Cancers Flashcards
Two types of brain tumors
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
* Malignancies that commonly spread to the brain: breast, colon, or lung
World Health Organization (WHO) Brain Tumor Grading
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
most common primary brain tumor sites
meninges (36.8%)
18.7% are in the lobes of the brain
(frontal 8.2%, temporal 6%, parietal 3.5%, occipital 1%).
symptoms of cancers
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.
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
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.
Imaging for cancers
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.
What is typically the first line of treatment for brain tumors?
Surgery
Surgical Complications in brain tumor resection
- 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
Complications of radiation therapy
- Acute radiation encephalopathy (2 weeks after treatment) - can include headaches
- Late (>12 months) complications of radiation (adults):
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
Late effects and complications of chemotherapy
Adults::
Cerebral white matter damage
Hearing loss
Secondary cancers
fatigue
neuropsychological deficits
Children::
Cerebral white matter damage
Hearing loss
Neuropsychological deficits
Cerebellar disruption
seizures
Paraneoplastic syndromes
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)
Acute lymphoblastic leukemia (ALL)
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.
Neuropsychological assessment for Bone marrow transplantation
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.
Brain tumor/treatment neuropsychological outcomes
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
Brain metastases occur most commonly in which region of the brain?
cerebral hemispheres
80% of brain metastases occur in the cerebral hemispheres
The most common causes of structural damage to the frontal lobes are…?
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.
