# Malignant Neoplasm of the Nervous System

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Glioblastoma Multiforme - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK558954/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND25.01 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
MALIGNANT NEOPLASM OF THE NERVOUS SYSTEM
Sources: Glioblastoma Multiforme - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK558954/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class ND25.01 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (5)
    - What it does depends on where the tumour sits and how big it is, and it looks like any other
      brain tumour
    - Neurological symptoms build up over days to weeks
    - The symptoms are vague and overlap with infection and inflammation, so suspicion has to be
      kept high
    - How it declares itself: raised pressure inside the skull 30%, weakness 20%, seizures 20%,
      altered awareness 17%, confusion 15%, visual loss 13%, speech difficulty 13%  [confusion ·
      loss of vision · seizures]
    - Location: above the tentorium in 85%, the frontal lobe in about a quarter, brainstem and
      spinal cord under 5% each, cerebellum under 3%
  SIGNS - what you find (1)
    - On examination a fifth have weakness, and around one in eight have a visual or speech deficit,
      with awareness altered in 17%
  TESTS (6)
    - On MRI the lesion has ragged edges and enhances at its rim because the blood-brain barrier has
      broken down
    - The centre is dark on T1 because it is dead tissue, and the rim is bright on T2 and FLAIR
      because of surrounding swelling
    - Perfusion imaging shows increased blood flow from the new vessels the tumour grows
    - MR spectroscopy characteristically shows a choline peak
    - Only histopathology settles the diagnosis
    - The tissue is then tested for GFAP, IDH mutation status and MGMT promoter methylation
  IF NOT THIS - what else fits (9)
    - A single secondary deposit in the brain
    - Primary lymphoma of the central nervous system
    - Brain abscess
    - A stroke, ischaemic or haemorrhagic, at the subacute stage
    - A resolving brain contusion
    - Demyelination in its mass-forming form
    - Radiation necrosis
    - A vascular malformation
    - Cerebral toxoplasmosis
  Source  StatPearls "Glioblastoma Multiforme" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Primary malignant CNS tumours such as glioblastoma or high-grade astrocytoma; the GP's
            role is urgent recognition and oncology/neurosurgery referral, with dexamethasone for
            cerebral oedema and analgesia for symptom control while the patient is worked up. -
            Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Primary malignant CNS tumours such as glioblastoma or high-grade astrocytoma; the GP's
            role is urgent recognition and oncology/neurosurgery referral, with dexamethasone for
            cerebral oedema and analgesia for symptom control while the patient is worked up.
   Caution  No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - A rapidly progressive focal neurological deficit, a new seizure, or signs of
            raised intracranial pressure such as early morning vomiting or papilloedema.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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