3- Benign and Malignant Brain Tumors Flashcards
What are the 3 types of primary brain neoplasms (arising from different cells within the CNS)?
Meningioma
Glioma
Primary CNS Lymphoma
What is the most common benign primary brain neoplasm?
Meningioma, slow growing
What is the most common malignant primary brain neoplasm?
Glioma
Secondary brain neoplasms (metastasized from a primary CA at a distant site) are most likely to have come from where?
Lung, melanoma, breast
What is the most common brain neoplasm is adolescents and young adults vs the most common brain neoplasm in adults > 30 yo?
Adolescents and young adults- primary brain neoplasm
Adults > 30 yo- secondary brain neoplasm
Although highly dependent on size, location, and extent of tumor, what are the more common clinical presentations of a brain neoplasm?
HA
Seizure
Focal neuro deficits
Cognitive dysfunction
Increased ICP
Nocturnal HA or HA worse in am/ worse with coughing, sneezing, valsalva, as well as N/V, AMS, and CN palsy may be indicitive of what, with respect to brain neoplasm clinical findings?
Increased ICP
What is the imaging of choice for brain tumor dx?
Brain MRI w/ contrast
(+/- CT head, chest, abd, pelvis)
What is the 2nd most common cause of CA related death in children?
Primary CNS tumors
Where do meningiomas arise from and are they slow or fast growing?
Arises from meninges
Slow growing
Meningiomas are typically asx and found incidentally, although if sx present with anosmia and visual deficits. What is the management besides referral?
Can defer tx if asx/ resect vs radiation if sx
What type of cell is the most abundant cell type in the CNS and surround neurons to provide support and insulation?
Glial cells
What are the 3 types of glial cells?
Astrocytes- main glial supporting cell in CNS
Oligodendrocytes- produce myelin
Ependymal cells- produce CSF
What is the most common glioma in adults?
Glioblastoma Multiforme (GBM)
- most deadly/ malignant, grade IV, poor prognosis
How are brain tumors classified?
Histology and molecular testing
What are the 2 main genetic tests performed as part of molecular testing for classification of brain neoplasms?
IDH mutation vs wildtype
Presence of 1p/19q codeletion
What is indicated if a pt has an IDH mutation vs IDH wildtype?
IDH mutation- better prognosis
IDH wildtype- worse prognosis
Presence of 1p/19q codeletion on molecular testing indicates what?
Favorable response to tx
How does the prognosis for oligodendroglioma compare to that of an astrocytoma?
Better prognosis compared to astrocytoma
Ependymomas usually occur in what population?
Kids
A primary CNS lymphoma is a rare form of what type of CA?
NHL
Who is at an increased risk for primary CNS lymphoma?
HIV, organ transplant
Should steroids play a role in the management of a primary CNS lymphoma?
Steroids should be held prior to bx b/c potential of making bx non-diagnostic
What is the management for primary CNS lymphoma?
Methotrexate = standard initial therapy
No role for surgery other than bx
What is included in the initial management for large/ sx brain neoplasms?
(signs/ sxs of elevated ICP, impending herniation)
Neurosurgical referral
Emergent eval/ neurosurgical attention
What is included in the initial management for smaller/ minimal sx brain neoplasms?
Outpatient management
What is included in the surgical management of a brain neoplasm?
Max tumor resection w/ preservation of neuro function
Awake craniotomy (allows mapping of speech, visual, sensory, motor functions)
Intraoperative MRI (assesses degree of resection)
In addition to surgery, what else is included in the management for brain neoplasms?
Radiation, chemo, supportive care
In addition to pain management, psychsocial sx management, anti-seizure meds, and support groups, what role might steroids play in the supportive care management of brain neoplasms?
Reduce IC edema and improve neuro function
(except do not use with primary CNS lymphoma)
