Cancers Flashcards
What are primary brain tumors?
Brain tumors that originate in the CNS. These are more common in children than in adults
What are metastatic brain tumors?
Brain tumors that are outside the nervous system and spread to the brain. These are more likely to occur in adults vs primary brain tumors. Cancer usually starts in breast, colon, or lung.
How are brain tumors classified?
Based on presumed call of origin and proliferative potential. Tumor grading ranges from I to IV, with higher numbers being more malignant (greater infiltration, more difficult to treat, and less differentiation).
What is the most common brain tumor site in adults?
Meninges (meningiomas)
If not the meninges, what is the next most common brain tumor site in adults?
Frontal lobes.
Then temporal, parietal, and occipital.
What is the second most common brain tumor in adults, after meningioma?
Glioblastoma.
Glioblastomas are a kind of astrocytoma (which is a glioma).
What are risk factors for developing brain tumors?
- Exposure to ionizing radiation
- Various genetic cancer predisposition syndromes (e.g., tuberous sclerosis, neurofibromatosis types 1 and 2, among others)
- There is increased risk of CNS lymphoma in HIV
What are determinants of severity of tumor?
- Tumor histology and grading to degree of malignancy
- Location and mass effect are important, as herniation may be caused by tumor growth
- Some tumors (e.g., diffuse pontine glioma) are not resectable and affect vital brain structures. These tumors are found in an area of the brainstem (the lowest, stem-like part of the brain) called the pons, which controls many of the body’s most vital functions such as breathing, blood pressure, and heart rate.
What are signs of a tumor?
- Headaches. Related to mass effect.
- Signs of increased intracranial pressure (headaches, nausea/vomiting)
- Progressive neurologic deficits (sensory and motor deficits, ataxia, cranial nerve palsies)
- Endocrinopathies (hormone problems - like hypothyroidism and hyperthyroidism)
- Seizures
- Cognitive/behavioral changes
What is usually associated with tumors?
Edema and hydrocephalus, which need to be treated urgently. Steroids can help reduce edema.
How are tumors treated?
- Surgery. Larger resection usually has better prognosis.
- Radiation. Because cancer cells are preferentially involved in replication rather than cell maintenance and repair, they are more vulnerable to effects of radiation. Radiation is delivered in fractions to allow for normal tissue repair. Radiation can be tough for older adults, due to reduced cellular repair mechanisms with aging.
- Chemotherapy. Chemotherapeutic agents target rapidly dividing cells by disrupting DNA and interfering with transcription and replication.
What are complications of radiation?
Acute radiation encephalopathy develops early on (approximately 2 weeks after beginning treatment), characterized by headaches, somnolence, responds to corticosteroids). Encephalopathy may be present for months after treatment but usually resolves in 12 months. If more than 12 months, effects are typically not reversible. Attention and short term memory px are common.
In adults, radiation can cause focal demyelination and edema. Vascular injury can also emerge over the long term and contribute to necrosis.
There may be local radionecrosis or diffuse leukoencephalopathy present. MRI may show diffuse atrophy, ventricular enlargement, and white matter abnormalities in severe cases.
What are issues to consider in assessing neuropsychological status during cancer treatment?
Comprehensive NP assessment should be deferred until after radiation therapy and chemo, secondary to fatigue, nausea, or other symptoms.
Which medications could be helpful in treating cognitive symptoms for patients undergoing brain tumor treatment?
Modafinil and other stimulants can be effective in addressing low arousal and fatigue.
Some research has pointed to donepezil for attention and processing issues related to cancer and its treatment.
For non-CNS cancers, what are chemotherapy effects in adults?
Research points to learning and memory px, particularly attention, working memory, and executive function during and after chemo. Increased risk of cognitive px is noted with higher doses, multiagent chemotherapy, intrathecal administration, and older age.
