Primary brain cancer

Primary brain cancer - Acute

Definition  

Brain tumors are the compilation of intracranial neoplasms; each of these neoplasms is specific regarding biology, prognosis, and treatment ; primary brain tumors exclude metastatic or secondary malignant tumors.

 

Medical History  

* Exposure to vinyl chloride

* Past medical history of Radiation therapy

* Past medical history of Epstein-Barr virus infection

* Past medical history of Solid organ transplant

* AIDS

* Past medical history of Simian adenovirus infection

* Hereditary disease

* Increased dietary intake of fat and cholesterol

* Dietary nitrate intake

 

Findings  

* Headache

* Seizure

* Abducens nerve palsy

* Impaired cognition

* Aphasia

* Visual field defect

* Blurred vision

* Personality change

* Disturbance in mood

* Poor concentration

* Sensory agnosia

* Tactile agnosia

* Graphesthesia absent

* Absence of 2-point discrimination

* Alexia

* Auditory discrimination aphasia

* Inappropriate behavior

* Indifference

* Loss of judgement

* Amnesia

* Reduced concentration span

* Expressive language impairment

* Dysphasia

* Prosopagnosia

* Alexia

* Nystagmus

* Decreased level of consciousness - Acute

* Loss of consciousness

* Nausea and vomiting - Acute

* Loss of appetite

* Intracranial hemorrhage

* Hemiparesis

* Ataxia

* Spasticity

* Muscle weakness

* Dysmetria

* Intention tremor

* On examination - dysdiadochokinesia

* Respiratory depression

* Urinary retention

* Urinary incontinence

 

Tests  

 

Suspected brain tumor and monitoring of known disease regarding extent, recurrence, and response to therapy  

* Magnetic resonance imaging of brain and brain stem: A normal MRI with and without contrast rules out a brain tumor . MRI characteristics such as enhancement, edema, mass effect, and calcification determine specific tumor type .

 

Suspected or known primary CNS lymphoma in patients without increased intracranial pressure

* Cerebrospinal fluid examination: Molecular markers of monoclonality increase the yield for a positive diagnostic CSF analysis; malignant lymphoid cell are seen rarely , and a brain biopsy usually is required for a definitive diagnosis

 

Differential Diagnosis  

* Cerebral metastases

* Infectious disease

* Inflammatory disorder

* Cerebrovascular disease

* Demyelinating disease of central nervous system

 

Treatment  

 

Drug Therapy  

 

Glioblastoma multiforme of brain  

 

TEMOZOLOMIDE

Adults: concomitant to standard radiotherapy: initial dose, 75 mg/m2 orally daily for 42 days; cycle every 28 days beginning 4 weeks after completion of initial therapy

Adults: maintenance, cycle 1: 150 mg/m2 orally once daily for 5 days followed by 23 days without treatment; cycles 2-6 (each 28-days): 200 mg/m2 orally daily for the first 5 days of the cycle if common toxicity criteria (CTC) grade less than or equal to 2 (except for alopecia, nausea and vomiting), absolute neutrophil count (ANC) greater than or equal to 1.5 x 109/L, and the platelet count is greater than or equal to 100 x 109/L; The dose remains at 200 mg/m2 per day for the first 5 days of each subsequent cycle except if toxicity occurs; if the dose was not escalated at Cycle 2, escalation should not be done in subsequent cycles

 

Procedural Therapy  

 

MRI compatible with or suggestive of primary brain tumor  

* Surgical procedure

 

Primary brain cancer  

* Radiation therapy procedure or service