General Considerations
Epidemiology
Incidence of symptomatic brain tumors: 12/100,000 population. Approximately 35,000 new patients diagnosed each year in the U.S.
Incidence by age: small peak before age 10 years; gradual increase from 15 years on; highest incidence between 75 and 84 years.
In children: brain tumors are most common form of solid tumor; second most common malignancy overall (after leukemia). Low-grade astrocytoma and medulloblastoma most common tumor types. 70% of all childhood brain tumors infratentorial.
In adults: malignant astrocytoma and meningioma most common.
Risk Factors
High-dose irradiation (gliomas, meningiomas, nerve-sheath tumors); immunosuppression caused by HIV or chronic immunosuppressive therapy (primary CNS lymphoma).
Genetic syndromes: NF-1 (gliomas), NF-2 (schwannoma, meningioma), Li-Fraumeni syndrome (autosomal dominant, multiple-cancer syndrome; glioma, medulloblastoma), TS (subependymal giant cell astrocytoma), Von Hippel-Lindau (hemangioblastomas of brain, spinal cord, retina).
Studies inconclusive for chemicals, viruses. No support for environmental electromagnetic radiation or cell phones as risk factors.
Clinical Diagnosis in Adults or Children
Symptoms and signs due to: brain invasion with destruction of underlying tissue; brain compression by mass and surrounding edema; CSF obstruction leading to hydrocephalus. Symptoms
may be focal or generalized (usually due to increased intracranial pressure [ICP]).
may be focal or generalized (usually due to increased intracranial pressure [ICP]).
Headache: first symptom in 30% to 40%. Usually non-localizing. Features suspicious of raised ICP: (a) early morning headache, awakening patient from sleep; (b) frequency, severity increasing over weeks to months; (c) accompanying nausea and vomiting; (d) associated papilledema or focal cerebral signs.
Seizures: occur in 1/3 of patients. Focal in onset; may generalize. Most common in glioblastoma, astrocytoma, oligodendroglioma.
Focal Symptoms by Tumor Location
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