1. Brain Tumor Information Module

2. Basic Brain Information and Anatomy

3. The brain is the major control center of a person’s body and mind
The brain is the major control center of a person’s body and mind. It is where ideas, senses, reflexes and movements originate. The human brain is extremely complex, but can be roughly organized into different structures that are responsible for different tasks.

4. Cerebral Cortex
-The largest, most familiar part of the brain
-Divided into left and right cerebral hemispheres that control the opposite sides of the body
-responsible for reading, speech, thinking, learning, emotions, and reactions to senses.
- Can be divided into more specific areas…

5. Divisions of the Cerebral Cortex
Frontal Lobe- gives you the ability to choose right from wrong, use correct social responses, and retain long term memories
Temporal Lobe – involved with speech, memory and hearing
Occipital Lobe – processes visual stimuli
Parietal Lobe – processes information to help with spatial orientation, manipulation of objects and understanding numbers

6. Inner Brain
The inner brain lies beneath the cerebral cortex and works as a connection between the cerebral cortex and the brainstem. Its structures determine our emotional state, consciousness, perceptions and reflexes.

7. Inner Brain Structures
Thalamus – processes information from the cortex and plays an important role in consciousness
Hypothalamus – Links the nervous system to the endocrine system, which makes it a major control center for emotions
Hippocampus – Responsible for memory formation and storage
Pituitary Gland – Controls hormone secretion

8. Inner Brain Structures
Basal Ganglia – A collection of nuclei that provide connections between the cortex, thalamus, and brainstem. These connections are involved with movement coordination, executing voluntary movements, perception, learning and memory.
Olfactory Bulb – Involved with smell.
Amygdala – Controls emotions, especially by forming emotional memories, and is also responsible for long-term memory.

9. Brain Stem
Responsible for essential life functions and relays information between the brain and the rest of the body
Midbrain – Controls reflexes and movement.
Pons - Responsible for breathing and arousal, and also coordinates movement information between the cortex and cerebellum.
Medulla – Maintains autonomic functions like breathing, blood pressure, and heart rate.

10. Cerebellum
Detects surroundings and coordinates movements to respond to specific situations

11. Important Links Brain Anatomy (for fun) 3-D Brain Anatomy

12. Question What are the 4 main lobes of the Cerebral Cortex?
What actions is the Cerebral Cortex responsible for?

13. Answer: The Cerebral cortex is responsible for: Frontal lobe
Long term memories, social interaction
Parietal lobe
Spatial orientation, object manipulation
Occipital lobe
Processing visual stimuli
Temporal lobe
Involved in speech, memory, and hearing

14. Meninges
The brain is a floating network of cells suspended in Cerebrospinal fluid (CSF). The CSF is produced by ependymal cells and circulates through the ventricles and meninges. The meninges cover the brain and attach it to the skull.

15. Meninges We have 3 Meninges Dura Mater Arachnoid Mater Pia Mater
The tough layer next to the skull
Arachnoid Mater
The middle layer that is made up of web-like projections that connect the two other layers and allows CSF to flow through
Pia Mater
The thinnest layer that lies closely against the brain

16. Ventricles There are four ventricles
The paired lateral ventricles
Third Ventricle
Fourth Ventricle
They are cavities in the brain that carry and promote the flow of cerebrospinal fluid

17. Question: What are the three Meninges? What flows through the Meninges
What are the big cavities in the brain that hold this fluid?

18. Answer Dura Mater, Arachnoid Mater , Pia Mater Cerebrospinal Fluid
Ventricles

19. Brain Matter
The brain is made up of neurons and glial cells. The neurons carry signals throughout the brain, while the glial cells mainly provide support for the neurons.

20. Neurons 100 billion neurons in the brain Have 3 basic parts Dendrites
Detect signals from the surrounding cells and transmits them to the cell body
Cell body
Contains the nucleus, which is the control center for the cell
Axon
Carries signals from the cell body to the end of the axon
The axon is covered with myelin, which is an insulating sheath that helps to speed up signal movement

21. Glial Cells Estimated 10x more glial cells than neurons
Do NOT chemo-electric carry signals
Main job is to hold neurons in place
Capable of secreting nutrients and other chemicals that can change signals sent throughout the brain

22. Types of Glial Cells Oligodendrocytes Schwann Cells
These cells produce myelin for the nerves outside of the brain and spinal cord
These cells produce myelin (insulating cover) for the nerves in the brain and spinal cord

23. Astrocytes Microglia
Eat foreign entities in the brain – part of the brain’s immune system
Anchor to neurons and provide support
Act as a buffer to absorb chemicals and promote homeostasis in the brain

24. Ependymal Cells Line the ventricles in the brain
Make CSF and helps it flow throughout the ventricles

25. Questions: Are there more neurons or glial cells in the brain?
What is the main role of glial cells?
Specifically, what do Oligodendrocytes do?
Specifically, what do Astrocytes do?

26. Answers:
Glial cells – There is up to ten times more glial cells than neurons
Glial cells provide support
Oligodendrocytes make the insulating cover for neurons (myelin)
Astrocytes anchor neurons and absorb chemicals in the brain

27. Brain Tumor Information
Brain Tumors arise when cell division occurs irregularly and uncontrolled. When more tissue is produced than needed, tumors are formed. They can grow in many different parts of the brain and involve different types of tissues and cells. If tumors are benign, they grow locally and do not spread. If a tumor is malignant, it is invasive and can spread throughout the body.

28. Malignant Brain Tumors
-When determining how malignant a brain tumor is, the cells are examined by a pathologist and given a grade. Brain tumors can be graded using the WHO classification system.
WHO Grade 1 – Well differentiated (Low Grade)
WHO Grade 2 – Moderately differentiated (Intermediate Grade)
WHO Grade 3 – Poorly Differentiated (High Grade)
WHO Grade 4 – Undifferentiated (High Grade)

29. Cell Differentiation Examples
A – Grade 2
B – Grade 3
C – Grade 4

30. Symptoms of a Brain Tumor
By Location:
Frontal lobe
Weakness, personality changes, speech disturbances
Parietal lobe
Loss or changes in sensation, changes in vision
Temporal lobe
Seizures, difficulty understanding, difficulties with language
Occipital lobe
Changes in vision
Cerebellum
Abnormal eye movements, loss of coordination, changes in gait, hearing loss, vertigo, headaches, nausea, vomiting

31. Diagnosis
The process of detecting and treating a brain tumor can be extremely stressful and complicated.
Once a patient goes to see the doctor, they do a basic neurological exam. This exam tests many functions, such as eye movements, pupil reactions, reflexes, hearing, mental abilities, facial movements, and balance and coordination.
If these are abnormal, the doctor may schedule an MRI or a CT Scan

32. MRI – Magnetic Resonance Imaging
The patient lies on a table that slides into a tunnel with a magnetic field
During the scan, radio waves are sent to the head. The different cell types in the brain cause the waves to bend, which are recognized by a computer that forms a picture.

33. CT Scan – Computed Tomography
For a CT Scan, a person is injected with a dye and then lies on a table. A big donut shaped machine circles the head and sends x-ray waves through the brain to measure the amount of rays that are emitted back in the machine vs. the amount that are absorbed. By putting together all of the signals, a computer forms a picture of the brain.

34. Biopsy
Once it is determined that there is a growth in the brain, a biopsy is done in order to make an accurate diagnosis. If the tumor is in an accessible location, a patient may choose to have the whole tumor removed and then send a sample away for the biopsy. If the tumor is inaccessible, a tiny needle can be inserted into the brain to capture a small sample of tissue. Once the samples are attained, they are sent to a neuropatholigst.

35. Pathology
The tissue samples are either frozen or dried, then sliced into very thin sections.
The slices are mounted on to slides and examined with a microscope
First, the cell type that the tumor originated from is determined
Next, the growth rate of the tumor is assessed
Finally, the type and grade of the tumor is diagnosed

36. Pathology Report
When a patient is diagnosed, the details are put into a document called a pathology report. Physicians write them with the intent that other physicians will read them, so they are often complex and difficult to decipher.
Get picture

37. Pathology Report Contents
Main Sections
Personal Information
Name, date of birth, etc.
Clinical History
A brief description of a person’s medical situation
Gross Description
Describes how the tissue looks to the naked eye
Microscopic Description
Describes how the tissue looks under the microscope
Diagnosis
States the final Diagnosis
This is the biggest section of the report that specifically describes the type of tumor, what tissues are involved and patterns of growth. This section provides important information that is used to determine how to treat the patient’s specific tumor type.
Comments

38. Questions What are some symptoms of brain tumors?
How is the level of malignancy graded?
What types of scans are done to see if a person has a brain tumor?
What document gives the results of a tumor analysis?

39. Answers:
Seizure, Nausea, Headaches, Weakness, Fatigue, Mood or Personality changes
WHO grade I-IV
MRI and CT Scan
Pathology report

40. Types of Brain Tumors Some are from a single cell type
Ex.- Astrocytoma, Oligodendroglioma
Some are from a mixed cell type
Ex. – Oligoastrocytoma, mixed glioma
Some are mixed with neurons
Ex. – Ganglioma
Some are from neurons
Gangliocytoma
Some are from other tumors that have metastasized
About 40% of brain tumors are metastatic
The most common cancers that spread
to the brain are lung, breast, melanoma, renal and colon cancers

41. Malignant Brain Tumors

42. Astrocytomas Arise from Astrocyte cells - Astrocytoma Video 4 types
Pilocytic Astrocytoma (grade I)
Occurs mostly in children, benign
Low-Grade Astrocytoma (Grade II)
Can be removed by surgery, but radiation is also recommended
Anaplastic Astrocytoma (Grade III)
Radiation and Chemotherapy recommended
Glioblastoma Multiforme (Grade IV)
Very aggressive and spreads throughout the CNS
Patients usually have neurological symptoms
Radiation and chemotherapy recommended
Account for about 25% of all brain tumors
Life expectancy is about a year
GBM Video

43. Oligodendroglioma Arise from oligodendrocytes
Average age of diagnosis = 35 years
9.4% of all primary brain and CNS tumors
Occur most frequently in the frontal lobe
Primary symptom is usually a seizure
Usually grade II or III
Median survival
11.6 years for grade II
3.5 years for grade III
Usually grows slower than an Astrocytoma

44. Mixed Glioma
Most often a mix between an astrocytoma and an oligodendroglioma = oligoastrocytoma
Primarily occurs people aged 20 – 50
Account for 1% of all brain tumors
Symptoms
Headache
Nausea and vomiting
Behavioral changes
Treatment based on most malignant cell type

45. Intraventricular Tumor
Make up about 10% of CNS tumors
May be composed of surrounding cells
Astrocytoma, Meningioma etc.
May arise from cells lining the ventricle
Ependymoma
5% of CNS tumors
Survival rate of 5-10 years
85% are benign
Tumor can block flow of Cerebrospinal fluid through the ventricles and cause obstructive hydrocephalus
May cause nausea, vomiting, deteriorating mental status, headache, neurological defects
Standard treatment includes surgery, and then radiation and/or chemotherapy if needed

46. Primary CNS Lymphoma 90% are diffuse large B-cell lymphomas
Can also be poorly characterized low-grade lymphomas, Burkitt lymphomas, and T-cell lymphomas
Incidence increasing – especially among immunocompromised patients
Most commonly occurs around age 55
Survival with radiation and chemotherapy is around 44 months

47. Metastatic Brain Tumors
Not a primary brain tumor
Composed of cancer cells that have spread from their original location
Most common:
Breast, Melanoma, Lung, Kidney
Treatment is composed of radiation and surgery if possible
Chemotherapy has not been found to be helpful
Surgery is not done when there are multiple tumors

48. Question What is the name of a Grade IV astrocytoma?
What is the average life expectancy for a Grade IV astrocytoma?
Oligodendrogliomas are usually what Grades?
What is a type of Intraventricular Tumor?

49. Answer:
Glioblastoma Multiforme
1 year
Grade II and III
Ependymoma

50. Benign Brain Tumors

51. Benign Tumors Caused by a group of cells that grow irregularly
Non-invasive and grow slowly
May cause pressure on important brain structures
Can be removed by surgery
Usually don’t grow back

52. Meningioma Arise from the meninges surrounding the brain
Accounts for about 20% of brain tumors
2nd most common brain tumor
Usually occurs during 40’s-60’s
May cause weakness, seizures
Small, slow growing tumors may not need to be treated be treated with surgery,
radiosurgery or radiation therapy

53. Pituitary Tumor Abnormal growth in the pituitary gland
Causes irregular hormone levels
Treatment
Surgery
Expanded Endonasal approach
Radiation
Drugs
To shrink tumor
To treat irregular hormone
levels

54. Other Benign Tumors Central Neurocytoma Chondroma Gangliocytoma
Typically in young adults in lateral ventricles
Chondroma
Arises from cartilage, usually at the base of the skull
Gangliocytoma
Occur in children/young adults and arises from ganglion
Schwannoma
Arise in the nerve sheath and can compress nerves
Cause pain, weakness and numbness

55. Questions What brain structure do Meningiomas arise from?
What can a Pituitary Tumor Cause?

56. Answers
Meninges
Irregular Hormone Levels

57. Treatment

58. Surgery Stereotactic Biopsy Craniotomy
3-D Mapping of the brain and removal of a small amount of specific tissue
Usually done when the tumor can not be removed
Explanation
Craniotomy
Done if the tumor is accessible and can be removed safely
A piece of skull is removed to reach the brain
Surgeons carefully separate tumor from brain tissue and remove as much as possible
Craniotomy video
Craniotomy Video - Dr. Mintz

59. Surgery Expanded Endonasal Approach
Surgeons reach structures in the brain by going through the nasal passages and sinus cavities
Animated Video

60. Chemotherapy Given mainly to high-grade tumors, but may also be
prescribed for low-grade or benign tumors
Designed to prevent cells from dividing or promote cell death
Certain tumors may become resistant to chemotherapy or may simply not react at all
May also kill healthy cells, especially in the gastrointestinal tract

61. Common Chemotherapy Drugs
Temozolomide (Temodar)
Most often prescribed for astrocytomas and other high-grade gliomas
Taken in 28 day cycles
Take pill from days 1-5
No pills from days 6-28
Cycle may be different for some individuals
May cause nausea, fatigue and
constipation

62. Other Chemotherapy Drugs
The PCV Regimen
6 cycles, each lasting 42 Days
Take CCNU pill on day 1
Taken at bedtime, may cause nausea
Vincristine injection on day 8 and 29
Usually given at hospital, may cause temporary nerve damage
Procarbazine pills on days 8-21
Taken at bedtime, may cause nausea, loss of appetite, fatigue, decrease in blood counts

63. Radiation Therapy Stereotactic Radiosurgery Not surgery
Precise radiation therapy given in concentrated beams
Gamma-ray or x-ray beams
Gamma Knife Surgery when gamma rays are used
Beams damage tumor cell DNA, causing it to shrink
Referred to as fractionated stereotactic radiosurgery when multiple treatments are done

64. Other Avastin (Bevacizumab)
Vascular endothelial growth factor-specific angiogenesis inhibitor
Stops the formation of blood vessels, which carry nutrients, into tumors
Often used in conjunction with chemotherapy
First drug that inhibits angiogenisis (blood vessel formation)
Approved in May 2009 for treatment of recurrent glioblastoma.
In IIIrd phase clinical trial for treatment of initial tumor growth

65. Biotherapy (Investigational)
Gene Therapy
Adenoviruses are viruses that can change the DNA composition in the cells that they infect
Made to target tumor cells in order
to change their DNA composition to
include the specific adenovirus DNA
component
Once the tumor cell DNA includes
the adenovirus DNA, it can be targeted
by a specific anti-viral agent
Adenovirus

66. Immunotherapy (Investigational)
Take tumor specific T-cells and helper t-cells (cells in the immune system that fight off disease) from the patient
Use Interleukin-2 to help them grow and duplicate
Transfer the T-cells back into the
body
Tumors inhibit immune system
activity, so this allows the immune
system to gain strength and fight
specific tumor cells
Quattrochi et al:
T-Cell killing a cancer cell

67. Common Medications Steroids – Decadron (Dexamethasone), Prednisone
Used to control swelling in the brain
Also can be prescribed to increase appetite
Side Effects
Insomnia
Weight gain with fat deposition in cheeks
High blood pressure
High blood sugar
Stomach ulcers

68. Common Medications Anti-Seizure Dilantin (Phenytion)
May cause rash
Tegretol (Carbamazepine)
Depakote (Valproic acid)
May cause tremor

69. Common Medications Anti-Nausea Anti-Constipation Zofran Senekot Colace
Usually given along with chemotherapy
Anti-Constipation
Senekot
Colace

70. Questions
What chemotherapy drug is most commonly prescribed for Astrocytomas and Other High Grade Gliomas?
What do radiation beams do to cells?
What are common Anti-Seizure medications?

71. Answers Temozolomide (Temodar)
It kills cell DNA, which causes the cells to shrink and die
Dilantin (Phenytion), Tegretol (Carbamazepine), Depakot (Valproic Acid)

72. Games, Puzzles, Quizzes