Brain tumours

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Recommendation Grade
Persistent headache in AYAs requires a neurological examination by the GP.
D
Recommendation Grade
AYAs presenting with recurrent headache and vomiting that cause early morning waking or occur on waking (signs of raised intracranial pressure) should be referred immediately to a specialist.
C
Recommendation Grade
The presence of any of the following neurological symptoms and signs in AYAs should prompt urgent or immediate referral:
  • New-onset seizures or fits
  • Cranial nerve abnormalities
  • Visual disturbances
  • Gait abnormalities
  • Motor or sensory signs
  • Deterioration in intellectual capacity
  • Unexplained behavioural and/or mood changes.


D
Recommendation Grade
An AYA presenting with a reduced level of consciousness requires emergency admission.
C

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Overview

Symptoms and signs

Brain and central nervous system (CNS) tumours should be suspected in adolescents and young adults (AYAs) presenting with persistent or recurrent headache and vomiting, new-onset seizures or fits, cranial nerve abnormalities (e.g. palsy), visual disturbances (e.g. dysconjugate eye movements), gait abnormalities, motor or sensory signs (e.g. limb weakness, loss of coordination, deafness, vision problems), deterioration in intellectual capacity (e.g. unexplained deteriorating school performance or developmental milestones) and behavioural and/or mood changes (e.g. change in personality, irritability).[1][2][3] Bladder and bowel disturbances may also be present.[1]

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Clinical assessment

Most AYAs presenting with headaches do not have brain cancer[2] and the risk from an isolated headache does not warrant investigation.[4] However, persistent headaches require a neurological examination by the general practitioner (GP).

The risk of headache due to brain cancer increases with the following factors: presence of vomiting, ‘non-tension’ type pain, and headache present for less than ten weeks;[2] headache combined with vomiting is the most common combination.[5] AYAs presenting with symptoms of brain or CNS tumours should be referred to a specialist; patients with recurrent headache and vomiting that cause early morning waking or occur on waking (signs of raised intracranial pressure) should be referred immediately.

Emergency department admission is required for AYAs presenting with a reduced level of consciousness.

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Risk factors

Brain and CNS tumours are known to be related to previous exposure to ionising radiation in AYAs.[3][6][7][8] Genetic disorders such as neurofibromatosis, Li-Fraumeni syndrome, tuberous sclerosis, nevoid basal cell syndrome and Turcot syndrome, male gender and Caucasian race have also been associated.[3][6]

However, brain and CNS tumours can occur in AYAs without any of these risk factors.

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References

  1. 1.0 1.1 Bleyer A. CAUTION! Consider cancer: common symptoms and signs for early detection of cancer in young adults Semin Oncol 2009 Jun;36(3):207-12 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19460578].
  2. 2.0 2.1 2.2 National Collaborating Centre for Primary Care. Referral Guidelines for Suspected Cancer. Clinical guideline 27. London: National Institute for Health and Clinical Excellence; 2005.
  3. 3.0 3.1 3.2 Adolescent and Young Adult Working Party of the Statewide Cancer Clinical Network. South Australian Adolescent and Young Adult Cancer Care Pathway: Optimising outcomes for all adolescent and young adult South Australians with a cancer diagnosis. Adelaide: South Australia Department of Health; 2010.
  4. Hamilton W, Kernick D. Clinical features of primary brain tumours: a case-control study using electronic primary care records Br J Gen Pract 2007 Sep;57(542):695-9 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17761056].
  5. Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S. Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS Pediatrics 2010 Jan;125(1):112-9 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20026498].
  6. 6.0 6.1 New Zealand Guidelines Group. Suspected cancer in primary care: guidelines for investigation, referral and reducing ethnic disparities. Wellington: New Zealand Guidelines Group; 2009.
  7. Kleinerman RA. Cancer risks following diagnostic and therapeutic radiation exposure in children Pediatr Radiol 2006 Sep;36 Suppl 2:121-5 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16862418].
  8. McKinney PA. Central nervous system tumours in children: epidemiology and risk factors Bioelectromagnetics 2005;Suppl 7:S60-8 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16142778].

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