Cancer

Question 1

What are cancers that affect CNS?

Answer 1

Primary neoplasms
Metastases
Result of treatment

Question 2

Which brain tumors are more common in children?

Answer 2

Primary neoplasm

Question 3

What is the most common tumor in adults?

Answer 3

Metastatic brain tumor, 20-40% of adults with cancer

Question 4

What are cancers that commonly metastasize to the brain?

Answer 4

Melanoma, breast, colon, lung

Question 5

What is the most common location of metastatic brain tumor?

Answer 5

White/Gray matter junction

Question 6

The is brain tumor classification based on?

Answer 6

Cell of origin and proliferation potential

Question 7

What does malingnancy refer to?

Answer 7

Local growth pattern and capacity to spread in the neuroaxis
Grades I-IV (most severe)

Question 8

What are characteristics and examples of Grade I tumors?

Answer 8

Well-differentiated
Non-proliferative
Slow growing

PIlocystic astrocytoma
Meningioma
Ganglioglioma

Question 9

Grade II tumors

Answer 9

Moderately differentiated
Somewhat infiltrative
Can progress to higher grades

Fibrillary astrocytoma
Ependymoma
Oligodendroglioma

Question 10

Grade III tumors

Answer 10

Poorly differentiated
Infiltrative
Tend to progress to higher grades

Anaplastic astrocytoma, ependymoma

Question 11

Grade IV

Answer 11

Undifferentiated
Widespread infiltration
Rapid recurrence

Glioblastoma
Medulloblastoma

Question 12

What are major categories of primary brain tumors?

Answer 12

Neuroepithelial:
Glial: astrocytomas, gliomas, ependymomas
Embryonal: medulloblastoma
Choroid plexus tumors
Tumors of cranial and peripheral nerves
Germ cell tumors
Tumors of the sellar region
Tumors of the meninges

Question 13

What are the most common tumor sites?

Answer 13

Meninges (34%), lobes (22%)

Question 14

Does primary brain tumor differ by sex?

Answer 14

Yes, overall incidence is higher in females
Pituitary and meninges tumors are more common in F
Neuroepithelial and gliomas are more common in M

Question 15

What is the survival rate?

Answer 15

5-year survival decreases with increasing age from 64% 20-29, 1% over 80,
In children lowest under 12 months
Poorest survival is in glioblastoma
Poor in multiple mets

Question 16

What age range has the highest proportion of adults with BT?

Answer 16

60-69

Question 17

What are determinants of severity?

Answer 17

Degree of malignancy, location, and mass effect

Question 18

What are common symptoms of brain tumors?

Answer 18

Signs of increased intracranial pressure (headaches, worse in the am, nausea/vomiting, progressive neurologic deficits, seizures, cognitive and behavioral changes

Question 19

What is the imaging modality of choice for BT?

Answer 19

MRI - with contrast - location + tumor characteristics

Question 20

What is cerebellar mutism syndrome?

Answer 20

Common in children following posterior fossa surgery
Mutism, emotional lability, cranial nerve deficits, and ataxia
Resolve from days/weeks to months later

Question 21

How does radiation therapy work?

Answer 21

Targets rapidly dividing cells by depositing energy in tissue, creating ionization and damaging DNA
Cancer cells more vulnerable due to their involvement in replication

Question 22

What are common complications of radiation therapy?

Answer 22

Acute radiation encephalopathy (2 weeks after tx, headaches, somnolence, worsening of preexisting deficits, response to corticosterioids

Early - 1-6 months, return to BL in 12 months
Reversible demyelination

Late - > 12 months, not reversible
Due to local radionecrosis of diffuse leukoencephalopathy
Diffuse atrophy, ventricular enlargement, and white matter abnormalities on MRI in severe cases
Attention and short-term memory problems

Question 23

How does chemotherapy work?

Answer 23

Targets rapidly dividing cells by disrupting DNA and interfering with transcription and replication

Question 24

What are late effects and complications of chemotherapy in children?

Answer 24

Leukoencephalopathy, particularly with antimetabolites (methotrexate)
Endocrine dysfunction
Cardiovascular problems
Hearing loss
Cerebellar symptoms
Secondary cancers
NP deficits

Question 25

What are complications of radiation in children?

Answer 25

Impairment of growth of normal tissue and subsequent brain development
Damage to hippocampal progenitor cells
White matter volume loss
Younger children highest at risk for neurocognitive toxictiy
Avoided in children under 3

Question 26

Non-CNS cancers chemotherapy effects

Answer 26

Most lit on breast CA
13-70% of patients report cognitive dysfunction
Variabiltiy based on treatment regimen, hormonal therapy, cog reserve, impact of other medical issues
Increased risk with intrathecal admin (to ventricles through LP) and older age