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The bare essentials
Neuro-oncology
  1. Jeremy Rees
  1. Correspondence to Dr J Rees, Consultant Neurologist, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; jrees{at}ion.ucl.ac.uk

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Neuro-oncology is a relatively new field within neurology. It encompasses the management of primary and secondary CNS tumours as well as the neurological complications of cancer. Unfortunately, brain tumours are one of the most devastating neurological diseases. Their management is best determined in a multidisciplinary team environment comprising neurologists, neurosurgeons, oncologists, neuropathologists, neuroradiologists and clinical nurse specialists. Technical developments in imaging are now directly impacting on clinical practice and new chemotherapeutic and biological agents are being trialled to improve the prognosis of these otherwise dismal diseases.

Brain tumours

Epidemiology

  • Each year about 16 000 people are diagnosed in the UK with a brain tumour (which is rare compared with many other cancers—for example, breast, lung, colorectal), but primary malignant brain tumours have a high case fatality.

  • They are the commonest cause of cancer related deaths in young men (under 45 years) and women (under 35 years), and are the commonest solid tumour in children.

  • There is a bimodal pattern of incidence, highest in the very young and in the elderly, with men exceeding women across the age spectrum (except meningiomas).

  • Annual incidence appears to be increasing, particularly for gliomas and primary CNS lymphomas, likely due to better case ascertainment with greater availability and access to imaging.

  • Most brain tumours are sporadic, the cause unknown and therefore they are not preventable.

  • Rare causes include previous exposure to ionising radiation, neurocutaneous syndromes (eg, neurofibromatosis, tuberous sclerosis, von Hippel–Lindau syndrome) and genetic tumour syndromes (eg, Li Fraumeni syndrome).

  • The role of mobile phones is unclear and recent data do not suggest an increased risk of glioma and meningioma.

  • About 20% of patients with cancer outside the nervous system develop brain metastases which are also becoming more common due to increasing survival from systemic disease.

WHO classification

The WHO classification (table …

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