Introduction to Brain Tumours: The Molly Lane Fox Brain Tumour Unit - - PowerPoint PPT Presentation

Introduction to Brain Tumours: The Molly Lane Fox Brain Tumour Unit

Dr Jeremy Rees National Hospital for Neurology and Neurosurgery Institute of Neurology, UCL

Brain Tumours

A lump in the head?

• Growth of abnormal cells arising from

normal brain structures

• May be Primary

e.g. glioma, germinoma, meningioma – these may be benign

• r malignant
• Or Secondary e.g. from breast, lung

cancer – these are always malignant

The Cancer Premiership Table

Brain Tumours Across the Ages

Brain anatomy

The Human Brain

The simplified human brain

Structure Function

Medical approach to brain tumours

Position in relation to the brain

INTRINSIC (e.g. glioma, lymphoma, germinoma) EXTRINSIC (e.g. meningioma, nerve sheath tumour)

Classification of Brain Tumours

BENIGN MALIGNANT

CELLULARITY, PLEOMORPHISM, MITOTIC ACTIVITY VASCULAR PROLIFERATION, NECROSIS

WHO Grading System

I II III IV

CELLULARITY, PLEOMORPHISM, MITOTIC ACTIVITY VASCULAR PROLIFERATION, NECROSIS

WHO Grading System

BENIGN

(low grade)

MALIGNANT

(high grade)

I II III IV

WHO Grading System

BENIGN

(low grade)

MALIGNANT

(high grade)

I II III IV

transformation

On the scan

On the operating table

Under the microscope

Diffuse astrocytoma (WHO grade II)

Frequency distribution of primary intracranial tumours

Tumour type Relative frequency

Glioma (all types) 60%

Meningioma 20% Pituitary adenoma 10%

Others 10%

How do brain tumours present?

Headache

Seizure

Neurological deficit

Location and speed of growth

• Slow –

growing tumours rarely cause headache – unless in children at the back

• f the brain
• Fast –

growing tumours cause headache and

• ther neurological problems e.g. loss of

function

• Tumours at the surface can cause seizures
• Deep-seated tumours can cause memory

loss, confusion and unsteadiness

First presenting symptoms

First symptom At hospital presentation Headache 23.5% 46.5% Seizure 21.3% 26.5% Confusion 4.5% 30.6% Personality problem 1.6% 21.6% Visual problem 3.2% 26.1% Language 5.8% 35.5% Unilateral weakness 7.1% 35.8% Unilateral numbness 2.3% 17.1% Unsteadiness 6.1% 41.6% Diplopia 0.3% 10.0% Other 24.2%

Headache, vomiting, blurred vision

Seizure

Confused, off legs

How do we treat brain tumours?

Treatments for Brain Tumours

• Surgery



Biopsy



Debulking



Resection

• Oncology



Radiotherapy



Chemotherapy



New agents

The Molly Lane Fox The Molly Lane Fox Brain Tumour Unit Brain Tumour Unit

The problem of Brain The problem of Brain Tumour Tumour

• Poor survival

Poor survival – – 15% at 5 years for 15% at 5 years for malignant malignant tumours tumours

• Fragmented care

Fragmented care -

• poor patient

poor patient experience experience

• Complex needs

Complex needs

• Rare disease, therapeutic nihilism

Rare disease, therapeutic nihilism

• Small numbers of clinical trials

Small numbers of clinical trials

The Multidisciplinary Team

Brain Tumour Unit Brain Tumour Unit

• Weekly Multidisciplinary Team Meeting
• Brain Tumour Office
• Clinical Trials and links with UCL Cancer

Institute

• UCL Partners Integrated Cancer System
• Patient Focus Groups, Online patient

feedback

Molly Lane Fox Unit Molly Lane Fox Unit

• First dedicated brain tumour unit nationally
• £

2.5 million raised by the National Brain Appeal and Molly’s Fund

• Mission Statement:

‘to provide multidisciplinary, high-quality, research-based and compassionate treatment, care and support to patients with brain tumours and their families and carers’

Molly Lane Fox Unit Molly Lane Fox Unit

• A dedicated in-patient space for

patients with brain tumours

• Assessment room for patients in DGHs

without the need for admission

• Treatment room
• Therapy input
• Patient experience -

quiet room, patient literature etc

And Finally And Finally

• The dichotomy between medical

science and patient care

• The need to improve the patient

experience

• The need to improve patient
• utcomes

Any Questions?