Brain Cancer Lecture Notes

Structure of the Brain

  • Major Portions of the Brain:

    • Cerebrum: Involved in higher brain functions.

    • Cerebellum: Coordinates voluntary movement.

    • Brain Stem: Controls basic life functions like breathing and heart rate.

  • Meninges and Skull: Protective layers surrounding the brain.

  • Brain divisions:

    • Diencephalon, Midbrain, Pons, & Medulla oblongata.

    • Corpus Callosum: Connects the left and right hemispheres.

Brain Functions

  • Brain tumors can disrupt normal functions by damaging healthy brain tissue.

Case Study Evaluation

  • Evaluating potential cancer diagnosis through brain function assessment.

Understanding Occam’s Razor

  • Definition: Refers to the principle of "shaving away" unnecessary assumptions. The simplest solution is preferred.

  • Application in diagnostics: Assume simpler causes for multiple symptoms.

    • Example: Bright Light Flash

    • Possibilities: Lightning vs. UFO; simpler explanation preferred.

    • Example: Urinary Problems in a 71-Year-Old Woman

    • UTI vs. Chlamydia; likelihood assessed.

Brain Anatomy and Functions Recap

  • Parietal Lobe: Sensory information coordination, perception, spatial relationships, recognition.

  • Occipital Lobe: Responsible for sight and visual information processing.

  • Cerebellum: Coordinates voluntary movements.

  • Brain Stem: Alerts, regulates breath, digestion, heart rate, and circulation.

  • Frontal Lobe: Handles executive functions, attention, and decision-making.

  • Temporal Lobe: Manages hearing, memory, and language comprehension (Wernicke's and Broca's areas).

Symptoms of Brain Tumors

  • Common Symptoms:

    • Morning headaches indicating increased intracranial pressure (ICP).

    • Projectile vomiting due to ICP increases.

    • Decreased consciousness and changes in mental state.

    • Seizures occurring for the first time.

    • Stiffness or pain in the neck.

    • Visual disturbances (loss or obscurations).

    • Cognitive difficulties and ataxia (coordination issues).

    • Generalized weakness (paresis).

    • Increased appetite loss.

Brain Cancers Overview

  • Primary Cancers: Develop mainly from cells in the central nervous system (CNS), primarily glial cells.

  • Statistics:

    • Approximately 1,500 cases per year in Denmark.

    • Approximately 25,000 cases annually in the US.

    • Most common in individuals over 65 years.

    • Brain and spinal tumors are the second-most common in children, next to leukemia.

Types of Brain Tumors

  • Any intracranial tumor can invade or impact critical brain areas, leading to neurological issues.The primary types include gliomas, meningiomas, and pituitary adenomas, each presenting unique growth patterns and treatment challenges.

Tumor Statistics

  • Statistics on brain tumors disaggregated by malignancy:

    • Malignant Tumors: 32% of cases.

    • Non-Malignant Tumors: 68% of cases (including specific types like ependymal tumors and meningiomas).

    • Discuss the five-year survival rates across different brain tumor types.

Glioblastoma Multiforme (GBM)

  • Prevalence: Most common malignant brain tumor, accounting for over 60% of cases in adults.

  • Prognosis: Poor median survival time of 14-15 months from diagnosis.

  • Common Complications: Seizures, edema, increased ICP, thromboembolism, cognitive dysfunction, and fatigue.

GBM Treatment Options

  • Symptom Management: High-dose corticosteroids for edema.

  • Surgical Intervention: Recommended protocol includes Stupp regimen:

    • PS of 0-2: Radiotherapy + concomitant temozolomide chemotherapy until progression, total dose of 60 Gy (2 Gy per day for 6 weeks).

  • Survival Statistics:

    • 2-year survival: 26.5% with Stupp protocol.

    • 10.4% with radiotherapy alone plus supportive medicines.

Factors Influencing Treatment Response

  • Checking if the tumor's MGMT methylation status: Determines response to chemotherapy.

  • MGMT methylation leads to decreased DNA repair, enhancing chemotherapy efficacy.

  • Exploration of targeted therapies aimed at specific molecular alterations, ongoing research involving radioligand and immunotherapy.

Journal Club Discussion

  • Focus: A scientist's experience testing new medicine on himself for glioblastoma; reference to specific article on neoadjuvant triplet immune checkpoint blockade in glioblastoma.

Take-Home Messages

  • Always apply Occam’s Razor when diagnosing conditions.

  • Formulate at least three potential diagnoses based on presented symptoms.

  • Various imaging modalities have pros and cons, but MRI with contrast is best suited for tumor detection.

  • Recognize the classic signs and symptoms of brain tumors, especially red flags related to brain anatomy.

  • GBM is acknowledged as the most prevalent malignant brain tumor in adults.

  • The treatment plan for GBM includes surgery and adherence to the Stupp regimen while managing symptomatic issues such as seizures and nausea.