🧠 Brain tumours can be primary (arising in the brain) or secondary (metastatic from other cancers). Symptoms reflect both the local effects of the lesion and raised intracranial pressure (ICP). Diagnosis relies on neuroimaging and histological confirmation.

🔎 Overview

Primary tumours arise from glial cells, neurons, or meningeal tissue.
Secondary tumours commonly spread from lung, breast, kidney, thyroid, testes, or melanoma.
Neuroimaging (MRI/CT) is essential; biopsy confirms histology.

🧬 Types of Brain Tumour

Primary: Gliomas (astrocytomas, oligodendrogliomas, glioblastomas), meningiomas.
Secondary (metastatic): From lung, breast, colorectal, kidney, testis, melanoma.
HIV-related: Primary CNS lymphoma (B-cell type).

🧾 Clinical Presentation

Headache – classically worse in the morning, aggravated by straining/coughing.
Seizures, personality/behaviour change, stroke-like deficits, or coma.
Raised ICP → nausea, papilloedema, visual disturbances.

📍 Localising Features

Olfactory groove tumour: Anosmia, disinhibition, personality change.
Cavernous sinus tumour: Ophthalmoplegia (CN III, IV, VI, V1, V2 involvement).
Foster Kennedy syndrome: Ipsilateral optic atrophy + contralateral papilloedema (often olfactory groove meningioma).
Pituitary adenoma: Hypopituitarism, headache, bitemporal hemianopia.
Pineal region tumour: Parinaud’s syndrome (loss of upward gaze).

🧪 Investigations

Bloods: FBC, U&E, LFT, ESR/CRP, ± HIV testing.
CXR: To exclude primary lung cancer in suspected metastasis.
Tumour markers: AFP, CEA, CA125, PSA, S-100 depending on suspicion.
Imaging:
- CT head with contrast – tumour enhancement due to BBB breakdown.
- MRI with gadolinium – superior for staging and characterisation.
Biopsy: Required for histology and treatment planning.

🖼️ Example Imaging

Initial CT head

Progressive lesion on Day 15

Confirmed tumour on MRI

💊 Management

Surgery: For histology, debulking, or relieving hydrocephalus.
Chemotherapy: e.g., temozolomide for gliomas.
Radiotherapy:
- External beam (e.g., medulloblastoma, CNS lymphoma).
- Stereotactic radiosurgery for small meningiomas.
Supportive care:
- Anticonvulsants for seizure prophylaxis.
- Dexamethasone for cerebral oedema.
- Neuro-oncology MDT for holistic care.
- Palliative care in advanced/inoperable cases.

💊 Brain Tumour Medications & Supportive Therapy

Drug / Therapy	Indication	Typical Dose	Common Side Effects	Key Contraindications / Cautions
Temozolomide (oral alkylating chemo)	High-grade gliomas (GBM, astrocytomas)	75 mg/m²/day during radiotherapy; 150–200 mg/m²/day × 5 days/month post-radiotherapy	Nausea, vomiting, myelosuppression, fatigue, lymphopenia	Severe myelosuppression, pregnancy, caution in hepatic impairment
Carboplatin / Cisplatin	Pediatric brain tumours, medulloblastoma, CNS metastases	Weight / BSA-based dosing per protocol	Nephrotoxicity, ototoxicity, myelosuppression, nausea	Renal impairment, hearing loss, pregnancy
Dexamethasone (corticosteroid)	Peritumoral cerebral oedema; raised ICP	4–16 mg/day orally or IV, titrated to symptoms	Hyperglycaemia, insomnia, weight gain, immunosuppression, GI upset	Uncontrolled diabetes, systemic infections, peptic ulcer disease
Anticonvulsants (Levetiracetam, Phenytoin)	Seizure prophylaxis / treatment in brain tumours	Levetiracetam 500–1500 mg BID; Phenytoin 100 mg TDS, adjust per levels	Drowsiness, dizziness, irritability, rash (esp. phenytoin)	Allergy, severe hepatic impairment (phenytoin), pregnancy (phenytoin caution)
Radiotherapy	Adjuvant therapy post-surgery; small meningiomas, medulloblastoma, CNS lymphoma	External beam: fractionated doses per tumour type; SRS: single fraction 12–24 Gy	Fatigue, alopecia, skin erythema, nausea; long-term: cognitive decline, radiation necrosis	Pregnancy, prior high-dose cranial irradiation
Supportive / Symptomatic Therapy	Edema, nausea, pain, mood disturbance	Varies: e.g., Mannitol 0.25–1 g/kg IV for acute raised ICP; antiemetics as needed	Fluid/electrolyte shifts, hypotension (mannitol), sedation (antiemetics/opioids)	Severe renal failure (mannitol), hypersensitivity to drugs

💡 Notes: - Always use multidisciplinary discussion (neuro-oncology MDT) for individualised treatment. - Dexamethasone should be tapered as soon as oedema improves to minimise side effects. - Chemotherapy dosing varies with protocol, tumour type, and patient tolerance; monitor blood counts closely. - Anticonvulsants may interact with chemotherapeutic agents (esp. phenytoin/carbamazepine).

💡 Exam Pearls

• Suspect brain tumour if “stroke” symptoms evolve over days/weeks. • Red flags: morning headache, seizures, personality change, progressive neurological deficits. • MRI with contrast + biopsy = gold standard for diagnosis.

📚 References & NICE Guidance

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Brain Tumours ✅