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Brain tumors

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I. The etiology and prevalence

  • Morbidity.

Primary brain tumors account for 2% of all malignant neoplasms (17 OOO cases per year) and cause 2.5% of deaths from them (10 OOO per year, Table. 14.1). Men suffer 1.5 times more often. The peak incidence occurs at ages 5-10 and 50-55 years. Brain tumor - the most common solid tumors in children (Ch. 18).

  • Etiology
    • Environmental factors (smoking, alcohol, food) does not affect the risk of CNS tumors. Ionizing radiation can induce the formation of meningiomas, schwannomas, sarcomas and astrocytomas. Electromagnetic radiation, including from mobile phones and computers that are not considered to be risk factors. Working with vinyl chloride may increase the risk of astrocytoma, the TM-nitroso compounds, aromatic hydrocarbons, hydrazines and triazeny cause astrocytoma in experimental animals, but the role of these substances in the pathogenesis of CNS tumors in humans is unknown.
    • Hereditary syndromes with skin lesions and CNS
      1. Neurofibromatosis type I
      2. Neurofibromatosis type II
      3. Tuberous sclerosis
      4. Gorlin syndrome, Goltz
      5. Neyrodermalny melanosis
    • Other hereditary syndromes.
      1. Lindaus disease
      2. Turkic syndrome
      3. Li-Fraumeni syndrome
    • Immunodeficiency (for organ transplantation or AIDS) dramatically increases the risk of primary CNS lymphoma.

Name

Age

Localization

Properties

Survival Radiation therapy Chemo-therapy

Astrocytoma

Adults, children less

Supratentorial

Slow growth, sometimes for many years

Median 5 years + In recurrent

Anaplastic

Adults

Supratentorial

The rapid growth

Medina 2.5 years + +
Glioblastoma

Adults
elderly

Supratentorial

Rapid growth, a very aggressive

Median 1 year + +
Oligodendro-glioma Any

Supratentorial, often in the frontal lobes

Often causes epileptic seizures

Median 5 years + +
Brain stem glioma

Children, adults rarely

The brain stem, especially the bridge

Severe complications due to destruction of cranial nerves

Median 1 year + Rarely

Pilotsitarnaya
astrocytoma

Children, adults rarely

Cerebellum, hypothalamus

The cure for radical surgery

Ten-year 80% + +

Ependymoma

Children
Adults

Fourth ventricle, the filum terminale

The cure for radical surgery; dissemination of likvoroprovodyaschim paths

Five-year 70% + Rarely

Medullobla stoma

Children, adults rarely

Cerebellum

Dissemination of likvoroprovo-dyaschim paths

Five-year
70-80%
+ +

Meningoblastoma

Adults

The surface of the hemispheres, stingray, thoracic spine

More common in women, treatment with radical surgery

Long-term + Rarely

Primary CNS lymphoma

Adults

Multitsentrichesky growth, around the ventricles

Dissemination of likvoroprovo dyaschim-paths of the eyes

Median 3-5 years + +

Germinoma

10-30 years

Pineal gland, over the Turkish saddle

High sensitivity to chemotherapy and radiation

Five-year 80% + +

Other Hermine-gene tumor

10-30 years

Pineal body

The morphology of the different and often identifies tumor markers

Five-year 25% + +

II. Diagnostics.

  • The clinical picture
    • Headache occurs in about 50% of cases, most often in young patients with rapidly growing tumors. The pain is usually deep, dull, and rarely severe or throbbing. Characterized by its gain in the morning, straining and lifting weights. Sometimes the pain is concentrated in one spot, corresponding to the tumor.
    • Epileptic seizures. The appearance of seizures in the age of 20 in 20% of cases are caused by a tumor.
    • Increased intracranial pressure is due to large tumor size or blockade likvoroprovodyashih tract (obstructive hydrocephalus).
    • The symptoms of supratentorial tumors usually patchy: hemiparesis (tumors of the frontal lobes), aphasia (left frontal and posterior temporal lobe), gemiagnoziya (parietal lobes), hemianopsia (occipital lobe).
    • The symptoms of tumors of the hypothalamus. There may be a violation of thermoregulation, diabetes insipidus, increased appetite, loss of visual field (with the involvement of the optic chiasm).
    • The symptoms of brain stem tumors (eg glioma) - the defeat of several cranial nerves, hemiparesis, ataxia.
    • Symptoms of nerve tumors (eg, schwannoma preddverno-cochlear nerve) nerve dysfunction, symptoms of compression of surrounding neural tissue (large tumors).
    • Symptoms of cerebellar tumors: dismetriya, ataxia, dizziness, nystagmus, headache, and vomiting.
    • Symptoms of spinal cord tumors: a lower spastic paraparesis and disturbance sensitivity below level of lesion, urinary incontinence and cap.
    • Symptoms of tumor infiltration of the meninges: disturbances in several parts of the CNS, as well as seizures and confusion. The defeat of the envelopes cause medulloblastoma, pineoblastoma, germ cell tumors, primary CNS lymphoma and sometimes ependymoma, although the bowl there are extracranial metastases of tumors (Ch. 32).
  • Survey
    • CT and MRI
    • Lumbar puncture
    • Angiography
    • Additional inspection
  • Survival rate.
Median survival for astrocytomas composes about 5 years in anaplastic astrocytomas - 2.5 years and in glioblastoma - 1 year. Five-year survival rate for glioblastoma - about 5%.
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