Brain Tumors - Clinical Principles Flashcards
Most common primary tumors that metastasize to brain?
Lung, breast, kidney
Characteristics of metastatic lesions?
Usually multiple, WELL-circumscribed lesions at gray-white junction.
Common tumors in children? Which region of the brain do tumors in children normally localize to?
Below tentorium (above tentorium in adults).
Pilocytic astrocytoma - benign
Medulloblastoma - malignant
Ependymoma - malignant
What is the most common symptom of brain tumors? Reason behind getting this symptom?
Headache
1) Trigeminal nerve innervates dura –> when mass pushes on dura causes HA
2) Increased pressure from obstruction (ependymoma)
If a patient presents with right homonymous hemianopsia and imaging reveals mass, where do you expect this mass to have localized?
Left occipital lobe
Surgical therapy guidelines for GBM?
Prognosis is POOR.
Since glioblastoma tends to localize in the midline, it is hard to accomplish COMPLETE resection.
Level I: insufficient evidence
Level II: resect more = improved survival
Radiation therapy guidelines for GBM?
Level I: recommended fro newly dx malignant adult gliomas
Level II: radiation plan includes margin AROUND tumor
1q chromosome status and survival?
1q deletion associated with more robust probability of survival in those with oligodendroglioma.
MGMT gene expression and response to chemotherapy?
MGMT is involved with gene repair
Silencing gene helps mediate response to chemo –> shown to increase survival in patients with glioma.
IDH1 and survival?
Expression of MUTANT IDH1 associated with improved survival of glioma patients.
Management for patients with high and low grade gliomas?
Observation? Surgical resection? Needle biopsy? Fractionated radiotherapy? Stereotactic radiotherapy? Chemotherapy?
Observation - no Surgical resection -no Needle biopsy - yes Fractionated radiotherapy - yes Stereotactic radiotherapy - no Chemotherapy - yes
Management for patients with pilocytic astrocytoma?
Observation? Surgical resection? Needle biopsy? Fractionated radiotherapy? Stereotactic radiotherapy? Chemotherapy?
Observation - yes Surgical resection - yes Needle biopsy - yes Fractionated radiotherapy - yes Stereotactic radiotherapy - yes Chemotherapy - no
Management for patients with metastatic carcinoma?
Observation? Surgical resection? Needle biopsy? Fractionated radiotherapy? Stereotactic radiotherapy? Chemotherapy?
Observation - no Surgical resection - yes Needle biopsy - no Fractionated radiotherapy - yes Stereotactic radiotherapy - yes Chemotherapy - no
Management for patients with meningioma?
Observation? Surgical resection? Needle biopsy? Fractionated radiotherapy? Stereotactic radiotherapy? Chemotherapy?
Observation - yes Surgical resection - yes Needle biopsy - yes Fractionated radiotherapy - yes Stereotactic radiotherapy - yes Chemotherapy - no
Factors influencing outcome?
Metastases - 50% 1 year survival Glioblastoma - 30% year survival Tumor biology/molecular marker Age Treatment
