BRAIN TUMOR

primary
management and
updates
 Outline
1. Definition and
Epidemiology
2. Signs and Symptoms

3. Diagnostic

4. Treatment

5. Primary Management

6. Conclusions
 1. Definition and Epidemiology

A brain tumor is
an abnormal
growth of tissue
in the brain or
central spine

that can disrupt

proper brain
function.
 1. Definition and Epidemiology
Classification (WHO) :

1. Neuroepithelial/Glioma : Astrositoma, oligodendroglioma, tumor

pineal, medulloblastoma
2. Spinal nerve and Cranial Nerve Sheath Tumor : Schwanoma,
neurofibroma
3. Meninges : meningioma, melanoma maligna
4. CNS Lymphoma and neoplasma hemopoetic
5. Germ Cell Tumor : Germinoma, Teratoma
6. Sellar Region Tumor : Craniofaringioma, Adenoma Pituitary
7. Cyst and Tumor like Conditions : Coloid cyst,
epidermoid/dermoid cyst
8. Metastatic Tumor
 1. Definition and Epidemiology
BENIGN : MALIGNANT :
- Least aggressive - Life threatening because
- Originate from cells they grow rapidly and
within or surrounding invade surrounding brain
the brain tissue
- Do not contain cancer - Contain cancer cells and
cells and Grow slowly often do not have clear
- Clear borders, do not borders
spreads into other - Spread throughout the brain
tissue and spine but rarely to other
- Tend not to return if areas of the body
removed entirely - Treated with surgery,
- Some can progress to chemotherapy and radiation
become malignant - May recur after treatment
 1. Definition and Epidemiology
PRIMARY :
Cancerous or benign,
tumors that start in cells of
the brain.
Primary brain tumors may
spread to other parts of
the brain or to the spine,
but rarely to other organs
METASTATIC/SECONDARY :
Begin in another part of the body
and then spread to the brain.
These tumors
are more common than primary
brain tumors and are named by the
location in which they begin.
They are treated based
on where they originate, such as
the lung, breast, colon or skin.
 1. Definition and Epidemiology
GRADING (WHO): Tumors can contain several
Lower Grade grades of cells; however, the
Grade I-II
most malignant cell
Not aggressive, long
term survival determines the grade for the
entire tumor
Higher Grade (even if most of the tumor is
Grade III-IV a lower grade).
Grow rapidly, more
damaged
Difficult to treat Some tumors can change
Considered the way they grow and may
malignant/cancerous become malignant over time.
1. Definition and Epidemiology
2. Signs and Symptoms
2. Signs and Symptoms
2. Signs and Symptoms
2. Signs and Symptoms
Presentation SIGN EFNS NICE BASH BASH US
(for
GP)
(for
susp
brain
Headache
Consortium Headache related to
New onset > age x x x
tumor)
x X brain tumor
of 50 yrs
Focal neurology X x x x
Non focal
neurology
x x x
1. Age > 50 yrs
(cognitive
impairment) 2. Change in headache
Change in x x x x x X
headache characteristic :
characteristics
progressive, progressive, aura
aura
Change with x x x 3. New Headache with
posture
Headache that x x X Cancer Elsewhere
wakes up
Headache on
awakening

Inaccurate portrayals of
Precipitated by
physical
x
tumor headache :
exertion
Exacerbated by x
physical
exertion 1. Worse in the early morning
Precipitated by
valsava
x
2. Accompanying nausea and
Exacerbated by
valsava
x vomiting
Risk factors for x 3. Exacerbation with valsava :
cerebral venous
thrombosis bending over, rising from
New headache x x x
with HIV recumbent position
New Headache x x x x
with cancer SIGN=Scottish Intercollegiate Guidelines
elsewhere Network; EFNS=European Federation of
Pulse Neurological Societies; NICE=National Institute
synchronous for Health and Care Excellence; BASH=British
tinnitus
Association for the Study of Headache
Headache with x x x
2. Signs and Symptoms
 2. Signs and Symptoms

Red flags warranting urgent investigationprobability of an

underlying tumour is likely to be greater than 1% if any of the
following are present:

1. papilloedema
2. headache with clinical features such as focal neurology
3. new-onset cluster headache
4. headache where abnormalities are found on neurological
examination or other neurological symptoms are present
5. significant alterations in consciousness, memory, confusion, or
problems with co-ordination
6. new epileptic seizure
7. cancer elsewhere in the body, especially breast and lung cancer.
 2. Signs and Symptoms
Orange flags need careful monitoring and a low threshold for
investigation should be maintainedprobability of an underlying
tumour is likely to be between 0.1 and 1% for headache:

1. that is new and without diagnostic pattern after 8 weeks

2. where vomiting also occurs
3. aggravated by physical exertion or Valsalva manoeuvre
4. that is longstanding, but has changed significantly, particularly if
there is a rapid increase in frequency
5. that is new in a patient aged over 50 years
6. awakening from sleep.
 3. Diagnostic

1. Neurologic Examination

2. Radiologic Examination :
Computed Axial Tomography (CAT/CT
Scan)
MRI : Spectroscopy, Perfusion,
functional
Positron Emission Tomography (PET
Scan)
3. Diagnostic
 4. Treatment

Surgery is used to diagnose and treat brain

tumors.
1. Ideally, the brain surgeon (neurosurgeon) can completely
remove a brain tumor with surgery.
2. If complete removal is not possible, the surgeon will remove
as much as possible (called a resection or debulking)
without negatively affecting the brains neurologic functions.
3. If a resection is not possible, then a biopsy will be done
(removing a small piece of tumor tissue) to diagnose the
tumor type and grade so treatment recommendations can be
made.
5. Primary Management
 5. Primary Management

Prehospital Care

supportive and directed to the presenting

symptom complex.

treat seizures in the usual manner.

definitive airway control with endotracheal intubation and,
possibly, hyperventilation in the
airway disturbance, breathing difficulty, signs of pronounced
elevation in intracranial pressure (ICP), and notable impairment of
consciousness may necessitate
 5. Primary Management

Emergency Department Care

Emergency department (ED) treatment of the patient with an
intracerebral neoplasm depends on both the nature of the
tumor and the general condition of the patient.

Decisions regarding surgical resection, initiation of radiation

treatment, and chemotherapy are beyond the scope of practice
of the ED physician.
 5. Primary Management
Corticosteroids
Reduce signs and symptoms related to cerebral edema.
Dexamethasone from 4-24 mg daily.
For patients with impaired consciousness or signs of increased
intracranial pressure (ICP), 10 mg IV [7] or 10-24 mg IV are recommended
as the first dose.

For patients with signs or symptoms of impending herniation and airway

compromise :
1. rapid-sequence intubation.
lidocaine and medication for rapid-onset neuromuscular blockade,
with precautions to diminish fasciculations.
Induction agents, such as thiopental, may be used.
2. hyperventilation.
3. use of mannitol with the appropriate consultant. (concern about rebound
increases in ICP makes its use problematic).
 6. Conclusion
Headache presentation is major symptoms in brain
tumor

There are benefits to early diagnosis of brain tumour

The treatment of brain tumor need a multidisciplinary

team