1. Brain Tumors 2.21.16 Mark Browning, M.D. IUSME

2. Differential Diagnosis includes: Primary CNS tumor Most common primary sites of brain mets: – Lung – Breast – Melanoma – Renal

3. Secondary Brain Tumors from Mets Breast Lung Kidney Bladder Melanoma Lymphoma Leukemia

4. Non-Glial Brain Tumors Meningioma 35% Pineal Gland Tumors 14% Primary CNS Lymphoma 2% Medulloblastoma 2% Craniopharyngioma 2% Acoustic Schwannoma

5. Brain Tumors….Glial Type Astrocytomas Grades 1,2 & 3 …8% Astrocytoma Grade IV (Glioblastoma) 16% Oligodendriglioma 2% Ependymoma

6. Primary Brain/Spinal Cord Tumors 78,000 Worldwide in 2015 23,000 in USA – 13,000 men – 10,000 women – 4,000 children of the 23,000 16,000 Deaths

8. Prognostic Classification GradeHistologyMedian Survival, Yrs [2] 1Pilocytic astrocytoma>10 2Well-differentiated astrocytoma>5 3Anaplastic astrocytoma3 4Glioblastoma multiforme1 WHO classification system – Tumors classified by cell origin and level of aggression (grades 1-4) [1,2] 1. Wen PY, et al. N Engl J Med. 2008;359:492-507. 2. DeAngelis LM. N Engl J Med. 2001;344:114-123.

9. Distributions of All Giomas Distribution of All Gliomas by Histology Subtypes Glioblastoma 50.7% All other astrocytomas 9.1% Anaplastic astrocytoma 7.9% Diffuse astrocytoma 1.7% Pilocytic astrocytoma 5.7% Oligodendrogliomas 9.2% Ependymomas 5.6% All other gliomas 10.1% CBTRUS Report, 2004-2005.

10. Primary Cancer of the CNS Risk factors: radiation exposure Familial syndromes: – Neurofibromatosis – Von Hippel-Lindau (VHL gene) – Li-Fraumeni (loss of p53)

11. Primary CNS tumors Childhood: most commonly low grade, infra- tentorial location Adults: high grade including GBM, supra- tentorial location Grade determines prognosis

12. CNS Summary Information Childhood tumors: low grade, infra-tentorial Adult tumors: more commonly high grade, supra-tentorial GBM is most lethal

14. Brain Tumors…Symptoms Headaches Seizures Personality Changes Nausea or Vomiting Balance Problems Changes in Speech or Aggressive Behavior Vision or perception problems Lactation, Growth in Hands or Feet

15. Brain Tumor Diagnosis MRI & CT Lumbar Puncture Myelogram Angiogram Biopsy Genetic Testing

16. Therapy of Primary Brain Tumors Glio/Astro Resection Radiation Rx Temadar