BRAIN TUMOR

NEERAJ MAURYA
 NEW MASS GROWTH.

 ABNORMAL, UNCONTROL,
IMMATURE, CONTINOUS CELL
DIVISION/PROLIFERATION
KNOWN AS TUMOR.
Brain tumors – classification
• Neuroepithelial tumors
• Tumors of the peripheral nerves
• Tumors originated from the meninges
• Tumors of the hemopoietic system,
affecting nervous system
• Germinal tumors
• Sellar tumors
• Tumors, spreading from the surounding
structures to the brain
• Metastatic tumors
 Neuroepithelial tumors

• Gliomas
The most common type of primary brain tumor is a glioma.
Gliomas begin from glial cells, which are the supportive
tissue of the brain. There are several types of gliomas,
categorized by where they are found, and the type of cells
that originated the tumor. The following are the different
types of gliomas:
• Astrocytomas
• Brain stem gliomas
• Ependymomas
• Optic nerve gliomas
• Oligodendrogliomas
• Pineocytoma / pineoblastoma
 Astrocytomas

 Astrocytomas are glial cell tumors that are derived

from connective tissue cells called astrocytes.
 These cells can be found anywhere in the brain or
spinal cord.
 Astrocytomas are the most common type of
childhood brain tumor, and the most common type of
primary brain tumor in adults.
 Astrocytomas are generally subdivided into high-
grade, medium-grade or low-grade tumors.
 In adults, astrocytomas are more common in the
cerebral hemispheres (cerebrum), where they
commonly cause increased intracranial pressure
(ICP), seizures, or changes in behaviour.
 In children, astrocytomas are more common in the
cerebellum, where they are called cerebellar
astrocytomas. They have problems with walking and
coordination, as well as double vision.
 Brain stem gliomas
 Brain stem gliomas are tumors found in the brain
stem.
 Brain stem gliomas occur almost exclusively in
children; the group most often affected is the school-
age child.
 The child usually does not have increased
intracranial pressure (ICP), but may have problems
with double vision, movement of the face or one side
of the body, or difficulty with walking and
coordination.
Ependymomas
 Ependymomas are also glial cell tumors. They
usually develop in the lining of the ventricles or
in the spinal cord.
 This type of tumor mostly occurs in children
younger than 10 years of age.
 Two percent of brain tumors are ependymomas.
Optic nerve gliomas
 Optic nerve gliomas are found in or around the
nerves that send messages from the eyes to the
brain.
 They are frequently found in children who have
neurofibromatosis.
 these tumors are usually located at the base of
the brain where hormonal control is located.
 These are typically difficult to treat due to the
surrounding sensitive brain structures.
 Oligodendrogliomas

 This type of tumor also arises from the supporting

cells of the brain. They are found commonly in the
cerebral hemispheres (cerebrum).
 Seizures are a very common symptom of these
tumors.
 These tumors have a better prognosis than most other
gliomas, but they can become more malignant with
time.
 About two percent of brain tumors are
oligodendrogliomas.
Pineocytoma / Pineoblastoma

 This is extremely rare tumors, originated from

pineal cells of brain.
 These are less well differentiated and show more
malignant feature.
 Tumors of peripheral nerves

Schwannoma: Originated from the sheet of the

intracranial segment of cranial nerves, especially VIII
(vestibulo-cochlear, vestibular part)-Acoustic
neurinoma, Cerebello-pontine angle tumor.
 Usually localized to the intra-canalicular part of the
nerve, later growing out, compressing brainstem.
 It is benign tumor, has slow growth, and may be
bilateral.
 Commonly, they present with loss of hearing, and
occasionally loss of balance, or problems with
weakness on one side of the face.
Tumors originated from the meninges
Meningiomas:
 Meningiomas are usually benign tumors that
come from the meninges, in the outer coverings
of the brain just under the skull.
 They are slow growing and may exist for years
before being detected.
 Meningiomas are most common in older
patients, with the highest rate in people in their
70s and 80s.
 They are commonly found in the cerebral
hemispheres just under the skull.
 Originated from cells of the arachnoidea.
 May be anywhere on meninges, but there are
typical sites:
◦ Fronto-basal (olfactory groove, Foster-
Kennedy syndrome)
◦ Convexity, Sphenoid bone, Parasellar, Falx
cerebri, Tentorium, Clivus.
Note: Meningeal Sarcoma and primary Meningeal
Melanoma are extremely rae tumors.
Tumors of the hemopoietic system
Primary nervous system lymphomas:
 B-cell originated tumor, non-Hodggkin
lymphoma.
 Occurs in immunsuppressed patients, mainly in
AIDS.
 MRI shows Round-like, sometimes multiple
lesions, usually close to CSF. Brain biopsy is
necessary.
 Treatment: corticosteroids decrease the size of
the tumors.
Germinal tumors

Germinoma:
 Primitive spheroidal cell tumor, coparable to
seminoma of testis.
Teratoma:
 A tumor containing a mixture of well
differentiated tissues like: dermis, muscles,
bone.
Sellar tumors or Pituitary tumors

Pituitary adenomas.
 Originated from endocrine gland cells of the
pituitary glands.
 The pituitary gland is a gland located at the base
of the brain. It produces hormones that control
many other glands in the body.
 Micro or macro-adenomas, Intra or suprrasellar
masses.
 Hormonally active or inactive.
Causes hormonal dysfunction

Hyperfunction
◦ hyperprolactinaemia (galactorrhoea,
amenorrhoea)
◦ GH overproduction (acromegaly)
◦ ACTH overproduction (Cushing disease)
◦ TSH overproduction (central
hyperthyreoidism)
Hypofunction:
decrease of one or all the upper hormones
(panhypopituitarism) Caused by compression of
the functioning normal gland tissue.
Metastatic brain tumors
 In adults, metastatic brain tumors are the most
common type of brain tumors.
 they spread in the brain through the local
invasion, lymphatic spread, bloodstream and
transcoelomic spread.
 These are tumors that begin to grow in another
part of the body and reached to the brain.
Mainly affect the Cerebral Hemisphere and
Cerebellum.
Metastatis brain tumors, in order of
frequency:

 Lung 64%
 Breast 14%
 Unknown origin 8%
 Malignant melanoma 4%
 Colorectal 3%
 Kidney 2%
 Others 5%
Aetiology
1. Genetic Factor:
 Normal cell growth and differentiation is
controlled by gene.
 There are three main gene which controlled the
normal cell growth and differentiation:
 Viral oncogene
 Proto oncogene
 Cellular oncogene
 Any alteration in these gene expression may
change the normal cellular state into malignant
state.
 Inactivation of expression of tumor suppressor
gene.
 Over expression of gene controlling growth
factor- Amplification.
2. Prolong use of clinical irradiation
3. Prolong use of immunosuppression
4. Use of cellular telephones
5. Exposure to high-tension wires
6. Use of hair dyes
7. Head trauma
8. Dietary exposure to n-nitrosurea
compounds
 Clinical Feature
 Symptoms of brain tumors are vary depending on the
size and location of tumor.
 Many symptoms are related to an increase in pressure
in or around the brain.
 There is no spare space in the skull for anything
except the delicate tissues of the brain and its fluid.
 Any tumor, extra tissue, or fluid can cause pressure
on the brain and result in increased intracranial
pressure (ICP).
Increased ICP may cause the following:

 Headache
 Vomiting (usually in the morning)
 Nausea
 Personality changes
 Irritability
 Drowsiness
 Depression
 Decreased cardiac and respiratory function and,
eventually, coma if not treated.
 Symptoms of brain tumors in the cerebrum may
include:

 Symptoms caused by increased intracranial pressure

 Seizures
 Visual changes
 Slurred speech
 Paralysis or weakness on half of the body or face
 Drowsiness and/or confusion
 Personality changes/impaired judgment
 Short-term memory loss
 Gait disturbances
 Communication problems
Symptoms of brain tumors in the brainstem
(base of brain) may include:
 Symptoms caused by increased intracranial pressure
(ICP)
 Seizures
 Endocrine problems (diabetes and/or hormone
regulation)
 Visual changes or double vision
 Headaches
 Paralysis of muscles of the face, or half of the body
 Respiratory changes
 Clumsy, uncoordinated walk
 Hearing loss
 Personality changes
Symptoms of brain tumors in the cerebellum (back of
brain) may include:

 Symptoms caused by increased intracranial

pressure
 Vomiting (usually occurs in the morning without
nausea)
 Headache
 Uncoordinated muscle movements
 Problems walking
 Investigation / Diagnosis
 In addition to a complete medical history and
physical examination, diagnostic procedures for brain
tumors may include the following:
 Skull X-ray - a diagnostic test which uses invisible
electromagnetic energy beams to produce images of
internal tissues, bones, and organs onto film.
◦ Beaten brass appearance & suture separation seen
in raised ICP (generally in children).
◦ Calcification shows glioma.
◦ Osteolytic lesion shows basal tumor of skull.
 Chest X-ray – used to identify metastatic tumor.

 Brain CT (Computed tomography) scan:

◦ A diagnostic imaging procedure that uses a
combination of x-rays and computer technology to
produce cross-sectional images (often called slices),
both horizontally and vertically, of the body.
◦ Administration of contrast media (containing
iodine) is necessary.
◦ CT scan shows detailed images of any part of
the body, including the bones, muscles, fat,
and organs. CT scans are more detailed than
general x-rays.

◦ CT is not proper for small tumors, mainly in

the posterior fossa. CT is prior to MRI in
evaluation of intratumoral calcification and
bone destruction.
 Magnetic resonance imaging (MRI) of Brain:
◦ The proper method of diagnostics of brain tumors.
that uses a combination of large magnets,
radiofrequencies, and a computer to produce
detailed images of organs and structures within the
body.
◦ More detailed spatial resolution, multi-planar
imaging, all parts of the brain are well visualized.
◦ Special tchniques (diffusion, perfusion MR, MR-
angiography, MR spectroscopy, functional MRI,
contrast enhanced MR)
◦ The best method for surgical planning.
 Angiography:
◦ Disclosing of the blood supply of some hyper-
vascularized tumors (e.g. angiomas,
meningiomas)
 Myelogram:
◦ A procedure that uses dye injected into the
spinal canal to make the structure clearly
visible on x-rays.
 Brain SPECT and PET:

◦ Evaluation of circulation and metabolism of

tumors.
◦ Differentation between tumors and lesions of other
nature in in contraversary cases.

 Brain biopsy:

◦ CT assisted, “stereotaxic” procedure. Exact

histological classification of tumors and Grading.
 Additional tests:

◦ CSF examination.
◦ EEG
◦ Evoked potentials.
◦ Hormonal tests.
◦ Genetics.
 Grading of tumor
 GX Grade cannot be assessed
 G1 Well differentiated (Low grade)
 G2 Moderately differentiated (Intermediate
grade)
 G3 Poorly differentiated (High grade)
 G4 Undifferentiated (High grade)
Four-tier grading scheme
 Grade 1 Low grade, Well-differentiated
 Grade 2 Intermediate grade, Moderately-
differentiated
 Grade 3 High grade, Poorly-differentiated
 Grade 4 Anaplastic, Anaplastic
Three-tier grading scheme
Grade 1 Low grade, Well-
differentiated
 Grade 2 Intermediate grade
 Grade 3 High grade, Poorly-
differentiated
Two-tier grading scheme
Grade 1 Low grade, Well-differentiated
 Grade 2 High grade, Poorly-
differentiated
Management
 Specific treatment for brain tumors will be
determined by:

◦ age, overall health, and medical history

◦ Type, location, and size of the tumor
◦ Extent of the condition
◦ tolerance for specific medications, procedures,
or therapies
◦ Expectations for the course of the condition
◦ opinion or preference
 Steroid Therapy:
◦ Steroids are used to reduced oedema surrounding
intracranial tumor, but they do not affect tumor growth.
 Radiotherapy:
◦ Radiation therapy kills brain tumor cells with high
energy x-rays, gamma rays and protons.
◦ Radiation therapy usually follows surgery because
kills tumor cells may remain in brain area.
◦ Radiotherapy broadly divided into two group:
1. External radiation therapy
2. Internal radiation therapy
1. External radiation therapy:
◦ Fractionated external beam therapy is most common
method of radiation therapy used for people with
brain tumor.
◦ Treatment depends on age, type & size of tumor.
◦ Treatment are usually 5 days a week for several
weeks with the aim of killing tumor cells and
protecting healthy cells / tissues in the area of tumor.
Generally used external radiation therapy are:
 Intensity modulated radiation therapy or 3-
dimensional conformal radiation therapy
 Proton beam radiation therapy
 Stereotactic radiation therapy
2. Internal radiation therapy:
 Also known as implant radiation therapy and Brachytherapy.
 Internal radiation is not commonly used to treating brain
tumor and is under study.
 A very small amount of radioactive material implanted inside
the brain called seeds.
 Radiations comes from these radioactive seeds and give off
for the months. They do not need to be removed once the
radiation is gone.
 E.g. Iodine125
 Complications:
◦ Increased oedema - cognitive impairment
◦ Demyelination -radiation induced tumor
◦ Radionecrosis
 Chemotherapy:
 Operative management:
 Newer therapies that may be used to treat brain
tumors:
Stereotactic radiosurgery :
A new technique that focuses high doses of radiation at
the tumor site from many different angles, while sparing
the surrounding normal tissue, with the use of photon
beams from a linear accelerator or cobalt x-rays.
Gene therapy:
A special gene is added to a virus that is injected into the
brain tumor. An antivirus drug is then given which kills
the cancer cells that have been infected with the altered
virus. this is still considered an experimental treatment.
Chemotherapy wafers:
Wafers containing a cancer-killing drug, BCNU, are
inserted directly into the area of the brain tumor during
surgery.
Targeted therapy:
Newer drugs that are aimed at specific parts of tumor
cells that help them grow. For example, a drug called
bevacizumab affects a tumor's ability to make new blood
vessels. It may be helpful for glioblastomas in adults.
Electric field treatments:
Electrodes are placed along the scalp to provide a mild
electric current that may affect tumor cells more than
normal brain cells.
Long-term outlook &Prognosis
 Prognosis greatly depends on all of the
following:
◦ Type of tumor
◦ Extent of the disease
◦ Size and location of the tumor
◦ Presence or absence of metastasis
◦ The tumor's response to therapy
◦ Age, overall health, and medical history
◦ Tolerance of specific medications, procedures, or
therapies
◦ New developments in treatment
 As with any cancer, prognosis and long-term
survival can vary greatly from individual to
individual.
 Prompt medical attention and aggressive therapy
are important for the best prognosis.
 Continuous follow-up care is essential for a
person diagnosed with a brain tumor.
 Side effects of radiation and chemotherapy, as
well as second malignancies, can occur in
survivors of brain tumors.
 Physiotherapy Management
 Physiotherapy assessment and management
based on physical & functional dysfunction.
 It is more often other brain conditions like –
Stroke.
Awareness of surroundings
are good…

But…..

Action taken against

them are Best…….
THANK
YOU