Brain tumors - description, symptoms (signs), diagnosis, treatment. Tumors of the brain and other parts of the central nervous system Tumor of the frontal lobe mcb 10

Purpose of treatment: achievement of complete, partial regression of the tumor process or its stabilization, elimination of severe concomitant symptoms.

Treatment tactics

Non-pharmacological treatment of IA

Stationary mode, physical and emotional peace, restriction of reading printed and fiction publications, watching television. Nutrition: diet number 7 - salt-free. With a satisfactory condition of the patient, "common table No. 15".

Medical treatment for IA

1. Dexamethasone, from 4 to 30 mg per day, depending on the severity of the general condition, intravenously, at the beginning of special treatment or during the entire hospitalization period. It is also used in the event of episodes of convulsive seizures.

2. Mannitol 400 ml, intravenous, used for dehydration. The maximum appointment is 1 time in 3-4 days, during the entire hospitalization period, together with potassium-containing drugs (asparkam 1 tablet 2-3 times a day, Panangin 1 tablet 2-3 times a day).

3. Furosemide - "loop diuretic" (Lasix 20-40 mg) is used after the introduction of mannitol, to prevent "rebound syndrome". It is also used independently in the event of episodes of convulsive seizures, increased blood pressure.

4. Diakarb - diuretic, inhibitor of carbonic anhydrase. It is used for dehydration at a dose of 1 tablet 1 time per day, in the morning, together with potassium-containing drugs (asparkam 1 tablet 2-3 times a day, Panangin 1 tablet 2-3 times a day).

5. Bruzepam solution 2.0 ml - a benzodiazepine derivative used in the event of episodes of convulsive seizures or for their prevention in case of high convulsive readiness.

6. Carbamazepine is an anticonvulsant drug with a mixed neurotransmitter action. It is used at 100-200 mg 2 times a day, for life.

7. B vitamins - vitamins B1 (thiamine bromide), B6 ​​(pyridoxine), B12 (cyanocobalamin) are necessary for the normal functioning of the central and peripheral nervous system.

List of therapeutic measures within the framework of the VSMC

Other treatments

Radiation therapy: external beam radiation therapy for tumors of the brain and spinal cord, used in the postoperative period, in an independent mode, with a radical, palliative or symptomatic purpose. Simultaneous chemotherapy and radiation therapy is also possible (see below).

In case of recurrence and continued tumor growth after previous combined or complex treatment where the radiation component was used, repeated irradiation is possible with the obligatory consideration of VDF, CRE, and a linear-quadratic model.

In parallel, symptomatic dehydration therapy is carried out: mannitol, furosemide, dexamethasone, prednisolone, diacarb, asparkam.

The indications for remote radiation therapy are the presence of a morphologically established malignant tumor, as well as the establishment of a diagnosis based on clinical, laboratory and instrumental research methods, and, above all, data from CT, MRI, and PET studies.

In addition, radiation treatment is performed for benign tumors of the brain and spinal cord: pituitary adenomas, tumors from the remnants of the pituitary duct, germ cell tumors, tumors of the meninges, tumors of the parenchyma of the pineal gland, tumors growing into the cranial cavity and spinal canal.

Radiation therapy technique

Devices: remote radiation therapy is carried out in a conventional static or rotational mode on gamma therapeutic devices or linear electron accelerators. It is necessary to manufacture individual fixing thermoplastic masks for patients with brain tumors.

In the presence of modern linear accelerators with a multi-lift (multi-leaf) collimator, X-ray simulators with a computer tomography attachment and a computer tomograph, modern planning dosimetric systems, it is possible to carry out new technological methods of irradiation: volumetric (conformal) irradiation in 3-D mode, intensely modulated beam therapy, stereotactic radiosurgery for brain tumors, image-guided radiation therapy.

Dose fractionation regimens over time:

1. Classical fractionation regimen: ROD 1.8-2.0-2.5 Gy, 5 fractions per week. Split or continuous course. Up to SOD 30.0-40.0-50.0-60.0-65.0-70.0 Gy in conventional mode, and SOD 65.0-75.0 Gy in conformal or intensively modulated mode.

2. Multifractionation mode: ROD 1.0-1.25 Gy 2 times a day, after 4-5 and 19-20 hours to SOD 40.0-50.0-60.0 Gy in the conventional mode.

3. Medium fractionation mode: ROD 3.0 Gy, 5 fractions per week, SOD - 51.0-54.0 Gy in the conventional mode.

4. "Spinal irradiation" in the mode of classical fractionation ROD 1.8-2.0 Gy, 5 fractions per week, SOD from 18.0 Gy to 24.0-36.0 Gy.

Thus, the standard treatment after resection or biopsy is fractionated local radiotherapy (60 Gy, 2.0-2.5 Gy x 30; or equivalent dose/fractionation) IA.

Increasing the dose over 60 Gy did not affect the effect. In elderly patients, as well as in patients with poor general status, it is usually suggested to use short hypofractionated regimens (eg 40 Gy in 15 fractions).

In a phase III randomized trial, radiotherapy (29 x 1.8 Gy, 50 Gy) was superior to better symptomatic therapy in patients over 70 years of age.

Method of simultaneous chemotherapy and radiation therapy

It is prescribed mainly for malignant brain gliomas G3-G4. The method of radiation therapy is carried out according to the above scheme in the conventional (standard) or conformal mode of irradiation, continuous or split course against the background of monochemotherapy with temodal 80 mg/m 2 orally, for the entire course of radiation therapy (on the days of radiation therapy sessions and days off 42-45 times).

Chemotherapy: is prescribed only for malignant brain tumors in adjuvant, neoadjuvant, independent mode. It is also possible to conduct simultaneous chemotherapy and radiation therapy.

For malignant gliomas of the brain:

For medulloblastomas:

In summary, concomitant and adjuvant chemotherapy with temozolomide (Temodal) and lomustine for glioblastoma demonstrated a significant improvement in median and 2-year survival in a large randomized IA trial.

In a large randomized trial, adjuvant chemotherapy including procarbazine, lomustine, and vincristine (PCV) did not improve IA survival.

However, based on a large meta-analysis, nitrosourea-containing chemotherapy may improve survival in selected patients.

Avastin (bevacizumab) is a targeted drug, the instructions for its use include indications for the treatment of malignant grade III-IV (G3-G4) gliomas - anaplastic astrocytomas and glioblastoma multiforme. Currently, large-scale clinical randomized trials are underway on its use in combination with irinotecan or temozolomide in malignant G3 and G4 gliomas. The preliminary high efficiency of these schemes of chemo- and targeted therapy has been established.

Surgical method: performed in a neurosurgical hospital.

In the vast majority of cases, the treatment of CNS tumors is surgical. A reliable diagnosis of a tumor in itself allows us to consider surgical intervention indicated. The factors limiting the possibilities of surgical treatment are the features of the localization of the tumor and the nature of its infiltrative growth in the area of ​​such vital parts of the brain as the brainstem, hypothalamus, and subcortical nodes.

At the same time, the general principle in neurooncology is the desire for the most complete removal of the tumor. Palliative surgery is a necessary measure and is usually aimed at reducing intracranial pressure when it is impossible to remove a brain tumor or at reducing spinal cord compression in a similar situation due to an unremovable intramedullary tumor.

1. Total removal of the tumor.

2. Subtotal removal of the tumor.

3. Tumor resection.

4. Craniotomy with biopsy.

5. Ventriculocisternostomy (Thorkildsen operation).

6. Ventriculoperitoneal shunt.

Thus, surgery is a generally accepted primary treatment approach to reduce tumor volume and obtain material for verification. Tumor resection is of prognostic value, and may give positive results when maximal cytoreduction is attempted.

Preventive actions

The complex of preventive measures for malignant neoplasms of the central nervous system coincides with those for other localizations. Basically, this is maintaining the ecology of the environment, improving working conditions in hazardous industries, improving the quality of agricultural products, improving the quality of drinking water, etc.

Further management:

1. Observation by an oncologist and neurosurgeon at the place of residence, examination once a quarter, for the first 2 years, then once every 6 months, for two years, then once a year, taking into account the results of MRI or CT scans.

2. Follow-up consists of clinical evaluation, especially of nervous system function, seizures or equivalents, and corticosteroid use. Patients should cut back on steroids as soon as possible. Venous thrombosis is often observed in patients with inoperable or recurrent tumors.

3. Laboratory parameters are not determined, except in patients receiving chemotherapy (CBC), corticosteroids (glucose) or anticonvulsants (CBC, liver function tests).

4. Instrumental observation: MRI or CT - 1-2 months after the end of treatment; 6 months after the last appearance for a follow-up examination; in the subsequent 1 time in 6-9 months.

List of basic and additional medicines

Essential Medications: See Medication and Chemotherapy above (ibid.).

Additional medicines: additionally prescribed medicines by consultant doctors (ophthalmologist, neuropathologist, cardiologist, endocrinologist, urologist and others) necessary for the prevention and treatment of possible complications of concomitant diseases or syndromes.

Indicators of treatment efficacy and safety of diagnostic and treatment methods

If response to treatment can be assessed, an MRI should be performed. The increase in contrast and the expected progression of the tumor, in terms of 4-8 weeks after the end of radiotherapy according to MRI, may be an artifact (pseudoprogression), then a repeat MRI study should be performed after 4 weeks. Brain scintigraphy and PET according to indications.

Response to chemotherapy is assessed according to the WHO criteria, but the state of the functions of the nervous system and the use of corticosteroids (McDonald criteria) should also be taken into account. Increasing overall survival and progression-free progression at 6 months is a valid treatment goal and suggests that patients with stable disease also benefit from treatment.

1. Complete regression.

2. Partial regression.

3. Process stabilization.

4. Progression.

Under the tumor it is customary to understand all neoplasms of the brain, that is, benign and malignant. This disease is included in the international classification of diseases, each of which is assigned a code, a brain tumor code according to ICD 10: C71 denotes a malignant tumor, and D33 is a benign neoplasm of the brain and other parts of the central nervous system.

Since this disease belongs to oncology, the causes of brain cancer, as well as other diseases in this category, are still unknown. But there is a theory that experts in this field adhere to. It is based on multifactoriality - brain cancer can develop under the influence of several factors at the same time, hence the name of the theory. The most common factors include:

Main symptoms

The following symptoms and disorders may indicate the presence of a brain tumor (ICD code 10):

• an increase in the volume of the medulla, and subsequently an increase in intracranial pressure;
• cephalgic syndrome, which is accompanied by the presence of a severe headache, especially in the morning and during a change in body position, as well as vomiting;
• systemic dizziness. It differs from the usual one in that the patient feels that the objects surrounding him are rotating. The cause of such an ailment is a violation of the blood supply, that is, when the blood cannot circulate normally and enter the brain;
• violation of the processes of perception of the surrounding world by the brain;
• failures of the musculoskeletal function, the development of paralysis - localization depends on the area of ​​brain damage;
• epileptic and convulsive seizures;
• violation of the organs of speech and hearing: speech becomes slurred and incomprehensible, and instead of sounds, only noise is heard;
• loss of concentration, complete confusion, and other symptoms are also possible.

Brain tumor: stages

The stages of cancer are usually distinguished by clinical signs and there are only 4 of them. In the first stage, the most common symptoms appear, for example, headaches, weakness and dizziness. Since these symptoms cannot directly indicate the presence of cancer, even doctors cannot detect cancer at an early stage. However, a small chance of detection still remains; cases of cancer detection during computer diagnostics are not uncommon.

Tumor of the temporal lobe of the brain

In the second stage, the symptoms are more pronounced, in addition, patients have impaired vision and coordination of movements. The most effective way to detect a brain tumor is an MRI. At this stage, in 75% of cases, a positive outcome is possible as a result of surgery.

The third stage is characterized by impaired vision, hearing and motor function, fever, fatigue. At this stage, the disease penetrates deep and begins to destroy the lymph nodes and tissues, and then spreads to other organs.

The fourth stage of brain cancer is glioblastoma, which is the most aggressive and dangerous form of the disease, it is diagnosed in 50% of cases. Glioblastoma of the brain has an ICD code of 10 - C71.9 is characterized as a multiform disease. This neoplasm of the brain belongs to the subgroup astrocytic. It usually develops as a result of the transformation of a benign tumor into a malignant one.

Ways to treat brain cancer

Unfortunately, oncological diseases are among the most dangerous diseases and difficult to treat, especially oncology of the brain. However, there are methods that can stop the further destruction of cells, and they are successfully used in medicine. The most famous among them

brain tumors- a heterogeneous group of neoplasms for which a common feature is the presence or secondary penetration into the cranial cavity. Histogenesis is variable and is reflected in the WHO histological classification (see below). There are 9 main types of CNS tumors. A: neuroepithelial tumors. B: meningeal tumors. C: Tumors from cranial and spinal nerves. D: tumors of the hematopoietic series. E: germ cell tumors. F: cysts and tumor-like formations. G: Tumors of the sella turcica. H: local spread of tumors from adjacent anatomical regions. I: Metastatic tumors.

Code according to the international classification of diseases ICD-10:

Epidemiology. Given the heterogeneity of the concept of "brain tumor", accurate generalized statistical data are not available. It is known that CNS tumors in children take the second place among all malignant neoplasms (after leukemia) and the first in the group of solid tumors.

Classification. The main working classification used to develop treatment tactics and determine prognosis is the WHO Classification for CNS Tumors. Tumors of neuroepithelial tissue.. Astrocytic tumors: astrocytoma (fibrillar, protoplasmic, gemistocytic [mast cell], or large cell), anaplastic (malignant) astrocytoma, glioblastoma (giant cell glioblastoma and gliosarcoma), pilocytic astrocytoma, pleomorphic xanthoastrocytoma, subependymal giant cell astrocytoma (tube). tumors (oligodendroglioma, anaplastic [malignant] oligodendroglioma) .. Ependymal tumors: ependymoma (cellular, papillary, clear cell), anaplastic (malignant) ependymoma, mixopapillary ependymoma, subependymoma .. Mixed gliomas: oligoastrocytoma, anaplastic (malignant) oligoastrocytoma, etc. . Choroid plexus tumors: papilloma and choroid plexus cancer Neuroepithelial tumors of unknown origin: astroblastoma, polar spongioblastoma, cerebral gliomatosis Neuronal and mixed neuronal glial tumors: gangliocytoma, dysplastic ha cerebellar ngliocytoma (Lermitte Duclos), desmoplastic ganglioglioma in children (infantile), dysembryoplastic neuroepithelial tumor, ganglioglioma, anaplastic (malignant) ganglioglioma, central neurocytoma, terminal filament paraganglioma, olfactory neuroblastoma (esthesioneuroblastoma), variant: olfactory neuroepithelioma. : pineocytoma, pineoblastoma, mixed/transitional tumors of the pineal gland. Embryonic tumors: medulloepithelioma, neuroblastoma (option: ganglioneuroblastoma), ependymoblastoma, primitive neuroectodermal tumors (medulloblastoma [options: desmoplastic medulloblastoma], medullomyoblastoma, melanin-containing medulloblastoma). Tumors of the cranial and spinal nerves.. Schwannoma (neurilemoma, neurinoma); variants: cellular, plexiform, melanin-containing. options: epithelioid, malignant tumor of the peripheral nerve trunk with divergence of mesenchymal and / or epithelial differentiation, melanin-containing. Tumors of the meninges.. Tumors from meningothelial cells: meningioma (meningothelial, fibrous [fibroblastic], transitional [mixed], psammomatous, angiomatous, microcystic, secretory, clear cell, chordoid, rich in lymphoplasmacytic cells, metaplastic), atypical meningioma, papillary meningioma, anaplastic (malignant) meningioma .. Mesenchymal non-meningothelial tumors: benign (osteochondral tumors, lipoma, fibrous histiocytoma, etc.) and malignant (hemangiopericytoma, chondrosarcoma [option: mesenchymal chondrosarcoma] malignant fibrous histiocytoma, rhabdomyosarcoma, meningeal sarcomatosis, etc.). : diffuse melanosis, melanocytoma, malignant melanoma (option: meningeal melanomatosis) .. Tumors of unclear histogenesis: hemangioblastoma (capillary hemangioblastoma) . Lymphomas and tumors of the hematopoietic tissue.. Malignant lymphomas.. Plasmacytoma.. Granulocellular sarcoma.. Others. Germ cell tumors(germinogenic) .. Germinoma .. Embryonic cancer .. Yolk sac tumor (endodermal sinus tumor) .. Choriocarcinoma .. Teratoma: immature, mature, malignant teratoma .. Mixed germ cell tumors. Cysts and tumor-like lesions.. Rathke's pouch cyst.. Epidermoid cyst.. Dermoid cyst.. Colloidal cyst of the III ventricle.. Enterogenic cyst.. Neuroglial cyst.. Granular cell tumor (choristoma, pituicytoma).. Neuronal hamartoma of the hypothalamus.. Nasal heterotopia glia.. Plasma cell granuloma. Tumors of the Turkish saddle area .. Pituitary adenoma .. Pituitary cancer .. Craniopharyngioma: adamantine-like, papillary. Tumors growing into the cranial cavity .. Paraganglioma (chemodectoma) .. Chordoma .. Chondroma .. Chondrosarcoma .. Cancer. metastatic tumors. Unclassified tumors

Symptoms (signs)

clinical picture. The most common symptoms of brain tumors are progressive neurological deficit (68%), headaches (50%), epileptic seizures (26%). The clinical picture mainly depends on the localization of the tumor and, to a lesser extent, on its histological characteristics. Supratentorial hemispheric tumors .. Signs of increased ICP due to mass effect and edema (headaches, congestive optic discs, impaired consciousness) .. Epileptiform seizures .. Focal neurological deficit (depending on location) .. Personality changes (most characteristic frontal lobe tumors). Supratentorial tumors of median localization.. Hydrocephalic syndrome (headache, nausea/vomiting, impaired consciousness, Parino syndrome, congestive optic discs) .. Diencephalic disorders (obesity/wasting, thermoregulatory disorders, diabetes insipidus) .. Visual and endocrine disorders in tumors chiasmal-sellar area. Subtentorial tumors.. Hydrocephalic syndrome (headache, nausea/vomiting, impaired consciousness, congestive optic discs).. Cerebellar disturbances.. Diplopia, gross nystagmus, dizziness.. Isolated vomiting as a sign of impact on the medulla oblongata. Tumors of the base of the skull. Often asymptomatic for a long time and only in the later stages cause neuropathy of the cranial nerves, conduction disorders (hemiparesis, hemihypesthesia) and hydrocephalus.

Diagnostics

Diagnostics. With the help of CT and / or MRI at the preoperative stage, it is possible to confirm the diagnosis of a brain tumor, its exact location and extent, as well as the presumptive histological structure. For tumors of the posterior cranial fossa and the base of the skull, MRI is more preferable due to the absence of artifacts from the bones of the base (the so-called beam - hardering artifacts). Angiography (both direct and MR - and CT - angiography) is performed in rare cases to clarify the features of the blood supply to the tumor.

Treatment

Treatment. Therapeutic tactics depends on the exact histological diagnosis, the following options are possible:. observation. surgical resection. resection in combination with radiation and/or chemotherapy. biopsy (usually stereotaxic) in combination with radiation and / or chemotherapy. biopsy and observation. radiation and / or chemotherapy without tissue verification based on the results of CT / MRI and the study of tumor markers.

Forecast depends mainly on the histological structure of the tumor. Without exception, all patients operated on for brain tumors need regular MRI / CT follow-up studies due to the risk of recurrence or continued tumor growth (even in cases of radically removed benign tumors).

ICD-10. C71 Malignant neoplasm of the brain. D33 Benign neoplasm of the brain and other parts of the central nervous system

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Glioblastoma of the brain

Neuroglia is a special type of brain cell that retains the ability to divide even after birth. Morphologically, cells are a type of neurons without an axon. According to their functions, astroglia are distinguished, which are involved in the formation of the blood-brain barrier (a barrier between blood and nervous tissue), oligodendroglia, which forms the myelin sheath, and ependymal glia, which lines the CSF pathways. In addition to the structural function, they contribute to electrolyte metabolism, carry out transport functions, and much more.

Unfortunately, It is neuroglia that is the source of many types of brain tumors.. So immature astroglial cells are the source of brain glioblastomas. Glioblastomas affect mainly people of working age (35-60 years), there are no clear gradations by gender.

Information for doctors. The coding of the diagnosis according to ICD 10 passes under the code C71. In this case, a digital specification of a certain localization of the tumor is necessary (0 - large brain, 1 - frontal lobe, 2 - temporal, 3 - parietal, 4 - occipital, 5 - ventricles, except for the fourth, 6 - cerebellum, 7 - trunk and 4th ventricle , 8 - glioblastoma beyond one specified localization). It is also possible to indicate the cipher C71.9 - an unspecified localization. It is obligatory to indicate the cytological nature of the tumor (glioblastoma), syndromal manifestations (hypertensive-hydrocephalic syndrome, etc.).

Causes

The causes of glioblastoma have not been reliably established. Hereditary factors, the role of intoxication, radio emission, and the action of mutagens are expressed. The infectious nature of tumor development was also considered at one time. However, one theory of the disease has not been approved.

Symptoms

The morphological features of the tumor (infiltrative, "penetrating" growth, the rate of increase in the mass of glioblastoma) lead to the rapid development of symptoms.

The main symptoms can be divided into two parts: cerebral and focal manifestations. General cerebral include hypertensive-hydrocephalic syndrome (bursting headaches, nausea, weakness), vestibular (uncertainty of gait, dizziness). Focal manifestations depend on the specific location of the tumor and include speech disorders, changes in the mental sphere, memory loss, inability to perform complex actions, etc.

Sometimes, against the background of a short period of general weakness and headache, a picture of hemorrhagic stroke may develop due to extensive hemorrhage into the tumor tissue. With damage to the brain stem, a threat to the life and death of the patient quickly sets in.

According to the size of the tumor, its cytological nature (the immaturity of the cells that make up the tumors and the rate of their growth) and some other parameters, there are four degrees of glioblastoma.

Treatment

Glioblastoma is practically not amenable to therapy, especially at stages 3-4. Surgical treatment, chemotherapy, radiological methods of treatment usually serve only the purpose of prolonging the life of patients. Surgical treatment of glioblastomas accidentally detected in the early stages and the possibility of neurosurgical access, as a rule, does not lead to a cure. Soon there is a recurrence of tumor growth. In this case, most often the tumor is located deep in the cerebral hemispheres. Modern neurosurgical care is not able to access such deeply located structures.

life forecast

The prognosis of life in glioblastoma is unfavorable. In most cases, death occurs within a few years after the onset of the first signs of the disease.

Astrocytoma of the brain: what is it and how to treat it?

There are various types of tumors in the central nervous system. Their source is various tissues. It is known that the main tissue of the nervous system is neurons. Their bodies form the cerebral cortex, or chamois, and also lie in the middle of the spinal cord. Their processes - dendrites and axons form pathways, or white matter.

But, in addition to nerve cells, there are cells - helpers that perform a connecting and trophic function. They are called glial tissue, or neuroglia, and make up about half the mass of the entire nervous system. One neuron may contain up to neuroglia cells. For example, oligodendrocytes are representatives of oligodendroglia, and astrocytes, similar to asterisks in the form of processes, are astroglia.

Astrocytes make up the supporting skeleton of the neural network, regulate their nutrition, maintain glycogen stores, and protect neurons. In general, these are cells - "nannies".

But sometimes it happens that it is from these cells that malignant tumors arise, such as brain astrocytoma. Since there are a lot of astrocytes, it is astrocytoma that is the most common among all brain tumors.

The ICD-10 does not provide for a separate histological labeling for tumors. There are localization options. Therefore, the general code C71 is provided for any tumor, and in the case of the presence of any tumor, for example, the cerebral hemispheres or the cerebellum, including astrocytoma, the code is set accordingly according to the ICD -10 code

Varieties of the tumor

The most important issue that worries the patient with suspicion is the prospect of a cure and the prognosis of life with brain astrocytoma. Neurosurgeons cannot say this right away, because the results of laboratory diagnostics are needed to determine the type of tumor. It can be performed during surgery, if there is an indication for removal, or with a stereotaxic targeted biopsy.

The prognosis in the presence of cerebral astrocytoma depends on its location and cellular composition. There are the following types of neoplasm:

• pilocytic form. It is practically benign. Therefore, she has slow growth and clear boundaries. Increasing, it does not germinate and does not destroy tissues, but only pushes them away. More often occurs in children. It often occurs in the brainstem, cerebellum, and optic tract. Refers to group 1 malignancy;
• fibrillar variant. This is a more dangerous tumor, this is evidenced by the lack of a clear border. Despite slow growth, it can destroy surrounding tissues. Fibrillar astrocytoma of the brain is more common in older age. Sometimes it can recur, so postoperative radiation therapy is required.
• anaplastic astrocytoma. A dangerous tumor of poorly differentiated cells that quickly germinates and destroys brain structures. It belongs to the 3rd group of malignancy, and occurs at a more mature age - in summer, more often in men. Anaplastic astrocytoma of the brain is one of the first causes in the structure of mortality from brain tumors.

About the next, and the last degree of malignancy, special mention should be made. This tumor, which has completely lost contact with the source - astrocytic glia - is called glioblastoma. These are the most undifferentiated cells that grow very quickly, destroying everything in their path. It most often affects her in adulthood, and more often men.

Sometimes it happens that the prognosis for anaplastic astrocytoma of the brain worsens significantly, as it transforms into glioblastoma. It can be said that death within a few months after the diagnosis of glioblastoma is common.

Signs and treatment

The most dangerous and unfavorable, almost fatal option is the astrocytoma of the brain stem of the maximum degree of malignancy, that is, glioblastoma. Any tumors of the trunk, even benign ones, are very dangerous. Removing them is very difficult, and with low differentiation, it is impossible.

In the trunk, on a tiny volume, there is a huge number of pathways and nuclei of cranial nerves, including vital ones. Therefore, the germination by a tumor, for example, of the autonomic nuclei of the X pair of cranial nerves (vagus), causes disorders of the heart that are incompatible with life.

Signs of such an astrocytoma can be detected in the presence of a sudden onset of an alternating syndrome, with an increase in symptoms. On one side, central paralysis occurs, and on the opposite side, damage to the cranial nerve (strabismus, paralysis of the tongue), or sensitivity disorders (pain, temperature, tactile) occurs.

In the case of a different localization of the tumor, there may be:

• headache;
• congestive signs in the fundus;
• nausea and vomiting;
• dizziness;
• epileptic seizures;
• bradycardia, or slow heart rate;
• violation of higher functions: counting, writing, intellect.

These are the most common symptoms. In the future, everything depends on the localization, since the astrocytoma can be located anywhere: in all lobes of the cerebral hemispheres, in the corpus callosum, in the trunk and subcortical nodes, in the region of the 3rd ventricle and the pellucid septum, quadrigemina and other places.

Treatment of cerebral astrocytoma is only surgical, followed by courses of radiation and chemotherapy. In the event that an inoperable tumor is diagnosed, for example, in the trunk, then only radiation and chemotherapy are used.

It is not possible to estimate the survival time after removal of an astrocytoma in general terms. You need to know the degree of malignancy. So, according to M. V. Bazunov, “after removal of astrocytomas, regardless of location, in almost 90% of cases, survival was more than 10 years.”

Astrocytoma ICD

Astrocytoma of the brain is a tumor of glial origin, which is formed from astrocytes. Astrocytes are stellate-shaped brain cells. This type of brain cells regulates the volume of intercellular fluid, and also ensures the normal functioning of nerve cells in the brain. Astrocytes have the ability to divide. But in the case when the process of reproduction becomes uncontrolled, the development of a malignant tumor is possible. Astrocytoma is often seen in men between the ages of 28 and 60. Thanks to modern improved diagnostic methods, doctors have found that almost the majority of brain tumors are astrocytomas. Astrocytoma is the most common form of glial tumor.

According to the ICD classification, astrocytoma refers to malignant neoplasms of the brain. ICD is an international classification of diseases of the 10th reading. Astrocytoma according to the ICD can have the following codes:

• C71 Malignant tumor localized in the brain;
• D43 Education of unknown etiology and character in the central nervous system.

Localization of astrocytoma

This form of glial tumor can develop at any age and be localized in different areas of the brain. Often this type of tumor is diagnosed in such parts of the brain:

• Large hemispheres of the brain - this localization is more often observed in adulthood;
• Brain stem (where the brain connects to the spinal cord). According to the ICD, such an astrocytoma was called spinal cord astrocytoma;
• Cerebellum (more common in childhood);
• The optic nerve in children.

Causes of astrocytoma

Currently, the exact causes that lead to the development of astrocytoma have not been established. But scientists have identified some factors that provoke the development of this malignant formation:

• Hereditary predisposition to the development of cancer;
• Negative effect of the environment (radiation, chemicals);
• Viruses that have a high risk of oncogenicity.

Classification of astrocytoma

Doctors distinguish several types of astrocytoma. The most common types of astrocytoma are:

• According to the ICD, polycytic astrocytoma is a benign formation that has clear boundaries. This type of tumor is localized in the cerebellum or in the brain stem and has a first degree of malignancy. This neoplasm is characterized by slow tumor growth. This form is more often diagnosed in childhood. Polycytic astrocytoma is treated only by surgery;
• Protoplasmic astrocytoma can be localized on the surface of the gray matter of the brain or in its cortical structures. This form of tumor does not affect healthy tissues during growth, which leads to a favorable prognosis for surgical treatment. In this case, the neoplasm grows very slowly and is characterized by a second degree of malignancy;
• Diffuse astrocytoma is one of the most severe forms of this tumor and has a second degree of malignancy. It has no clear boundaries, is characterized by very rapid growth, which is unfavorable for surgical treatment;
• Anaplastic astrocytoma is characterized by grade 3 malignancy, rapid growth, and indistinct borders. This form of astrocytoma grows into healthy brain tissue, which complicates surgical treatment;
• Glioblastoma is the most severe form of astrocytoma and is characterized by the fourth degree of malignancy. It is characterized by very intensive growth, which is manifested by a rapid increase in tumor size. This form of astrocytoma grows deep into healthy tissue, making surgical treatment impossible.

Clinical symptoms of astrocytoma

This tumor is characterized by both general (developing due to the toxic effect of tumor metabolites or compression of adjacent brain structures) and local symptoms (with localization in a certain area of ​​the brain).

Common symptoms of astrocytoma:

• Headaches of a permanent nature;
• Dizziness, fainting;
• Nausea, vomiting;
• Unmotivated weakness;
• Speech disorders and memory impairment;
• High blood pressure, which is a consequence of increased numbers of intracranial pressure;
• Disturbances in coordination during movement;
• Disorder of vision, hearing, smell, taste;
• Seizures and epileptic seizures.

Diagnosis of astrocytomas

To establish the diagnosis of astrocytoma, the following diagnostic methods are used:

• Full collection of complaints;
• Complete examination by a neurologist, ophthalmologist, otolaryngologist, neurosurgeon;
• Computed tomography of the brain (localization of the tumor is determined);
• Magnetic resonance imaging of the brain (evaluate the anatomical structures of the brain and the presence of astrocytomas in the early stages of development);
• Histological examination by biopsy (accurately indicates the presence of cancer cells);
• Angiography (examines the vascular bed of the brain);
• Visual, vestibular function is assessed;
• Mental status is assessed;
• ultrasound of the brain;
• Electroencephalography.

Treatment of astrocytomas

The method and extent of treatment depends on the location of the tumor, its size and degree of malignancy.

The main therapeutic measures used to treat astrocytomas:

• Radical or partial removal of the neoplasm;
• Radiation therapy;
• Chemotherapy.

In the case when the tumor has grown into healthy brain tissue, a partial surgical removal of the tumor is performed. When the tumor has clear boundaries and grows into healthy tissues, a radical removal of the neoplasm is performed. The radiation method of treatment involves the destruction or suspension of the development of the pathological process. The chemotherapeutic method of treatment is characterized by the use of special drugs that destroy tumor cells, since they have a toxic effect on them.

glioblastoma

Glioblastoma is considered the most dangerous malignant brain tumor that develops from glial cells. The main distinguishing criteria include the disordered arrangement of cells that have undergone a malignant process, changes in the configuration of blood vessels, widespread edema, and the presence of necrotic areas in the brain. In addition, glioblastoma is characterized by rapid progression, involving surrounding tissues in the process, as a result of which the tumor does not have clear boundaries.

The nervous system is considered the only place of its localization. Most often, a malignant neoplasm is located in the temporal and frontal regions. However, cases of detection of a focus in other brain structures, such as the trunk, cerebellum, and even in the spinal cord, are not excluded. Glioblastoma may contain various types of cells, such as astrocytes and oligodendrocytes. According to statistics, about 50% of all neoplasms of the brain are glial tumors, of which the majority are glioblastomas.

ICD-10 code

Causes of glioblastoma

The causes of glioblastoma are not well understood and have no evidence base. However, despite the fact, there are still some factors that stimulate its appearance. These include gender and age - most often glioblastoma occurs in males from 40 to 60 years old, the presence of other concomitant tumors, for example, astrocytoma, which can become the primary focus of the distribution of altered cells. In addition to internal factors, it is worth paying attention to working conditions, since harmful production using chemicals or rubber has a negative impact on human health. Genetic predisposition and traumatic brain injury can also be a trigger in the development of glioblastoma.

Symptoms of glioblastoma

Clinical manifestations of glioblastoma depend on the location of its localization and damage to certain brain structures. Glioblastoma has a large number of manifestations that are inherent not only to this tumor, but also to other diseases. Such symptoms of glioblastoma are called non-specific. In addition, they can be focal and cerebral in nature. Focal symptoms are caused by damage to the brain structures responsible for certain functions in the human body, as a result of which there is a violation in the work of the corresponding organ or system. The cerebral clinic is characterized by signs of involvement in the process of more of the brain.

Glioblastoma can present with headaches. This sign is considered quite common and one of the earliest symptoms that makes people see a doctor. Painful sensations in the temporal and frontal regions disturb more than half of people with a tumor. Of course, glioblastoma is not the only cause of headaches, but still, if this symptom is present for a long period and other pathologies are excluded, it is recommended to conduct additional examinations for the presence of a neoplasm in the brain. Headaches are permanent, high intensity, can increase with physical exertion, bending over, sneezing, coughing, and do not decrease after taking painkillers, antispasmodic or vascular drugs. A characteristic feature of headaches in brain tumors is an increase in their intensity in the morning, as there is an accumulation of fluid in the brain tissues. This is due to a violation of the outflow of blood from the head in a horizontal position. Glioblastoma is characterized by intensive growth, which is why a large amount of toxic substances has a negative effect on brain structures, including veins. As a result, the affected vessels cannot cope with their function and provide a normal outflow of blood.

The next symptom is dizziness, which does not depend on a change in the position of the head or body. It refers to cerebral manifestations and appears due to a sharp increase in intracranial pressure. If the glioblastoma has affected the cerebellum, pons, cerebellopontine ganglion or posterior cranial fossa, then the vestibular apparatus will suffer. In this case, dizziness will be considered a focal symptom.

In addition, there are such symptoms of glioblastoma as nausea and vomiting, which are of central origin, as a result of which they are not associated with food intake and vomiting does not bring relief. Most people report general weakness, increased fatigue and drowsiness. Violation of visual function and hearing may be the result of increased intracranial pressure or compression of the optic or auditory nerve by a tumor-like formation or swollen tissues. Violation of the speech function, as well as the loss of the ability to transform one's thoughts into connected speech, are noted when the speech center is affected. Thus, memory and mental abilities may deteriorate. In addition, a change in the frequency of breathing or even its oppression is most often manifested by a unilateral process.

Mental disorders are manifested in the form of lethargy, general weakness and apathy. Sometimes there is confusion, during which a person is not quite clearly aware of where he is and does not react to the events surrounding him. Some symptoms of glioblastoma are manifested by paralysis of a certain part of the body or the entire side, and sensitivity disorders are also noted. Horizontal nystagmus can manifest as side-to-side floating movements that are not noticeable to the person himself. If there are cases of hallucinations, but they are mostly not visual, but tactile or auditory. It can be barely audible sounds, single touches or smells. The likelihood of developing epileptic seizures is approximately 10% of all people diagnosed with glioblastoma.

Glioblastoma of the brain

Glioblastoma of the brain, depending on its specific characteristics, can be divided into several types. Among them, giant cell is distinguished, which consists of huge cells with several nuclei; multiform, isolated due to pronounced polymorphism of cells and tissue structures, as well as a high risk of hemorrhage and necrotic processes. The third type of neoplasm is called gliosarcoma, which is distinguished by its aggressiveness and speed of development.

Depending on the affected area, glioblastoma of the brain can manifest itself with various symptoms, ranging from loss of appetite to coma.

Glioblastoma of the brain stem

This type of neoplasm is distinguished by its poor prognosis in terms of treatment, as it is considered an inoperable pathology. This is due to the presence of important structures in the brain stem that are responsible for the vital functions of the body. The trunk is the junction of the brain and spinal cord. It has nuclei of cranial nerves, as well as respiratory and vasomotor centers. In this regard, if a glioblastoma of the brain stem is detected, then the symptoms will manifest themselves in the form of respiratory and palpitations. The disease can begin both in the trunk itself and in another part of the brain. Glioblastoma has a high rate of development and spread, as well as significant cell atypicality.

Glioblastoma multiforme

Glioblastoma multiforme has its own distinctive features. Among them, one can single out a large number of various cells and tissues, as well as the emergence of new structures. The disease belongs to the most aggressive forms of brain tumors and accounts for almost a third of all intracranial neoplasms. The source of tumor development is glial cells, which, under the influence of provoking factors, begin to degenerate into atypical cells. Most often, glioblastoma is localized in the cerebral hemispheres, however, cases of damage to the spinal cord or trunk by a malignant process are recorded.

Polymorphic cell glioblastoma

The polymorphocellular form of the disease is diagnosed quite often. In cytological examination, tumor cells have a different size and shape. Their cytoplasm occupies little space relative to other structures and is weakly stained during examination. Cell nuclei are also distinguished by their polymorphism; one can find bean-shaped, oval, round and irregular shapes. Polymorphic cell glioblastoma also has giant cells, in the middle of which there is one nucleus.

Isomorphic cell glioblastoma

Glioblastoma, which has an isomorphic cellular composition, is extremely rare. Tumor cells are characterized by uniformity, but there are still some slight differences in the size and shape of the nuclei in the cells. The most common are rounded and oval shapes. Isomorphic cell glioblastoma consists of cells whose cytoplasm and thin cell processes are not clearly contoured, and division areas are quite common.

Glioblastoma grade 4

Depending on the presence of certain signs, brain tumors have four grades of malignancy. The first degree is considered the boundary between benign and malignant processes. Such neoplasms do not have signs of malignancy. The second degree already contains one of the signs, which is most often cellular atypia. Tumors of these degrees grow slowly and are among the least malignant neoplasms. The third degree includes two signs, but without necrotic processes. Tumors grow faster than in previous degrees and are considered malignant. As for the fourth degree, but it is characterized by all the signs of malignancy, including necrosis. Thus, grade 4 glioblastoma has a high growth rate, and is itself considered the most malignant of all primary brain tumors. The prognosis for life is unfavorable.

Glioblastoma recurrence

Despite significant progress in the field of medicine, in particular, in neurosurgery, the question of the rapid development of glioblastoma and its frequent relapses still remains open. Glioblastoma refers to those tumors with an irregular shape that do not have clear boundaries. In this regard, the removal of the tumor is completely impossible, so the recurrence of glioblastoma is observed quite often. Neoplasm cells are highly resistant to radiation, as a result of which the possibilities of using radiation therapy are limited due to the sensitivity of surrounding healthy cells. In addition, chemotherapy courses also cannot guarantee tumor reduction, since not all drugs can penetrate the blood-brain barrier. A complex of therapeutic measures, including surgical removal of glioblastoma, radiation and chemotherapy, cannot guarantee a complete recovery.

The main reason for the rapid progression and development of relapses is miRNA-138. Glioblastoma, namely stem cells, are capable of producing this miR-138. it can be used as a neoplasm biomarker. There is an assumption that when this indicator is neutralized, the likelihood of slowing the progression of the disease increases, as well as increasing the survival rate of people diagnosed with glioblastoma. Thanks to this discovery, the recurrence of glioblastoma can be observed as an exception, and not the rule, as in our time.

Classification of a brain tumor according to ICD 10

ICD10 - International Classification of Diseases 10th revision. If you decide to be treated in a foreign clinic, then most likely you will first of all be asked what ICD10 code your doctor diagnosed.

It is important to know that D43 are benign brain tumors, and C71 are malignant, that is, cancer.

benign

Benign neoplasm of the brain and other parts of the central nervous system (D33).

A benign brain tumor is located in:

Astrocytomas - description.

Short description

Astrocytomas are the largest and most common group of primary CNS tumors, differing in location, sex and age distribution, growth pattern, malignancy, and clinical course. All astrocytomas are of "astroglial" origin. Incidence: 5–7: population in developed countries.

For all astrocytomas, the universal grading system (WHO) is applied according to the histological criterion "grade of malignancy" Grade 1 (piloid astrocytoma): there should be no sign of anaplasia Grade 2 (diffuse astrocytoma): 1 sign of anaplasia, more often nuclear atypia Grade 3 (anaplastic astrocytoma): 2 features, more often nuclear atypia and mitosis Grade 4 (glioblastoma): 3–4 features: nuclear atypia, mitosis, vascular endothelial proliferation and/or necrosis.

There are a number of clinical and pathological groups of astrocytomas.

Diffuse-infiltrative astrocytoma. This concept combines several types of tumors of varying degrees of malignancy.

Diffuse astrocytoma (WHO-2) - 10-15% of all brain astrocytomas, peak incidence 30-40 years, men / women - 1.2: 1; are more often located supratentorially in the cerebral hemispheres. clinical picture. Most often, these tumors are manifested by episyndrome, focal neurological deficit, signs of increased ICP are added at a late stage of the disease. Diagnostics. Tumors have characteristic CT and MRI semiotics. Treatment. Tactics: removal of the tumor or observation / symptomatic therapy (the decision can be made only after consulting a neurosurgeon). The previously popular tactic - biopsy + radiation therapy - has no advantage over "observation". Prognosis: The average life expectancy after surgery is 6–8 years with pronounced individual variations. The clinical course of the disease is mainly influenced by the tendency of these tumors to malignant transformation, which is usually observed 4-5 years after the diagnosis. Clinical favorable prognostic factors are young age and "total removal" of the tumor. Among diffuse astrocytomas, a number of histological variants are distinguished. Fibrillar astrocytoma - the most common variant, consists mainly of fibrillar tumor astrocytes. Nuclear atypia is a diagnostic criterion. Mitoses, necrosis, endothelial proliferation are absent. Low to moderate cell density in the slide. Protoplasmic astrocytoma, a rare variant, consists mainly of tumor astrocytes with a small body and thin processes. The cell density in the preparation is low. Characteristic features are mucoid degeneration and microcysts. Gemistocytic astrocytoma. This variant is characterized by the presence in the fibrillar astrocytoma of a significant fraction of hemistocytes (usually more than 20%). Hemistocyte - A variant of the astrocyte with a large, angular, malformed eosinophilic body.

Anaplastic astrocytoma (WHO-3) accounts for % of all brain astrocytomas, peak incidence 40–45 years, men/women -1.8:1; located most often supratentorially in the cerebral hemispheres. Currently, the dominant point of view is that anaplastic astrocytoma is the result of malignant transformation of diffuse astrocytoma. Its pathomorphology is characterized by signs of diffuse infiltrative astrocytoma with severe anaplasia and high proliferative potential. The clinical picture is in many ways similar to diffuse astrocytoma, but signs of increased ICP are more common, and there is a more rapid progression of neurological symptoms. Diagnosis: Tumors do not have characteristic CT and/or MRI semiotics and may often appear as diffuse astrocytoma or glioblastoma. Treatment: Currently, the standard treatment algorithm is combined treatment (surgery, radiation therapy, polychemotherapy). Forecast. The average life expectancy after surgery and adjuvant treatment is about 3 years. The clinical course of the disease is mainly influenced by the transformation into glioblastoma, which is usually observed 2 years after the diagnosis. Clinical favorable prognostic factors are young age, "total removal" of the tumor and a good preoperative clinical status of the patient. The presence of an oligodendroglial component in the tumor may increase survival to >7 years.

Glioblastoma (GBM) and its variants (WHO-4). It is the most malignant of astrocytomas and accounts for about 50% of all brain astrocytomas, the peak incidence is 50–60 years, men/women - 1.5:1; is located most often supratentorially in the cerebral hemispheres. There are primary (more often) and secondary GBM (as a result of malignancy of diffuse or anaplastic astrocytoma). Its pathomorphology is characterized by signs of diffuse infiltrative astrocytoma with severe anaplasia, high proliferative potential, signs of endothelial proliferation and/or necrosis. clinical picture. Primary GBM is characterized by a short history dominated by nonspecific neurological symptoms and rapidly progressive intracranial hypertension. In secondary GBM, the clinic is in many ways similar to anaplastic astrocytoma. Diagnostics. The tumor has a characteristic CT and MRI semiotics; differential diagnosis is usually carried out with metastasis and abscess. Characteristic is the invasive growth of the tumor along long conductors (GBM in the form of a "butterfly" when germinating through the corpus callosum). Treatment. At the moment, the standard treatment algorithm is combined treatment (surgery and radiation therapy, the role of polychemotherapy in increasing survival in GBM has not been reliably proven at the moment, and the need for its implementation is considered only in cases where all other methods of treatment have been performed and turned out to be ineffective (" therapy of desperation).Prognosis.Mean survival after surgery and adjuvant treatment is about 1 year.Clinical favorable prognostic factors are similar to those of anaplastic astrocytoma.

In addition to typical glioblastoma multiforme, the following histological variants are distinguished: Giant cell glioblastoma is characterized by a large number of giant malformed multinucleated cells. Gliosarcoma is a two-component malignant tumor with foci of both glial and mesenchymal differentiation.

Pilocytic (piloid) astrocytoma is a tumor of childhood, characterized by a relatively “delimited” growth pattern (unlike diffuse astrocytomas) and has characteristic features of localization, morphology, genetic profile and clinical course. It belongs to the lowest (1st degree of malignancy according to the WHO classification for tumors of the central nervous system) and has the most favorable prognosis. It is most common before the age of 20 years. The most common localization is the cerebellum, visual pathways, brain stem. The clinical picture is characterized by a very slow increase in both focal (depending on the location of the tumor) and cerebral symptoms with good adaptation of the body. Especially characteristic is the slow increase in occlusive hydrocephalus in tumors of the cerebellum and brain stem. Diagnostics. The tumor has a characteristic CT and MRI semiotics, which, together with the clinical picture, makes it possible to make a diagnosis before surgery. Contrast-enhanced MRI is the standard preoperative examination for such patients. The treatment is surgical, the goal of the operation is the "total removal" of the tumor, which is often impossible due to localization (brain stem, hypothalamus). Forecast. The survival of patients is often more than 10–15 years, and therefore there are no exact values ​​for survival due to difficulties in analyzing such a long follow-up. Note. Among piloid astrocytomas (more often hypothalamic) there is a small subgroup of tumors with pronounced locally "invasive growth" and a tendency to metastasize to subarachnoid spaces.

Pleomorphic xanthoastrocytoma - a rare tumor (less than 1% of all astrocytomas), occupies an intermediate position in the series of "malignancy" due to its dual behavior (WHO-2). In some cases, the tumor is well demarcated and slowly growing with a favorable prognosis. At the same time, cases of its malignant transformation with an unfavorable prognosis are described. clinical picture. Most often, the tumor occurs at a young age and is manifested by episyndrome. Characteristic is the superficial subcortical localization and the tendency to involve the adjacent membranes of the brain in the pathological process (“meningo-cerebral” volumetric process). Diagnosis: CT/MRI. The treatment is surgical, the goal of the operation is the "total removal" of the tumor, which is often achievable. Forecast. 5-year survival rate is 81%, 10 - 70%. An independent prognostic factor is increased (more than 5 mitoses in a high magnification field) mitotic activity. Most tumors with an aggressive course are characterized by this indicator.

ICD-10 D43 Neoplasm of uncertain or unknown nature of the brain and central nervous system C71 Malignant neoplasm of the brain

Appendix. Genetic aspects Two types of damaged genes have been registered in astrocytomas: dominantly inherited oncogenes, protein products of the gene accelerate cell growth; typical damage - an increase in the dose of a gene due to amplification or an activating mutation of tumor growth suppressors, the protein products of the gene inhibit cell growth; typical damage - physical loss of the gene or inactivating mutation Mutations: TP53 gene (*191170, 17p13.1, Â) MDM2 (164585, 12q14.3–12q15, Â) CDKN1A (*116899, 6p, Â) CDKN2A and CDKN2B (9p21) CDK4 and CDK6 (12q13–14) EGFR (*131550, 7, Â).

Treatment of astrocytoma of the brain

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In the article we discuss astrocytoma of the brain. We talk about its types, symptoms and diagnosis. You will learn how the treatment is carried out, what is the prognosis, what nutrition is needed for this disease.

What is an astrocytoma of the brain

Astrocytoma is a brain tumor that develops from astrocytes - neuroglial cells. The density of astrocytoma is similar to the gray matter of the brain, has a pale pink tint. The boundaries of the tumor are quite clear, but in advanced cases they are difficult to determine. In the cavity of an astrocytoma, cysts often form, they grow slowly, and can reach large sizes.

Cysts in the tumor often occur in children, the astrocytoma itself in childhood is mainly located in the cerebellum. For adult patients, localization of the neoplasm in the cerebral hemispheres is typical.

ICD-10 code - C71 Malignant neoplasm of the brain.

The classification of astrocytomas is combined with the stages of malignancy of the disease.

There are the following types of astrocytoma:

• pilocytic or piloid - stage 1 malignancy, relatively benign tumor, has clear boundaries and slow growth, is located in the small brain, brain stem, optic nerves;
• fibrillar - stage 2 of malignancy, grows slowly, there are no clear boundaries, most often occurs in young people under 30 years old, protoplasmic astrocytoma is also referred to stage 2;
• anaplastic - stage 3, astrocytoma has no clear boundaries, it grows rapidly and grows into other brain tissues, occurs in patients years;
• glioblastoma - stage 4 malignancy, the tumor has no boundaries, it is characterized by rapid growth and germination in the brain tissue, occurs in patients of age, predominantly male.

In addition to the above types of tumors, microcystic cerebellar astrocytoma and diffuse cerebral astrocytoma are also isolated. However, classification by grade is most important for prognosis.

Symptoms and Diagnosis

Symptoms of cerebral astrocytoma depend on the size and location of the neoplasm. Small astrocytomas practically do not give themselves away, they are characterized by a long asymptomatic course, which makes them difficult to detect.

As the tumor grows, the patient develops the following symptoms:

• headaches;
• vertigo;
• attacks of nausea and vomiting, most pronounced in the morning after waking up;
• memory impairment;
• deterioration in concentration;
• decreased mental function;
• violations of speech function;
• dulling or increased sensitivity;
• deterioration of motor function;
• decreased vision, hearing, smell;
• mood swings.

With the development of the first signs of the disease, you should consult a doctor. Timely diagnosis and prescribed treatment significantly increase the chances of success.

Clinical examination is carried out by a neurologist, neurosurgeon, otolaryngologist and ophthalmologist. The examination includes a neurological examination, determination of visual acuity and ophthalmoscopy, threshold audiometry, diagnostics of the vestibular apparatus and the mental state of the patient.

• ECHO EG brain;
• electroencephalography;
• computed tomography;
• magnetic resonance imaging;
• angiography.

To determine the degree of malignancy, a histological examination is carried out, the material is taken by performing a stereotactic biopsy or surgical intervention.

Treatment

Removal of brain astrocytomas is carried out mainly by the surgical method. The tumor is subject to removal if it is small in size and has clear boundaries, is located in insignificant areas of the brain. Before the operation, the organ must be punctured, this allows doctors to determine the density of the tissue and detect cysts.

If the tumor does not have clear boundaries, it can be removed, to eliminate the remaining cells, the patient is prescribed radiation therapy or chemotherapy.

Large tumors are not removed, since with extensive growth in the brain tissue, the main centers of the brain of the head will be affected. In these cases, shunting may be performed to reduce hydrocephalus, as well as the appointment of symptomatic therapy to improve overall well-being.

Carrying out a full-fledged stereotactic radiosurgery is possible only with a small size of the formation, not exceeding 3 centimeters. Radiosurgical removal of a brain astrocytoma is carried out under the control of computer or magnetic resonance imaging, for this a special stereotaxic frame is put on the patient's head.

External radiation therapy is carried out repeatedly - the patient is prescribed from 10 to 30 sessions of irradiation of the affected area.

When choosing chemotherapy as the main or additional method of treatment, the patient is prescribed cytostatics, they are taken orally or by intravenous administration.

You will learn more about the treatment of brain astrocytoma in the following video:

Nutrition

A healthy lifestyle plays an important role in the treatment and prevention of cerebral astrocytoma. In addition to physical activity and the rejection of addictions, changes also apply to the patient's diet.

Eliminate fatty and fried foods and other foods containing carcinogens from your menu. Do not drink coffee, soda, alcoholic beverages. Give preference to natural food - fresh vegetables and fruits, cereals, foods that improve brain function. Include in your diet salmon fish and fish oil, walnuts, avocados, broccoli, blueberries, pomegranates, red berries, green tea.

Forecast

The following factors influence the prognosis of life in cerebral astrocytoma:

• the degree of malignancy of the neoplasm;
• patient's age;
• localization of education;
• the rate of transition of the tumor to another stage;
• a history of relapses.

First of all, the prognosis of life with astrocytoma depends on the stage of the disease. In the first stage, a life expectancy of 10 years is possible. Upon transition to stage 2, this value decreases to 7-5 years. In the last stages of pathology, life expectancy is 3-4 years.

What to remember

1. Astrocytoma of the brain - a tumor that grows from astrocytes, has 4 degrees of malignancy.
2. The clinical picture in astrocytoma includes headaches and neurological disorders of various nature.
3. Treatment of the tumor is carried out surgically, using radiation therapy, radiosurgery and chemotherapy.

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Tumors of the brain and other parts of the central nervous system

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan (Orders No. 883, No. 165)

general information

Short description

Tumors of the central nervous system (CNS) include benign and malignant neoplasms that develop from the cellular elements of the nervous system and other tissues (meninges, blood vessels, connective tissue) located in the cranial cavity and inside the spinal canal (A. G. Zemskaya et al. , 1985).

CNS tumors range from 1.8% to 2.3%. The incidence of brain tumors is 7-8 times higher than the incidence of the spinal cord. (B. M. Nikiforov et al., 2003). Of all brain tumors, gliomas account for 40-67%, and meningiomas 27%. There are 2 age peaks: in infancy - 4%,000, and in the age group - 27%,000. Spinal cord tumors account for 0.9-2.5% of 000, with the most common tumors being schwannomas and meningiomas. (Chapman & HallMedicalWHO, 2000).

According to the Kazakh Cancer Registry (indicators of the oncological service of the Republic of Kazakhstan. Almaty for 2009), the incidence of CNS tumors in 2009 was 600 or 3.8% 000. The main causes of the development of CNS tumors should be considered as proven influence of two factors: disembryogenetic and mutagenic.

Brain tumor code for mcb 10

How is cerebral edema coded according to ICD 10?

The International Classification of Diseases of the Tenth Revision is the only document in which pathologies are encrypted in the same way for all countries.

A condition such as cerebral edema according to ICD 10 can be encrypted in several ways. An etiological factor plays an important role in determining the pathology code. In the case of edema, this may be:

• trauma of the cranium and brain;
• ischemic or hemorrhagic stroke;
• intracranial hematoma;
• inflammation of the meninges;
• birth trauma (or other pathologies of labor activity);
• severe childhood infections;
• intoxication damage to the nervous tissue;
• infectious process.

Depending on the cause that caused the edema, the coding of the pathological process may change. However, the class always remains the same.

Encryption options

Cerebral edema, according to the ICD code 10, belongs to the class where diseases of the nervous system are indicated. It is under G93 for other brain lesions. There are 9 categories in this paragraph, and the pathological accumulation of fluid is under the number 6. That is, the full code for this disease is as follows: G93.6. However, the encryption may be different.

The following conditions are excluded from this paragraph:

• Brain swelling caused by birth trauma. Pathology code: P11.0. It refers to other birth injuries of the central nervous system. There are 4 items in this section.
• Traumatic edema. Condition code: S06.1. It is in the section of intracranial injuries. It is possible to additionally use the fifth character in the encoding (1 or 0), which will indicate the presence or absence of an open wound.

Cerebral edema should be coded according to ICD 10 to take into account statistical data. With the help of such encryption, it is more convenient to store and process information. And since pathology poses an immediate threat to life and often ends in death, the code is needed to correctly calculate mortality, taking into account the etiological factor, which helps to develop effective methods to prevent mortality.

Causes and symptoms of cerebral edema, ICD disease code 10

All information on the site is provided for informational purposes only. Before using any recommendations, be sure to consult your doctor. Self-medication can be dangerous for your health.

HMO - cerebral edema (ICD-10 code gives G93) - refers to diseases of the nervous system. Cerebral edema is another name for this serious illness. This is the reaction of the body to adverse factors, a formidable complication of intracranial pathology. With such a pathophysiological reactive state, certain changes occur in the brain tissues.

Of great importance are the causes associated with the autonomic nervous system. Interstitial, vascular lesions are characteristic of BT. About 0.07% of cases of pathology are registered among newborns. At the age of 4-12 years there is a peak incidence in children. In any age period, cerebral edema associated with trauma can occur.

2 Varieties of OGM

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They differ in methods of treatment, genesis, location of painful foci, the rate of development of the disease.

There are 4 types of pathology:

1. Exposure to bacteria, toxic substances, malnutrition of the brain during cerebral ischemia, impaired cell osmoregulation, swelling of the membranes of brain cells are the causes of cytotoxic BT. Pathology develops as a result of oxygen starvation immediately after tissue damage.
2. With interstitial BT, vascular permeability does not change. In the ventricles of the brain increases intracranial pressure - ICP. Pathology occurs due to head dropsy - hydrocephalus.
3. Bacterial meningitis, epilepsy, tumors or brain metastases are the causes of vasogenic BT. The permeability of the capillary wall increases. Blood plasma proteins exit the vascular bed into the intercellular space. Such high-molecular nitrogen-containing compounds expand due to the accumulation of sodium ions and liquids in them. Neuronal death occurs in the intercellular substance of the brain. This is the most common type of pathology.
4. As a result of impaired excretion of salts, water intoxication of the central nervous system, osmotic edema develops.

Depending on the affected area, OGM is distinguished:

3 Clinical picture of the disease

The liquid portion of the blood leaks through the walls of blood vessels. The brain swells, increases in volume. Violation of cerebral circulation is associated with increased intracranial pressure. The displacement of brain structures into the foramen magnum occurs due to the progression of edema. The deterioration of cerebral circulation is the cause of cell death. Part of the brain is destroyed irrevocably. The patient feels severe attacks of a bursting headache.

General somatic lethargy. Decreased mental activity, a constant desire to sleep are noted at the onset of the disease. Problems with speech. Memory losses. Paroxysmal muscle contraction - convulsions. Spontaneous dizziness, which is accompanied by panic fear, poor balance, severe vomiting. Loss of normal ideas about space and time. Weakened reaction to irritation, complete immobility - stupor.

Often there are pauses and interruptions in breathing. Tendon reflexes fade away. The tone of the muscles of the back of the head increases. Acts of swallowing are violated. There is visual impairment. Paralysis of the oculomotor nerve develops. There is diplopia - doubling of the visible image. Pupil dilation is noted. Their reactions are greatly reduced. Vision disappears completely if the artery of the posterior parts of the brain is compressed.

Cerebral edema develops very quickly in children (ICD-10 code - G93.6). If an BT develops in a newborn, the patient constantly screams in a sharp, shrill voice. Later, a soporous state occurs, which is characterized by loss of consciousness, loss of voluntary reflexes. Hyperthermia appears - an increase in body temperature.

If, due to microcirculation disorders, the capillaries are not adequately supplied with blood, this provokes the development of necrosis, and ischemia is aggravated. If cerebral edema is left untreated, the most deplorable consequences can occur, often coma develops. The risk of death increases.

4 Diagnostic tests

The neurologist diagnoses and prescribes treatment. The nature of the disease can be identified using a general blood test. The type, size and localization of edema are determined using a brain tomogram. Neurological examination gives a complete picture of the pathology.

5 Therapy for cerebral edema

Depending on the cause and symptoms of the disease, the doctor determines the tactics of treatment. In most cases, it is necessary to treat the disease that caused the swelling of the brain.

ASTROCYTOMA is:

Astrocytoma - a class of glial tumors of the brain and spinal cord derived from astrocytes; grow infiltratively, clearly not delimiting from the brain tissue. Incidence: 5-6:population.

WHO classification in ascending order of malignancy (Stage)

Low stage diffuse astrocytoma

Glioblastoma is the most malignant type of astrocytoma. Histological variants

Pilocytic astrocytoma (piloid, hairy) is a highly differentiated (mature, benign) tumor containing parallel bundles of glial fibers that resemble hair in appearance; usually well demarcated from surrounding tissues.

Pleomorphic xanthoastrocytoma is a rare tumor that grows slowly and is well demarcated from surrounding tissues, but malignancy is possible.

Low-stage diffuse astrocytomas (relatively benign)

Fibrillar astrocytoma is the most common variant; originates predominantly from fibrous astrocytes, a small amount of fibrillar-protoplasmic astrocytes is acceptable. Cysts are often found

Subependymal astrocytoma (subependymal glomerular astrocytoma, subependymoma) is a fibrillar astrocytoma originating from the glia adjacent to the ependyma; it is characterized by small accumulations of tumor cells

Fibrillar protoplasmic astrocytoma originates from fibrous and plasma astrocytes

Protoplasmic (plasmic) astrocytoma is a rare variant of a tumor consisting of small neoplastic astrocytes with a small number of processes

Spindle cell astrocytoma is a benign glial tumor of the brain, characterized by the arrangement of elongated bipolar cells with spindle-shaped nuclei in the form of a bundle.

Anaplastic astrocytoma (atypical, heterotypic, de-differentiated, malignant, malignant) - diffuse astrocytoma with anaplasia (nuclear atypia, polymorphism) and rapid growth: it can be reborn from low-stage astrocytoma; clinic and treatment are similar to low-stage astrocytomas, but the duration of the course is shorter

Astrocytoma polymorphocellular is characterized by significant cell polymorphism

Large cell astrocytoma (mast cell) consists mainly of hypertrophied astrocytes.

Glioblastoma (see Glioblastoma).

Genetic Aspects

2 types of damaged genes:

Dominantly inherited oncogenes, protein gene products accelerate cell growth; typical damage - an increase in the dose of a gene due to amplification or an activating mutation

Tumor suppressors, protein products of the gene inhibit cell growth; typical damage is a physical loss of a gene or an inactivating mutation

TP53 gene (, 17р13.1, 99

MDM2(, 12ql4.3-12ql5.99

CDKN1A (*116899, 6p, 90

CDKN2A and CDKN2B(fy1)

EGFR (*, 7, 99.

Characteristic

Pilocytic (piloid) astrocytoma

Histologically benign and relatively slow growing glial tumor

Manifests in childhood or adolescence

Localization: optic nerve, optic chiasm, hypothalamus, thalamus and basal ganglia, cerebral hemispheres, cerebellum and brain stem; the spinal cord is affected much less frequently

The course of the disease is slow, with the possibility of stabilization or regression at any stage, rarely leading to death.

Diffuse astrocytomas - tumors located in any area of ​​the central nervous system, mainly in the hemispheres of the brain, usually clinically manifest in adults

Tumors diffusely infiltrate both adjacent and distant brain structures. There is a pronounced tendency to malignancy

Can be reborn from low-stage astrocytomas

The clinic and treatment are similar to low-stage astrocytomas, but the duration of the course is shorter

The clinical picture in anaplastic astrocytoma develops rapidly (in 50% of cases within less than 3 months), sometimes resembling a stroke, except in cases of secondary glioblastoma.

Clinical picture

diagnosis and treatment - see Brain tumors. Tumors of the spinal cord.

The prognosis depends on the age of the patient (the younger the patient, the worse the prognosis), as well as the degree of malignancy of the tumor (immature tumor - the prognosis is worse). Benign astrocytomas: with radical removal, the prognosis is relatively favorable. Patients can expect 3-5 years of life before relapse. With low-stage astrocytomas, the median survival is 2 years. There may be a transition to a more malignant form, the spread of the tumor.

See also Glioblastoma. Oligodendroglioma. Tumors of the brain. Tumors of the spinal cord. ependymoma

C71 Malignant neoplasm of the brain

D33 Benign neoplasm of brain and other parts of central nervous system