Question 1

Two types of brain tumors

Accepted Answer

Abnormal replication of cells inside the skull cavity due to genetic alternations that allow cells to circumvent normal cell regulatory functions and avoid immune system targeting. Primary Brain Tumors Originate in the CNS Are more common in children than adults Metastatic Brain Tumors Primary cancer is outside the nervous system and spreads to the brain Occur in 20–40% of adults with cancer Most common intracranial tumor in adults Malignancies that commonly spread to the brain: breast, colon, or lung gray and white matter junctions

Question 2

World Health Organization (WHO) Brain Tumor Grading

Accepted Answer

I - Well-differentiated Non-infiltrative Slow growing Good possibility of cure with surgery Ex: Ganglioglioma, Meningioma, Pituicytoma II - Moderately differentiated Somewhat infiltrative Can progress to higher grades Ex: Ependymoma, Oligodendroglioma III - Poorly differentiated Infiltrative Typically require adjuvant chemotherapy and/or radiation Tend to progress to higher grade IV - Undifferentiated Widespread infiltration High degree of necrosis Require multi-modality treatment Ex: Glioblastoma (poorest survival rate for all age groups), Medulloblastoma, Pineoblastoma

Question 3

Most common primary brain tumor sites

Accepted Answer

Meninges (36.8%) 18.7% are in the lobes of the brain (frontal 8.2%, temporal 6%, parietal 3.5%, occipital 1%). Other sites include the cranial nerves, spinal cord, pituitary, craniopharyngeal duct, brainstem, and cerebellum.

Question 4

Symptoms of cancers

Accepted Answer

Headaches - Most common presenting symptom in adults and children and are related to mass effect; new-onset headaches associated with nausea/vomiting and increased severity in the mornings Signs of increased intracranial pressure (ICP) - Headaches, and nausea/vomiting. Progressive neurological deficits Posterior fossa tumors, common in children, can present with nausea/vomiting and ataxia. Pineal tumors can present with Parinaud syndrome (lack of upward gaze, nystagmus) and double vision. Pituitary tumors - disruption of hormone functioning in the hypothalamic/pituitary times. Seizures - 15–20% of children present with seizures; 25–30% of adults present with seizures; 40–60% of adults have seizures at some time in the illness course.

Question 5

Imaging for cancers

Accepted Answer

MRI is preferred choice for diagnosing and monitoring brain tumors CT can show most tumors and can identify calcifications and hemorrhage but may not identify posterior fossa tumors or low-grade gliomas.

Question 6

What is typically the first line of treatment for brain tumors?

Accepted Answer

Surgery NOTE: may not be feasibly in the context of multiple metastases or sites. Maybe curative for low grade tumors and extra axial tumors (e.g., meningioma, pituitary tumors).

Question 7

Surgical Complications in brain tumor resection

Accepted Answer

- Perioperative stroke - Motor or sensory deficits - Damage to pituitary/hypothalamic structures - Posterior fossa or cerebellar mutism syndrome (complication of cerebellar tumor resection): Symptoms include mutism, emotional lability, cranial nerve deficits, and ataxia. Mutism and motor deficits resolve over days/weeks/months

Question 8

Complications of radiation therapy

Accepted Answer

- Acute radiation encephalopathy (2 weeks after treatment) - can include headaches - Late (>12 months) complications of radiation (adults): not reversible. Attention and short-term memory problems common Incontinence Gait disturbance - Late (>12 months) complications of radiation (children): - neuropsychological deficits (associated with associated with damage to developing white matter) hearing loss cataracts infertility Impaired growth and development secondary malignancy

Question 9

Late effects and complications of chemotherapy

Accepted Answer

Adults: Cerebral white matter damage Hearing loss Secondary cancers fatigue neuropsychological deficits Children: Cerebral white matter damage Hearing loss Neuropsychological deficits Cerebellar disruption seizures

Question 10

Paraneoplastic syndromes

Accepted Answer

Rare (<5%) neurological complication of non CNS cancer constellation of symptoms (seizures, amnesia, and confusion) that suggests possible autoimmune reaction to cancer . Progressive Encephalomyelitis - Seizures, amnesia, mental status changes, affective changes Cerebellar Degeneration - Motor incoordination leading to progressive gait ataxia; dysarthria, nystagmus, vertigo, diplopia, Opsoclonus Myoclonus - myoclonus (jerking) of trunk, limbs, head, diaphragm, larynx, pharynx Children: Acute lymphoblastic leukemia (ALL)

Question 11

Acute lymphoblastic leukemia (ALL)

Accepted Answer

most common malignancy of childhood, and 5-year survival rates are 90% with treatment. cancer of the blood and bone marrow in which precursors of lymphocytes proliferate and crowd out healthy and functional cells. It is most commonly diagnosed in the preschool years. Contemporary treatment protocols include systemic and intrathecal chemotherapy; very high risk patients are treated with cranial radiation therapy.

Question 12

Neuropsychological assessment for Bone marrow transplantation

Accepted Answer

assessments should include measures of memory and learning, processing speed, and executive function. Studies monitoring cognitive changes during treatment should include tests with alternate forms and should use reliable change or regression techniques to interpret changes over time. Younger age and intensive pre-treatment conditioning for bone marrow transplantation have been shown to be risk factors of neurocognitive dysfunction.

Question 13

Brain tumor/treatment neuropsychological outcomes

Accepted Answer

IQ generally preserved but radiation (higher doses) and chemotherapy at an early age are at risk for decline in IQ A triad of cognitive processes appears particularly affected—attention, working memory, and information processing speed—because fluid cognitive skills are more vulnerable to disruption. Visuospatial and visual motor skills are often compromised in childhood cancer survivors. Verbal abilities generally preserved Reduced fine motor speed and output are common. Psychosocial adjustment - Depression and anxiety issues are common

Question 14

Brain metastases occur most commonly in which region of the brain?

Accepted Answer

cerebral hemispheres 80% of brain metastases occur in the cerebral hemispheres

Question 15

The most common causes of structural damage to the frontal lobes are...?

Accepted Answer

vascular disorders, brain tumors, and traumatic injury Stroke and TBI commonly affect the frontal lobes. Additionally, 9% of primary brain tumors occur in the frontal lobes of the brain; 25% of primary malignant gliomas occur in the frontal lobes.

Question 16

Radiation therapy affects the developing brain by primarily causing...?

Accepted Answer

compromise of white matter Radiation induced damage to oligodendrocyte precursor cells is one of the mechanisms of CNS toxicity related to radiation. Damage to oligodendrocytes and precursors leads to demyelination and reduced normal appearing white matter.

Question 17

Adult survivors of childhood brain tumors are at increased risk for:

Accepted Answer

Secondary tumors, late-onset seizures, and stroke.

Question 18

What does chelation treatment do?

Accepted Answer

Chelation treatment is effective in removing lead from blood but it has not been shown to reverse any neuropsychological deficits associated with elevated blood lead levels.

Question 19

A side effect of intrathecal (injection in spinal cord) chemotherapy with methotrexate is:

Accepted Answer

leukoencephalopathy (cerebral white matter damage)

Question 20

Acute radiation toxicity

Accepted Answer

Develop early on ~ 2 weeks after beginning tx. SXS --> headaches, somnolence (excessive sleepiness), presumably related to transient demyelination and neuroinflammation.

Question 21

Common late effect from chemotherapy

Accepted Answer

memory problems

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Cancers Flashcards

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