Faculty of Pharmacy

Suez Canal University

Pharm D program – 2nd Year
Oncology Project

BRAIN TUMORS
‫‪Prepared By:‬‬
‫الزهراء فوزي عبدالقادر خليل‬
‫نيرة محسن حسين بيومي‬
‫نوران عالء الدين محمد نور السعدني‬
‫إياد إيهاب محمد‬
‫ماجد محمود حسين الليثي‬
‫محمد عالء عادل‬
‫هدى عاطف سعد علي‬
‫عمر حمدي عبدالمعطي احمد‬
‫محمد اشرف عبد الحميد علي يوسف‬
‫ايمان محمد عبد العزيز أحمد‬
‫إسراء علي علي متولي‬
‫ايمان محمد السعيد الشحات‬
‫عبدالرحمن محمد محمود‬
‫تسنيم مجدي ابراهيم‬
‫نادين خالد عبدهللا مصطفى‬
‫مصطفى محمود عبد الحميد عبد الرحيم‬
‫سارة أحمد محمد زين‬
‫محمد أيمن محمد علي‬
‫آالء محمد سمير مصطفى طه‬
‫هاجر عبدالرحمن محمود الفيومى‬
What are brain tumors ?
 A brain tumor is a growth of cells in the brain or near it. Brain tumors
can happen in the brain tissue. Brain tumors also can happen near the
brain tissue. Nearby locations include nerves, the pituitary gland, the
pineal gland, and the membranes that cover the surface of the brain.
 Brain tumors can begin in the brain. These are called primary brain
tumors. Sometimes, cancer spreads to the brain from other parts of the
body. These tumors are secondary brain tumors, also called
metastatic brain tumors.
 Many different types of primary brain tumors exist. Some brain
tumors aren't cancerous. These are called noncancerous brain tumors
or benign brain tumors. Noncancerous brain tumors may grow over
time and press on the brain tissue.
What are brain tumors ?

 Brain tumors range in size from very small to very large.

Some brain tumors are found when they are very small
because they cause symptoms that you notice right away.
Other brain tumors grow very large before they're found.
Some parts of the brain are less active than others
 Brain tumor treatment options depend on the type of
brain tumor you have, as well as its size and location.
Common treatments include surgery and radiation
therapy.
 Types of brain cancer
Typically, Benign Brain Tumors Other Benign Brain Lesions and Cysts Brain Tumors with Variable
 Meningioma • Arachnoid Cyst Grades (From More Benign to

• Colloid Cyst Malignant)
Pituitary Adenoma
• Dermoid or Epidermoid Cyst
 Craniopharyngioma • Encephalocele • Glioma
 Schwannoma • Fibrous Dysplasia • Astrocytoma
 Nasopharyngeal Angiofibroma • Rathke’s Cleft Cyst
• Oligodendrogliomas

• Petrous Apex Lesion
Choroid Plexus Tumor
• Ependymal Tumors
 Dysembryoplastic Neuroepithelial Tumor Typically, Malignant Brain Tumors
• Sub ependymoma
 Neurofibroma • Chordoma
 Hemangioblastoma • Chondrosarcoma • Hemangiopericytoma
• Medulloblastoma • Germ Cell Tumors
 Chondroma
• Olfactory Neuroblastoma
 Giant Cell Tumor • Lymphoma • Pineal Tumors
 Osteoma • Gliosarcoma
• Rhabdomyosarcoma
• Paranasal Sinus Cancer
• Atypical Teratoid/Rhabdoid Tumor
(AT/RT)
Types of brain tumors

Typically, Benign Brain Tumors

Meningioma
Meningioma is the most common primary brain tumor, accounting for more than 30% of all brain tumors.
Meningiomas originate in the meninges, the outer three layers of tissue that cover and protect the brain just
under the skull. Women are diagnosed with meningiomas more often than men. About 85% of meningiomas are
noncancerous, slow-growing tumors. Almost all meningiomas are considered benign, but some meningiomas
can be persistent and come back after treatment.
Pituitary Adenoma
Adenoma, a type of tumor that grows in the gland tissues, is the most common type of pituitary tumor. Pituitary
adenomas develop from the pituitary gland and tend to grow at a slow rate. About 10% of primary brain tumors
are diagnosed as adenomas. They can cause vision and endocrinological problems. Fortunately for patients
affected by them, adenomas are benign and treatable with surgery and/or medication.
Types of brain tumors

Craniopharyngioma
These benign tumors grow near the pituitary gland and can appear as solid tumors or cysts.
Craniopharyngiomas often press on nerves, blood vessels or parts of the brain around the
pituitary gland. Like adenomas, they can also cause vision and endocrinological issues.
They usually affect children and teens as well as adults over the age of 50.
Schwannoma
Acoustic neuromas (vestibular schwannomas) are benign, slow-growing tumors of the
nerve that connects the ear to the brain. Less than 8% of primary brain tumors are acoustic
neuromas.
Types of brain tumors

Nasopharyngeal Angiofibroma
Nasopharyngeal angiofibroma, also known as juvenile nasopharyngeal angiofibroma,
is a benign skull base tumor in the nose that is usually diagnosed in adolescent boys.
It is the most common benign tumor of the nasopharynx . It spreads to areas around
the nose, causing symptoms such as congestion and nosebleeds.
Choroid Plexus Tumor
Choroid plexus tumors are rare tumors that are found in the choroid plexus — the part
of the brain within its ventricles that produces cerebrospinal fluid.
This can result in increased pressure on the brain and enlargement of the skull. A rare
malignant type of choroid plexus tumor is the choroid plexus carcinoma.
Types of brain tumors

Dysembryoplastic Neuroepithelial Tumor

This is a type of neuronal-glial brain tumor — it is made of a mix of neurons and
supporting cells. Dysembryoplastic neuroepithelial tumors are rare benign tumors that
occur in the tissues covering the brain and spinal cord. Typically found in children and
teens, these tumors can cause seizures
Neurofibroma
Neurofibromas are benign, generally painless tumors that can grow on nerves anywhere
in the body. In some cases, these soft, fleshy growths develop in the brain
Hemangioblastoma
Hemangioblastomas are benign tumors of the blood vessels that can form in the brain.
Types of brain tumors

Chondroma
Chondromas are very rare benign tumors made of cartilage. They can develop in the
cartilage found in the skull base and the paranasal sinuses, but they can also affect
other body parts such as the hands and feet
Giant Cell Tumor
Named for their extremely large cells, giant cell tumors are rare bone tumors that
usually affect the leg and arm bones. They may also be found in the skull.
Osteoma
Osteomas are benign bone tumors (new bone growth) that usually develop on the
skull base and facial bones. In general, these slow-growing tumors cause no
symptoms
Types of brain tumors

Other Benign Brain Lesions and Cysts

Arachnoid Cyst
Arachnoid cysts are common benign brain cysts that occur in the membranes
surrounding the brain and are filled with cerebrospinal fluid. They are usually present
since birth, cause no symptoms, and are often left untreated.
Colloid Cyst
This is a benign mass that appears in the third ventricle of the brain. It can block the
cerebrospinal fluid pathways, causing headaches and hydrocephalus
Dermoid or Epidermoid Cyst
Dermoid and epidermoid cysts are slow-growing masses that form from leftover skin
tissue in embryonal development. They are treated with surgery, and follow-up
procedures can be done safely if complete extirpation is not possible during the first
surgery.
Types of brain tumors

Encephalocele
Encephalocele is a sac-like protrusion of the brain and the membranes that
cover it through an opening in the skull. This rare birth defect occurs when
the neural tube, in which the brain and spinal cord form, fails to close
completely during fetal development.
Fibrous Dysplasia
Fibrous dysplasia is a rare bone disorder in which scar-like fibrous tissue
develops instead of normal bone. As the bone grows, the fibrous tissue
gradually expands, weakening the bone. Fibrous dysplasia usually develops in
the skull base and facial bones, thighbone, shinbone, ribs, upper arm bone or
pelvis..
Types of brain tumors

Brain Tumors with Variable Grades (From More Benign to Malignant)

Glioma
Glioma is a common type of tumor originating in the brain, but it can sometimes be found in
the spinal cord. About 33% of all brain tumors are gliomas.
Astrocytoma
A common form is pilocytic astrocytoma, a benign brain tumor arising from the supporting
brain cells and usually found in young adults or children. It can be treated with surgery if the
entire tumor can be removed.
Oligodendrogliomas
Glioblastomas, an especially aggressive tumor type
diffuse midline gliomas or hemispheric gliomas are newly described types of gliomas that
have specific mutations associated with a more aggressive nature.
Types of brain tumors

Germ Cell Tumors

During normal development of an embryo and fetus, germ cells usually become eggs (in
the female) or sperm (in the male).

Pineal Tumors
Pineal tumors are those tumors that appear in the region of the pineal gland. They are deep
in the brain and can cause hydrocephalus by blocking the cerebrospinal fluid pathways.
Types of brain tumors

Typically, Malignant Brain Tumors

Chordoma
Chordomas are a rare form of bone cancer usually found in the base of the skull or the
lower back. Less than 1% of all primary brain tumors are diagnosed as chordomas.
Chondrosarcoma
Chondrosarcoma is a malignant bone cancer that mainly affects cartilage. Chondrosarcoma
usually develops in patients between the age of 50 and 70.
Medulloblastoma
Medulloblastoma is the most common malignant brain tumor in children. It commonly
affects children between ages 5 and 9, and is rare in people over 30. It arises in the
cerebellum, a part of the brain located at the base of the skull
Differential diagnosis of brain tumors
according to symptoms :

Alzheimer’s disease
Encephalitis

Headaches or migraines
Meningitis

Lyme disease
Multiple Sclerosis
Subdural hematoma
Pseudo tumor cerebri
Differential diagnosis of brain tumors according to
radiological imaging

 Intraaxial Vs. Extraaxial

 Pattern Analysis
 Neoplastic Vs. Non-neoplastic Disease
 Single Vs. Many Lesions
 Metastatic Disease
 Primary Neoplasms
1. Extraaxial Neoplasms
2. interaxial Neoplasms
 Primary CNS Lymphoma
 Brain cancer staging
Staging describes how far cancer has spread from where it began. Tumors that begin in the brain
are not staged, because while they may spread to other parts of the central nervous system

Grade means how different the tumor cells look from normal cells when the pathologist examines
them under a microscope. Brain tumors are graded from 1 to 4

 Grade 1: The cells look nearly like normal brain cells, and they grow slowly.
 Grade 2: Compared with cells in a Grade I tumor, these cells look less like normal cells.
 Grade 3: Cells in the tumor look very different from normal cells.
 Grade 4: The tumor has cells that look the most abnormal and tend to grow quickly.
Risk factors of brain cancer
Intrinsic (uncontrollable) Extrinsic (controllable)
 Age • Home and work exposures
 Sex • Exposure to infections, viruses, and allergens
• Electromagnetic fields
 Family history • Ionizing radiation
 Race and ethnicity • Head injury and seizures
• N-nitroso compounds

Age. Brain tumors are more common in children and older adults
Sex. In general, men are more likely than women to develop a brain tumor
Family history. About 5% of brain tumors may be linked to hereditary genetic factors or conditions, including Li-
Fraumeni syndrome, neurofibromatosis, nevoid basal cell carcinoma syndrome, tuberous sclerosis,
Race and ethnicity. In the United States, White people are more likely to develop gliomas but less likely to
develop meningioma than Black people. Also, people from northern Europe are more than twice as likely to
develop a brain tumor as people in Japan.
Risk factors of brain cancer

Exposure to infections, viruses, and allergens. Infection with the Epstein-Barr virus (EBV)
increases the risk of central nervous system (CNS) lymphoma.

Electromagnetic fields. Most studies evaluating the role of electromagnetic fields, such as energy
from power lines or from cell phone use, show no link to an increased risk of developing a brain
tumor in adults
Ionizing radiation. Previous treatment to the brain or head with ionizing radiation, including x-
rays, has been shown to be a risk factor for a brain tumor.

Head injury and seizures. Serious head trauma has long been studied for its relationship to brain
tumors. Some studies have shown a link between head trauma and meningioma but not between
head trauma and glioma.

N-nitroso compounds. Dietary N-nitroso compounds are formed in the body from nitrites or
nitrates found in some cured meats, cigarette smoke, and cosmetics
 Brain cancer Diagnosis

 Physical examination:
1. neurological exam
2. Vision exam
3. Hearing exam tests
 Clinical presentation:
1. General symptoms of a brain tumor
2. Symptoms that may be specific to the brain tumor location
 Radiological findings:
1. Nuclear medicine bone scan
2. Angiography
3. MRI (magnetic resonance imaging)
4. CT (computed tomography) scan
5. PET (positron emission tomography) scan
 Biopsy
 Tumor markers
Diagnosis

Physical examination:
Neurological exam
During the brain cancer diagnosis process, the care team will start by performing a
neurological examination.
A neurological examination includes checking:
 reflexes, balance and coordination
 fine motor skills, such as picking up an object and handwriting
 muscle strength
 response to pain
 awareness of surroundings
 judgment, reasoning and memory
 the ability to calculate and speak
Vision exam includes checking eye movement and field of vision.
Hearing exam tests how well you hear sound
Clinical presentation:

General symptoms of a brain tumor:

 Headaches, which may be severe and worsen with activity or in the early morning
 Seizures. People may experience different types of seizures
 Motor seizures
 Personality or memory changes
 Nausea or vomiting
 Fatigue
 Drowsiness
 Sleep problems
 Memory problems
 Changes in ability to walk or perform daily activities.
Symptoms that may be specific to the brain tumor location

 Pressure or headache near the tumor.

 Loss of balance and difficulty with fine motor skills is linked with a tumor in the
cerebellum.
 Changes in judgment, including loss of initiative, sluggishness, and muscle weakness
 Partial or complete loss of vision is caused by a tumor in the occipital lobe or temporal
lobe of the cerebrum.
 Changes in speech, hearing, memory, or emotional state, such as aggressiveness
 Altered perception of touch or pressure, arm.
 Vision changes, including loss of part of the vision or double vision can be from a
tumor in the temporal lobe, occipital lobe, or brain stem.
Radiological findings:
Nuclear medicine bone scan
By capturing images of bones on a computer, a nuclear medicine bone scan may reveal whether the brain
cancer has spread to the bone. This procedure uses X-rays to obtain multiple, detailed, images of the blood
vessels in the brain.

MRI (magnetic resonance imaging): MRIs are used to look for brain and spinal cord tumors because they tend
to provide greater detail than CT scans

CT (computed tomography) scan: CT scans create detailed images of the body’s soft tissues and may be
performed when MRI is not an option, such as with overweight or claustrophobic patients. CT scans also show
greater detail of bone structures near the tumor

PET (positron emission tomography) scan: PET scans may be used for fast-growing, high-grade tumors.
Following treatment, a PET scan may be performed to determine whether tumor tissue remains.
 Biopsy and Tumor Markers

Biopsy

A biopsy for brain cancer involves the removal of a small amount of the cancerous brain
tissue.
A needle biopsy may be performed for tumors in difficult-to-reach or critical areas of the
brain.

Tumor markers

The main lab test for brain cancer is advanced genomic testing, which analyzes a tumor’s
genomic profile, also referred to as a tumor marker, to look for DNA alterations that may
be causing the cancer to grow.

1p/19q co-deletion: When the p-arm of chromosome 1 and the q-arm of chromosome 19
are missing, it’s referred to as a 1p/19q co-deletion
.
IDH mutation: When a mutation is found in the isocitrate dehydrogenase gene of patients
with glioma tumors

MGMT changes: When the methyl guanine methyl transferase gene has changed, the care
team is able to better evaluate the patient’s glioblastoma prognosis.
Treatment and Management

 Brain tumours may be treated with surgery, radiation

therapy, chemotherapy or steroid therapy, or a combination of
these treatments.
 Some tumours can be removed completely by surgery
(craniotomy). Post-operative radiotherapy improves local
control and survival. For glioblastomas, temozolomide may be
added during or after radiotherapy to further improve
outcomes.
 If a tumour cannot be removed, the aim of treatment is to slow
growth and relieve symptoms by shrinking the tumour and any
swelling around it. Treatment options include radiation therapy
with or without temozolomide.
Radiation therapy

 Radiation therapy is the use of high-energy x-rays or other particles to destroy

tumor cells. Doctors may use radiation therapy to slow or stop the growth of a
brain tumor. It is typically given after surgery and possibly along with
chemotherapy

The most common type of radiation treatment is called external-beam
radiation therapy, which is radiation given from a machine outside the body.
When radiation treatment is given using implants, it is called internal
radiation therapy or brachytherapy. A radiation therapy regimen, or schedule,
usually consists of a specific number of treatments given over a set period of
time.
Therapies using medication

 The treatment plan may include medications to destroy tumor cells.

Medication may be given through the bloodstream to reach cancer cells
throughout the body. When a drug is given this way, it is called systemic
therapy. Medication may also be given locally, which is when the medication
is applied directly to the cancer or kept in a single part of the body..
 Medications are often given through an intravenous (IV) tube placed into a
vein using a needle or as a pill or capsule that is swallowed (orally). It may
also be given through a catheter or port, which are used to make IV
injections easier.
The types of medications used for a brain tumor include:
 Chemotherapy
 Targeted therapy
Therapies using medication

 Some drugs are better at going through the blood-brain barrier. These are the
drugs often used for a brain tumor, such as temozolomide (Temodar), lomustine
(CCNU), or others.
 For people with glioblastoma and high-grade glioma, the latest standard of care
is radiation therapy with daily low-dose temozolomide. This is followed by
monthly doses of temozolomide after radiation therapy for 6 months to 1 year.
 For people with anaplastic astrocytoma that is newly diagnosed or has not
responded to treatment, temozolomide may be part of the recommended
treatment plan.
 A combination of 3 drugs, lomustine, procarbazine (Matulane), and vincristine
(Vincasar), has been used along with radiation therapy. This combination is
sometimes called PCV.
Targeted Therapy

 Bevacizumab (Avastin, Mvasi) is an anti-angiogenesis therapy used to treat

glioblastoma multiforme when previous treatment has not worked. Anti-
angiogenesis therapy is focused on stopping angiogenesis, which is the process
of making new blood vessels.
 Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are a type of targeted
therapy that is not specific to a certain type of tumor but focuses on a
specific genetic change called an NTRK fusion. This type of genetic change is
found in a range of tumors, including some brain tumors
 Dabrafenib (Tafinlar) with trametinib (Mekinist) are approved for use in
combination in tumors that contain BRAF mutations. These drugs can be
effective in adult and pediatric malignant brain tumors.
 References:
 https://my.clevelandclinic.org/health/diseases/6149-brain-cancer-brain-
tumor
 https://www.hopkinsmedicine.org/health/conditions-and-diseases/brain-
tumor
 https://www.nhs.uk/conditions/brain-tumours/
 https://www.hopkinsmedicine.org/health/conditions-and-diseases/brain-
tumor/brain-tumor-types
 https://www.mayoclinic.org/diseases-conditions/brain-tumor/diagnosis-
treatment/drc-20350088
 https://www.mdanderson.org/cancer-types/brain-tumor.html
 https://braintumor.org/brain-tumors/diagnosis-treatment/signs-symptoms/
 https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-
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