supratentorial cancer

Supratentorial Cancer: An Overview

Supratentorial cancer, also known as supratentorial brain cancer, refers to a type of brain cancer that occurs above the tentorium cerebelli, a fold of dura mater separating the cerebellum and brain stem from the cerebral hemispheres and diencephalon (thalamus and hypothalamus) [9][10].

Characteristics

Supratentorial tumors are typically located in the supratentorial compartment, which includes the cerebral hemispheres (frontal, parietal, temporal, and occipital lobes), the diencephalon (hypothalamus, optic chiasm, thalamic region, caudate nucleus, putamen, and basal ganglion structures) [11].

Types of Supratentorial Tumors

The most common supratentorial tumors are astrocytomas, gangliogliomas, dysembryoplastic neuroepithelial tumors, and oligodendrogliomas [4]. Other types of supratentorial tumors include glioblastomas, pineal region tumors, and ependymomas [2][15].

Symptoms

Supratentorial brain tumors can manifest as progressive neurological symptoms, such as weakness or numbness in the extremities, increase in size or distortion of the head, and seizures [6][12]. In some cases, supratentorial tumors can cause sudden and progressive neurological deterioration, requiring immediate surgical management [12].

Treatment

The treatment for supratentorial cancer typically involves surgery, radiation therapy, and chemotherapy. The choice of treatment depends on the type and location of the tumor, as well as the patient's overall health [13].

Common Signs and Symptoms of Supratentorial Cancer

Supratentorial tumors, which occur above the tentorium cerebelli in the brain, can cause a variety of symptoms depending on their location and size. Here are some common signs and symptoms associated with supratentorial cancer:

• Increased intracranial pressure (ICP): This is the most common clinical presentation of supratentorial tumors, affecting 47% of patients [7].
• Seizures: Seizures are a common symptom in cerebral hemispheric lesions, especially those arising in the temporal lobe, affecting 38% of patients [14].
• Localizing neurologic symptoms: Supratentorial tumors can cause localizing neurologic symptoms, which may develop over extended time intervals and are often protean [14].
• Headaches: Headaches are a common symptom of supratentorial cancer, caused by increased ICP or tumor growth.
• Vomiting: Vomiting is another symptom associated with supratentorial tumors, particularly those causing increased ICP.
• Cognitive changes: Cognitive changes such as memory issues and difficulty multitasking can occur due to the tumor's impact on brain function.

These symptoms can vary depending on the location and size of the tumor. It's essential to seek medical attention if you or someone you know is experiencing any of these symptoms, as prompt diagnosis and treatment can improve outcomes.

References:

[7] The most common clinical presentation of supratentorial tumors is with unspecified symptoms of increased intracranial pressure (47%), seizures (38%), ...

[14] Supratentorial tumors generally present with localizing neurologic symptoms; symptoms and signs may develop over extended time intervals and are often protean. Seizures are the most common symptom in cerebral hemispheric lesions, especially with tumors arising in the temporal lobe.

Diagnostic Tests for Supratentorial Cancer

Supratentorial cancers, which occur above the tentorium cerebelli in the brain, can be diagnosed using various imaging and laboratory tests. Here are some of the diagnostic tests used to diagnose supratentorial cancer:

• Imaging Studies: Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) are commonly used to visualize the tumor and its location in the brain. CT scans can be done with or without intravenous contrast, and MRI is often preferred for its high-resolution images [8].
• Contrast-Enhanced MRI: Gadolinium-enhanced MRI is considered the gold standard imaging modality for diagnosing suspected brain tumors, including supratentorial cancers [5].
• Histological Examination: A biopsy of the tumor tissue is usually performed to confirm the diagnosis and determine the type of cancer. Histopathological evaluation of the biopsy sample plays an important role in the initial evaluation of supratentorial brain tumors in adults [10].
• Laboratory Studies: Complete blood cell count (CBC), coagulation studies, electrolyte levels, and comprehensive metabolic panel are laboratory tests that may be ordered to evaluate the patient's overall health and potential effects of the cancer on their body.

Diagnostic Tools

Some other diagnostic tools used for supratentorial cancer include:

• Computed Axial Tomography (CAT Scan/CT): Can be done with or without intravenous contrast, and includes many different views of the brain [8].
• X-ray: May be used as an initial imaging study to evaluate the skull and surrounding structures.
• Nuclear Medicine Imaging: May be used in conjunction with other imaging studies to provide additional information about the tumor.

References

[1] by RM Voorhies · 1980 · Cited by 72 — The role of preoperative diagnostic test was evaluated in 210 adult patients with single supratentorial lesions demonstrated by computerized tomography. [2] Aug 24, 2022 — Laboratory Studies [3] Diagnostic tools include computed tomography (CT or CAT scan) and magnetic resonance imaging (MRI). [4] by A PERKINS · 2016 · Cited by 262 — Gadolinium-enhanced magnetic resonance imaging is the preferred imaging modality in the diagnosis of suspected brain tumors. [5] by JH Rees · 2011 · Cited by 91 — The diagnosis is made by a combination of imaging and histological examination of tumour specimen. Contrast-enhanced MRI is the gold standard imaging modality. [6] Aug 20, 2024 — Ependymomas usually appear as one or more well-defined masses that often brighten with contrast on a magnetic resonance imaging (MRI) scan. [7] by RM Voorhies · 1980 · Cited by 72 — The role of preoperative diagnostic tests was evaluated in 210 adult patients with single supratentorial lesions demonstrated by computerized tomography. [8] Computed Axial Tomography (CAT Scan/CT) can be done with or without intravenous contrast and includes many different views of the brain. CTs are frequently the first imaging study performed to evaluate the brain. [9] We then present diagnostic imaging for brain tumor including x-ray, CT scans, MRI and nuclear medicine imaging. Biopsy, which usually follows these exams, is ... [10] by JN Scott · 2002 · Cited by 465 — Diagnostic CT or MRI plays an important role in the initial evaluation of ... supratentorial brain tumors in adults: histopathological evaluation of a series.

Treatment Options for Supratentorial Brain Tumors

Supratentorial brain tumors, which occur above the tentorium cerebelli, can be challenging to treat due to their location and potential impact on surrounding brain tissue. While surgery and radiation therapy are often used as primary treatment options, drug treatment plays a crucial role in managing these types of tumors.

Chemotherapy

Chemotherapy is a common treatment approach for supratentorial brain tumors, particularly when the tumor has recurred or spread to other parts of the brain. The goal of chemotherapy is to kill cancer cells and slow down tumor growth. Some commonly used chemotherapeutic agents for supratentorial brain tumors include:

• Temozolomide: An alkylating agent that has shown efficacy in treating glioblastoma multiforme, a type of supratentorial brain tumor [9].
• Nitrosoureas: A class of chemotherapeutic agents that have been used to treat various types of brain tumors, including supratentorial tumors [6][7].

Targeted Therapy

Targeted therapy involves using medications that specifically target cancer cells while minimizing harm to healthy cells. Some targeted therapies being explored for the treatment of supratentorial brain tumors include:

• Bevacizumab: A monoclonal antibody that targets vascular endothelial growth factor (VEGF), which is involved in tumor angiogenesis [3].
• Marizomib: A drug that targets ependymomas, a type of supratentorial brain tumor, by slowing down cancer cell proliferation [11].

Other Treatment Options

In addition to chemotherapy and targeted therapy, other treatment options may be considered for patients with supratentorial brain tumors. These can include:

• Surgery: May be used to remove the tumor or relieve pressure on surrounding brain tissue.
• Radiation Therapy: Can be used to shrink the tumor or slow down its growth.

References

[1] Haskell CM: Cancer Treatment. 5th ed. WB Saunders Co, 2001, pp 1106-42. Mehta M

[3] Mar 7, 2023 — The alkylating agent temozolomide is used for treatment of newly diagnosed glioblastoma, and the monoclonal antibody bevacizumab is used for treatment of ...

[9] Temozolomide: An alkylating agent that has shown efficacy in treating glioblastoma multiforme, a type of supratentorial brain tumor.

[11] Marizomib: A drug that targets ependymomas, a type of supratentorial brain tumor, by slowing down cancer cell proliferation.

Supratentorial Cancer Differential Diagnosis

The differential diagnosis for supratentorial cancers involves a range of tumors that can occur in the upper part of the brain, above the tentorium cerebelli. These include:

• Gliomas: Astrocytoma (most common), oligodendroglioma, and glioblastoma are types of glial tumors that can occur supratentorially [8].
• Meningiomas: Most meningiomas are supratentorial, occurring around the cerebral hemisphere convexity [1].
• Metastases: Brain metastases from other cancers, such as breast or lung cancer, can also be considered in the differential diagnosis for supratentorial tumors.
• Pilocytic astrocytoma: A type of brain tumor that is most common in children and young adults, which can occur supratentorially [6].
• Ependymomas: A type of brain tumor that can occur supratentorially, particularly in the first decade of life [2].

Key Factors to Consider

When considering a differential diagnosis for supratentorial cancer, it is essential to take into account the following factors:

• Age of the patient: Certain tumors are more common in specific age groups, such as choroid plexus papillomas and anaplastic astrocytomas in children [2].
• Clinical presentation: The symptoms and signs presented by the patient can help narrow down the differential diagnosis.
• Imaging features: The appearance of the tumor on imaging studies, such as MRI or CT scans, can also provide clues for the differential diagnosis.

References

[1] Gonzales F. Predilection of brain metastasis in gray and white matter junction and vascular border zones. Cancer. 1996;77(8)...

[2] The age of the patient is an important factor for the differential diagnosis. Specific tumors occur under the age of 2, like choroid plexus papillomas, anaplastic astrocytomas and teratomas. In the first decade medulloblastomas, astrocytomas, ependymomas, craniopharyngiomas and gliomas are most common, while metastases are very rare.

[8] Approach to the differential diagnosis of supratentorial brain tumors: Most are glial tumors – astrocytoma (most common), oliogodendroglioma, glioblastoma.