Brain tumors Flashcards
Peak incidence of brain tumors in adults
74-84 yrs of age; avg age of onset is 54
Localizing symptoms of supratentorial tumors
Unilateral or migraine-type HAs, endocrine abnormalities, focal & generalized seizures, focal neurologic findings
Benign tumors
Do not invade nearby cells, tend to be circumscribed & well-differentiated, resemble cell of origin Can undergo malignant transformation & given their location, can become lethal
Anaplastic astrocytoma is most common in the
Cerebral cortex (adults), brainstem & cerebellum (children)
Effects of brain tumor chemotherapy treatment on CNS
WM particularly vulnerable Onset of changes may be delayed by months Evidence that chemo for non-cerebral tumors can impact functioning as well
Meningiomas are most common where?
Along the superior sagittal sinus, sphenoid ridge, & near optic chiasm
Most common sources for metastatic brain tumors
Lung (35-50%), breast (13-20%), melanoma (9-10%)
Most common brain tumors in adults
Glioblastoma & brain metastases; meningioma, schwannoma
Angioma
Congenital vascular malformation involving blood vessel proliferation that resembles a tumor
Short-term effects of chemotherapy for pediatric brain tumors
Drops in fine motor speed/coordination, performance on drawing/copying tasks
Radiation necrosis
Cerebral infarction from occlusion of small cerebral vessels that are damaged during high-dose radiation therapy for brain tumors; does not typically appear until approx. 6-18 mos after radiation therapy is complete
What types of cancers are most frequently associated with paraneoplastic syndromes?
Small cell lung, breast, testicular, ovarian
What type of chemotherapy is most common associated with neurocognitive effects in children?
High-dose IV cytarabine or methotrexate or intrathecal methotrexate
Olfactory groove meningioma
Tumor that originates in arachnoidal cells along the cribiform plate; may involve ipsilateral or bilateral anosmia & mental changes, including abulia, confusion, forgetfullness, & inappropriate jocularity
Effects of brain tumor radiation treatment on the CNS
Causes apoptosis in tumor cells & in non-tumor cells Dose-limited neurtoxicity is assoc. w/ spongiosis of the WM & vacular damage Can have both acute & delayed effects Impairements of memory & processing speed common
Predictors of poorer psychological outcome following pediatric brain tumors
Low child IQ, single parent family, low SES, higher family stress, mod-sev disfigurement, certain tumor locations, severe fx impairment
Paraneoplastic syndrome
Rare neurologic disorder caused by remote effects of cancer in the body leading to autoimmune response
CNS lymphoma is more common where?
Around ventricles
Risk factors for developmental stagnation after cranial irradiation
Younger age at time of treatment, higher dose of radiation, use of adjuvant therapies, higher baseline functioning = greater decline in overall IQ
Anaplasia
Loss of cell differentiation that is characteristic of most malignant tumors
What do declines in cognitive status with increasing time since radiotherapy treatment in children actually represent?
Stagnation in development rather than regression
Grade IV tumor
High-grade malignant tumor, rapid growth, high infiltration potential, not encapsulated, identified in multiple areas of brain, high recurrence potential
Academic outcome following pediatric brain tumor
57% have specific academic deficits, mostly arithmetic Those w/ hydrocephalus are particularly at risk Tx involving IT methotrexate & cranial RT either alone or in combo sig. increases likelihood for need of SPED services
Nonspecific signs of pediatric brain tumors
Developmental delays or regression, signs of increased ICP, increased fatigue, irritability, papilledema
Emotional distress following pediatric brain tumor
Mild withdrawal & social deficits in subset Significant parental distress & poor family functioning PTS symptoms are present in family members of survivors & less consistently in survivors themselves
GBMs are most common in the
Cerebral cortex
Radiation-associated encephalopathy
From radiation tx of tumors; associated with demyelination & necrosis; appears as subcortical dementia
Schwannomas are most common on
CN VIII
What is the most common type of paraneoplastic syndrome?
Limbic encephalitis w/ personality changes, memory loss Associated with non-systemic cancer, long/oat cell carcinoma, ovarian
Prognosis for metastatic brain tumors is better with the following factors
Better for age
Lambert-Eaton syndrome
Impaired presynaptic Ach release; paraneoplastic syndrome
Radiotherapy in children is associated with what NP effects?
Visual motor integration, verbal fluency, visual memory, exec fx (no single profile); relatively intact verbal memory & language skills
Malignant tumors
Anaplastic (cannot be clearly demarcated), usually proliferate rapidly, invade & destroy nearby cells
Ependymoma
CNS neoplasm made up of relatively undifferentiated ependymal cells (usu. from central canal of spinal cord)
Grade II tumor
Low grade malignant tumor, slowly growing, low infiltration potential, encapsulated but w/ poorly defined borders, greater potential for recurrence than I
Oligodendrogliomas are most common in the
frontal lobes
Common types of brain tumors in children
Low-grade astrocytomas, primitive neuroectodermal tumors (medulloblastoma most common), high-grade gliomas (more common in adults)
Grade I tumor
Low grade, slowly growing, low infiltration potential, encapsulated with clearly defined borders, tend not to recur
Treatment for brain tumors depends on what 3 factors?
Histological type, location, size
Grade III tumor
High-grade malignant tumor, rapid growing, high infiltration potential, poorly encapsulated, tend to recur
Localizing symptoms of infratentorial tumors
HA, nausea, persistent vomiting, balance problems & gait disturbances, signs of CN dysfx
