressive chemoradiotherapy and surgery.• Brainstem gliomas have the poorest prognosis of any form of brain cancer, with most patients dying

within one year, even with therapy that typically consists of radiation to the tumor along with corticosteroids.

However, one type of brainstem glioma, a focal seems open to exceptional prognosis and long-term survival has frequently been reported.

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