Neurological oncology

Neurological oncology is the study of brain and spinal tumours, and neurological complications of cancer. Primary brain tumours may occur anywhere in the brain, with supratentorial tumours being more frequent in adults and infratentorial tumours in children. Secondary tumours usually arise from lung cancer, breast cancer and melanoma. The most common presenting symptoms of a brain tumour are headache, seizures, confusion, progressive neurological deficit and cognitive decline. Surgery is indicated for curative resection of an extrinsic tumour, debulking of a large intrinsic tumour, relief of hydrocephalus and tissue diagnosis of an unresectable tumour. Radiotherapy is indicated as an adjunct to surgery in partially resected tumours at risk of recurrence or as primary treatment of malignant gliomas. Chemotherapy is indicated in a limited number of rarer tumours and concomitantly with radiotherapy for the primary treatment of glioblastoma multiforme. The prognosis of brain tumours is highly variable. Neurological complications of cancer are common and may occur either as a result of direct or metastatic tumour infiltration into the nervous system or as a complication of cancer therapy. Paraneoplastic neurological disorders are immune-mediated remote effects of cancer that may present before the primary tumour and cause serious neurological morbidity.