Brain Cancer: Staging and Treatment

Question 1

What are the 4 grades of astrocytoma/glioma?

Answer 1

1) Juvenile Pilocytic
2) Diffuse (slow-growing, no distinct borders)
3) Anaplastic (signs of mitosis)
4) Glioblastoma (lots of mitosis, death, blood vessels)

Question 2

What is Grade 1 astrocytoma/glioma? What are its characteristics?

Answer 2

Juvenile Pilocytic; clear border

Question 3

What is Grade 2 astrocytoma/glioma? What are its characteristics? What is the survival rate?

Answer 3

Diffuse; slow growing, no distinct borders; 20-60% survival rate.

Question 4

Why is chemotherapy no very effective for brain tumors?

Answer 4

Difficulty getting past the blood/brain barrier.

Question 5

What is Grade 3 astrocytoma/glioma? What are its characteristics? Survival rate?

Answer 5

Anaplastic; signs of mitosis; 0-50%

Question 6

What is Grade 4 astrocytoma/glioma? What are its characteristics? Survival rate?

Answer 6

Glioblastoma; lots of mitosis, necrosis, diffuse border, signs of local metastasis in brain; 4-15%

Question 7

What does necrosis on an MRI tell you about a brain tumor?

Answer 7

It is fast-growing.

Question 8

What is the survival rate for glioblastoma?

Answer 8

4-15%

Question 9

What is the survival rate for Grade 2 (diffuse) astrocytoma/gioma?

Answer 9

20-60%

Question 10

What is the survival rate for Grade 3 (anaplastic) astrocystoma/glioma?

Answer 10

10-50%

Question 11

If you have no necrosis and no mitosis, but diffuse borders, what stage is the astrocytoma/glioma and what is the survival rate?

Answer 11

Grade II (Diffuse); 20-60%

Question 12

True or false: A patient cannot survive multifocal lesions on the brain.

Answer 12

True

Question 13

What are the two types of GBMs?

Answer 13

1) Primary (big tumor and fast-growing)

2) Secondary (progresses slowly)

Question 14

True or false: We know the genetics of primary GBM tumors at each step of its development.

Answer 14

False; we only know it at the end.

Question 15

True or false: We know the genetics of secondary GBM tumors at each step of their development.

Answer 15

True

Question 16

What does Mdm2 overexpression cause in primary GBM tumors?

Answer 16

Deactivation of p53

Question 17

What are 4 common mutations in primary GBM tumors?

Answer 17

1) Mdm2 overexpression
2) EGFR amplification
3) INK4A/ARF loss
4) PTEN loss

Question 18

What are 4 common mutations in low-grade secondary glioma?

Answer 18

1) PDGF, FGF overexpression

2) p53 mutation

Question 19

What mutations lead to low-grade glioma becoming anaplastic?

Answer 19

CDK4 amplification and Rb or INK4a/ARF loss.

Question 20

What mutation sometimes leads to secondary anaplastic glioma becoming GBM?

Answer 20

PTEN loss (only 5% of the time)

Question 21

What are two types of radiation used to treat brain cancers?

Answer 21

1) 3D Conformational

2) Proton Beam Therapy

Question 22

What is the benefit of proton beam therapy over 3D Conformational Radiation?

Answer 22

The protons only affect the targeted area and leave the rest of the brain unaffected by radiation.

Question 23

What type of cells are GBM tumor cells?

Answer 23

astrocytes

Question 24

What cells are the support cells of the brain?

Answer 24

astrocytes