Cancer Flashcards
What are cancers that affect CNS?
Primary neoplasms
Metastases
Result of treatment
Which brain tumors are more common in children?
Primary neoplasm
What is the most common tumor in adults?
Metastatic brain tumor, 20-40% of adults with cancer
What are cancers that commonly metastasize to the brain?
Melanoma, breast, colon, lung
What is the most common location of metastatic brain tumor?
White/Gray matter junction
The is brain tumor classification based on?
Cell of origin and proliferation potential
What does malingnancy refer to?
Local growth pattern and capacity to spread in the neuroaxis
Grades I-IV (most severe)
What are characteristics and examples of Grade I tumors?
Well-differentiated
Non-proliferative
Slow growing
PIlocystic astrocytoma
Meningioma
Ganglioglioma
Grade II tumors
Moderately differentiated
Somewhat infiltrative
Can progress to higher grades
Fibrillary astrocytoma
Ependymoma
Oligodendroglioma
Grade III tumors
Poorly differentiated
Infiltrative
Tend to progress to higher grades
Anaplastic astrocytoma, ependymoma
Grade IV
Undifferentiated
Widespread infiltration
Rapid recurrence
Glioblastoma
Medulloblastoma
What are major categories of primary brain tumors?
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
What are the most common tumor sites?
Meninges (34%), lobes (22%)
Does primary brain tumor differ by sex?
Yes, overall incidence is higher in females
Pituitary and meninges tumors are more common in F
Neuroepithelial and gliomas are more common in M
What is the survival rate?
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
What age range has the highest proportion of adults with BT?
60-69
What are determinants of severity?
Degree of malignancy, location, and mass effect
What are common symptoms of brain tumors?
Signs of increased intracranial pressure (headaches, worse in the am, nausea/vomiting, progressive neurologic deficits, seizures, cognitive and behavioral changes
What is the imaging modality of choice for BT?
MRI - with contrast - location + tumor characteristics
What is cerebellar mutism syndrome?
Common in children following posterior fossa surgery
Mutism, emotional lability, cranial nerve deficits, and ataxia
Resolve from days/weeks to months later
How does radiation therapy work?
Targets rapidly dividing cells by depositing energy in tissue, creating ionization and damaging DNA
Cancer cells more vulnerable due to their involvement in replication
What are common complications of radiation therapy?
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
How does chemotherapy work?
Targets rapidly dividing cells by disrupting DNA and interfering with transcription and replication
What are late effects and complications of chemotherapy in children?
Leukoencephalopathy, particularly with antimetabolites (methotrexate) Endocrine dysfunction Cardiovascular problems Hearing loss Cerebellar symptoms Secondary cancers NP deficits
What are complications of radiation in children?
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
Non-CNS cancers chemotherapy effects
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
