Chapter 5: Brain Cancer

Epidemiology

Work-up

1. Neuroimaging study (MRI of the brain preferred over CT)

   No other staging work-up is required except:

2. Primary CNS lymphoma: MRI of spine, lumbar puncture, and ophthalmologic examination

3. PNET/medulloblastoma: MRI of spine and lumbar puncture when safe to do so

Pathology

1. Neuroepithelial Tumors

   1. Glial tumors

      1. Astrocytic tumors (45–50%)

         • Glioblastoma multiforme (GBM grade IV): 50%

         • Anaplastic astrocytoma (AA grade III): 30%

         • Diffuse astrocytoma (grade II): 20%

         • Gliosarcoma (grade IV): <5% of GBM

         • Pilocytic astrocytoma (grade I): <1%

      2. Oligodendrogliomas/oligoastrocytomas (5–10%)

         • Oligodendroglioma (O grade II)

         • Anaplastic oligodendroglioma (AO grade III)

         • Oligoastrocytoma (OA grade II)

         • Anaplastic oligoastrocytoma (AOA grade III)

      3. Ependymal tumors (5%)

         • Myxopapillary ependymoma (grade I)

         • Ependymoma (grade II)

         • Anaplastic ependymoma (grade III)

         • Subependymoma

   2. Neuronal and mixed glial-neuronal tumors (<1%)

      • Central neurocytoma

      • Dysembryoplastic neuroepithelial tumor

      • Desmoplastic infantile astrocytoma/ganglioma

      • Ganglioma

      • Paraganglioma

   3. Nonglial tumors

      1. Embryonal tumors (<5%)

         • Primitive neuroectodermal tumors (PNET)

         • Medulloblastoma

         • Ependymoblastoma

      2. Choroid plexus tumors (<1%)

         • Choroid plexus papilloma

      3. Pineal tumors (<1%)

         • Pineoblastoma

         • Pineocytoma

2. Meningeal Tumors (15–28%)

   • Benign meningioma (grade I): >90%

   • Atypical meningioma (grade II): 6%

   • Anaplastic meningioma (grade III): 2%

   • Hemangiopericytoma

3. Germ Cell Tumors (<1%)

4. Nerve Sheet Tumors (4–8%)

   • Schwannoma

5. Primary CNS Lymphoma (PCNSL) (1–5%)

6. Metastatic Tumors

Adesina AM et al. Histopathology of primary tumors of the central nervous system. In: Prados M, ed. Brain Cancer: American Cancer Society Atlas of Clinical Oncology. Hamilton, Ontario, Canada: BC Decker Inc.; 2002:16–47

Greenberg H et al. Brain Tumors. Oxford University Press, 1999:1–26

WHO Classification of Tumors. IARC Press, 2000:6–7

Staging