Brain metastasis

Question 1

If patient has primary lung cancer this may spread to the brain. what is the best way to treat brain metastasisi

Answer 1

surgical resection.
Small cell lung cancer responds well to chemotherapy but overall rates don’t show significant survival benefit.

WBRT helps response to chemo without survival benefit.

Question 2

best way to treat solitary lung brain metastasis is

Answer 2

surgical resection followed by whole brain radiation therapy or steroeotactic radiosurgery with or withotu WBRT.

Question 3

why is systemic chemotherapy not the best treatment for brain mets?

Answer 3

poor penetration through the blood brain barrier

should have chemotherapy after treatment of brain mets

Question 4

can ppl with brain metastasis get anticoagulation with increased risk for intracerebral hemorrhage?

Answer 4

no increased risk for most cancers except for RCC, melanoma, coriocarcinoma, thyroid.

most pts can safely get anticoagulation without increased risk for ICH

Question 5

first line treatment for VTE and someone with metastatic brain mets?

Answer 5

low molecular weight heparin which is superior to Warfarin

Question 6

how long to treat someone with VTE and cancer?

Answer 6

indefinitely.

Question 7

cancers that have brain metastasis

Answer 7

seen in melanoma, choriocarcinoma, thyroid carcinoma, renal cell carcinoma

These do have greater risk for bleeding

Question 8

tx of pts with VTE and have brain mets from melanoma, choriocarcinoma, thyroid carcinoma, renal cell carcinoma

Answer 8

need inferior vena cava filters to reduced short term risk for PE

Question 9

absolute contraindication for AC

Answer 9

recent surgery, hemorrhagic stroke, active lbeeding brain mets with high risk for bleding

Question 10

are IVC filters better than AC

Answer 10

no. They decrease short term risk for PE but they can risk risk for future VTE and do not reduce risk of PE related death.

Question 11

brain metastasis will present on CT or MRI imaging with

Answer 11

no restricted diffusion on diffusio nweighted MR sequences

Brain abscess will cause homogenous restricted diffusion.

Cerebral abscess causes fever and peripheral leukocytosis

Question 12

when to provide prophylactice anticonvulsant medications with brain tumors?

Answer 12

only provide anti seizure meds if pt has a newly diagnosed brain tumor and presented with a seizure

Question 13

prophylactic anticonvulsant medications are indicated in pts who have had these brain conditions:

1 week then taper

Answer 13

• craniotomy for brain tumor resection
• brain MRI showing acute hemorrhage into tumor
• significant mass effect/ edema in vinicity of cortex
• pt has new brain mass and presents with seizure

steroids can acutely reduce edema and lower risk for seizure

Question 14

what procedure is absolutely contraindicated if someone presents with a brain mass with midline shift

Answer 14

lumbar puncture due to risk of herniation.

Question 15

for single brain mass what is the treatment of choice

Answer 15

surgical resection

whole brain radiation for people who have multiple brain metastasis.

Question 16

what to give prior to whole brain radiation therapy?

Answer 16

give steroids before to prevent swelling after radiation

Question 17

least like to metastasize to the brain

Answer 17

prostate

Question 18

cancers that can metastasize to the brain?

Answer 18

breast
lung
melanoma
lymphoma
renal