Jeremy Rees 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 or 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
CELLULARITY, PLEOMORPHISM, MITOTIC ACTIVITY
VASCULAR PROLIFERATION, NECROSIS
BENIGN
MALIGNANT

WHO Grading System
CELLULARITY, PLEOMORPHISM, MITOTIC ACTIVITY
VASCULAR PROLIFERATION, NECROSIS
I II III IV

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
of the brain
• Fast – growing tumours cause headache and
other 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
Brain Tumour Unit

The problem of Brain
Tumour
• Poor survival – 15% at 5 years for
malignant tumours
• Fragmented care - poor patient
experience
• Complex needs
• Rare disease, therapeutic nihilism
• Small numbers of clinical trials

The Multidisciplinary Team

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
• 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
• 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
• The dichotomy between medical
science and patient care
• The need to improve the patient
experience
• The need to improve patient
outcomes

Any Questions?