Tumor

Tumor

Signs and Symptoms
1. Headaches
2. Nausea
3. Difficulty with balance
4. Speech difficulties
  1. Types
    1. Apraxia of speech
    2. Cluttering
    3. Dysarthria
    4. Dysprosody
    5. Muteness
    6. Speech Sound Disorders
    7. Stuttering
    8. Voice Disorders
5. Confusion
6. Seizures
7. Hearing problems
8. Behavior changes
10. Limb Weakness
11. Vomiting
  1. Causes
    1. Central nervous system
      1. Closed head injury
      2. Increased ICP
      3. Migraine
      4. Seizures
      5. Vestibular
    2. Gastrointestinal
      1. Functional disorders
      2. Obstruction
      3. Organic disorders
    3. Infectious
    4. Medications and Toxins
    5. Metabolic
    6. Miscellaneous
      1. Acute glaucoma
      2. Psychiatric disorders
      3. Acute MI
      4. Nephrolithiasis
      5. Pain
12. Loss of consciousness
Eye
1. Normal
  1. Muscles
  2. Visual Pathway
    1. 1- Retina
      1. 2- Optic nerve
        3- Optic chiasma
        4- Optic tract
        5- Lateral Geniculate Body (L.G.B.) - Diencephalon
        6- Optic radiation
        7- Primary visual cortex (visual cortex, area 17)
2. Abnormal
  1. Double Vision
    1. Causes
      1. Brain problems
        Migraine
        Increased ICP
      2. Nerve problem
        Diabetes
        Myasthenia gravis
        MS
        Guillain Barre syndrome
      3. Cornea Problems
        Astigmatism
        Dry eyes syndrome
        Infections
      4. Lens Problems
        Cataract
      5. Eye Muscle Problems
        Strabismus
        Graves disease
Risk factors
1. Age
2. Home & Work Exposures
3. Gender
4. Family History
5. Exposure to infections, viruses and allergens
6. Electromagnetic fields
7. Race and ethnicity
8. Ionizing Radiation
9. Head Injury & Seizures
Metastatic (50%) / Primary (50%)
1. Primary tumors
  1. In adults are usually supra-tentorial
  2. In children are usually infra-tentorial
  3. Rarely metastasize outside the CNS
  4. Classification
    1. Tumors of neuroepithelial tissue
      1. Gliomas
        Astrocytoma
        Infiltrating astrocytic tumors
        Diffuse astrocytoma, grade II
        Moderate cellularity / No anaplasia
        Mild to moderate increase in the number of glial cell nuclei / Variable nuclear pleomorphism / Branching fibrillary processes
        Anaplastic astrocytoma, grade III
        Cellularity, anaplasia, mitoses
        More cellular areas / Greater nuclear pleomorphism / Mitotically active cells are often
        Glioblastoma, grade IV
        Most common primary malignant tumor in adults usually arises in the cerebral hemisphere
        Malignant, high-grade tumor
        Characteristically crosses the corpus callosum (butterfly lesion)
        Tumor cells are GFAP positive
        Poor prognosis, death in less than one year
        Marked anaplasia and pleomorphism / Pronounced vascular changes with endothelial hyperplasia (glomeruloid appearance / Areas of necrosis surrounded by tumor cells (pseudopalisading)
        Localized astrocytic tumors
        Pilocytic astrocytoma, grade I
        Benign cytological features
        Associated with a variety of acquired mutations
        Mean survival 6-8 years
        Aggressive, affect older patients
        Oligodendroglioma
        Closely packed cells with large round nuclei surrounded by a clear halo of cytoplasm “Fried egg” appearance of cells"
        Long survival (5-10 yrs)
        Ependymoma
        Tubules, rosettes with cells encircling vessels or pointing towards a central lumen / Perivascular pseudo-rosettes are a characteristic finding on biopsy
        Recur after surgery, acquire more aggressiveness
      2. Choroid plexus tumors
      3. Neuronal tumors
      4. Tumors of the pineal region
    2. Embryonal tumors
      1. Medulloblastoma, grade IV
        Histology reveals small round blue cells, homer- wright rosettes present
      2. Craniopharyngioma
    3. Tumors of cranial nerves
      1. Schwannoma
        Two patterns (Antoni A interlacing bundles of elongated cells with palisading of nuclei / Antoni B looser, less cellular pattern than Antoni A)
      2. Neurofibroma
      3. MPNST
    4. Tumors of the meninges
      1. Meningioma
        Good prognosis
    5. Tumors of the sellar region
      1. Pituitary adenma
    6. Metastatic
      1. Mostly carcinomas
      2. Common primary sites (Breast / Lung / Skin / Kidney / GIT)
      3. Single or multiple lesions
      4. May be the first presentation of the primary
Investigations
1. Neurological examinations
2. Blood tests
3. X-ray (Skull and Chest)
4. Brain scans
  1. CT) / Contrast enhancement
  2. MRI / Contrast enhancement
  3. Positron emission tomography (PET)
5. Single photon emission computed tomography (SPECT)
6. Ultrasound imaging (Neurosonography)
7. Angiography
8. CSF analysis
9. EEG
10. Evoked potentials
11. Biopsy
12. Eye Examination
  1. Cranial nerve
    1. Optic II (vision)
      1. Visual acuity - Eye chart / Visual field – confrontation / Visual reflexes (2-3) & accommodation reflex / Colour vision / Fundoscopy
    2. III, IV and VI (Ocular gaze and posture)
      1. Following finger / Smooth pursuit
Management
1. Treat/Manage Symptoms
2. Surgery
  1. Risks of Surgery
    1. Allergic reaction to anesthesia / Bleeding in the brain / Blood clot / Brain swelling / Coma / Impaired speech, vision, coordination, or balance / Infection / Memory problems / Seizures / Stroke
3. Chemotherapy
4. Radiation
5. Targeted therapy
6. Clinical trials
7. Palliative treatment

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	Created by Moza Rashid about 7 years ago