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Principles and Procedures > Cancers of the CNS > Flashcards

Cancers of the CNS Flashcards

1
Q

CNS tumors include tumors of the? (2 answers)

A

Brain and Spinal Cord

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2
Q

CNS tumors can be under 4 different categories, what are they?

A

Primary, Secondary(Metastatic), Benign, Malignant

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3
Q

What are CNS tumor’s typical behavior?

A

Locally Invasive

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4
Q

Why are CNS tumors so deadly in regards to the structures they affect?

A

Structures affected cannot repair or regenerate themselves, which is the cause of permanent damage

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5
Q

Why would CNS tumors that are benign be considered Malignant?

A

Due to their close proximity to critical structures and inaccessibility

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6
Q

What is the 5-year survival rate for CNS tumors?

A

35%

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7
Q

What percentage of CNS tumors involve the brain?

A

85-90%

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8
Q

What percentage of CNS tumors involve the spinal cord?

A

15-20%

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9
Q

What is significant about brain tumors in pediatric patients?

A

Most common pediatric solid tumor

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10
Q

What age are CNS tumors most prevalent in?

A

50-80 yo

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11
Q

What are the two age groups affected most be CNS tumors?

A

3-12 yo and 50-80 yo

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12
Q

What percentage of CNS tumors involved the Cerebrum?

A

75%

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13
Q

What is the function of the cerebrum?

A

Sensory impulse interpretation and Voluntary muscle activity

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14
Q

At what age are gliomas most prevalent?

A

40-75 yo

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15
Q

(Look at Brain Diagram). What number correlates with the cerebrum?

A

1

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16
Q

(Look at Brain Diagram). What number correlates with the Corpus Callosum?

A

2

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17
Q

(Look at Brain Diagram). What number correlates with the Pons?

A

7

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18
Q

(Look at Brain Diagram). What number correlates with the Cerebellum?

A

5

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19
Q

(Look at Brain Diagram). What number correlates with the medulla?

A

6

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20
Q

What is the ratio of Primary brain occurrence to Secondary?

A

1:10

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21
Q

What percentage of patients will experience cerebral metastasis?

A

30%

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22
Q

What are cerebral mets significant to adults?

A

Most common brain tumors

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23
Q

How do cerebral Mets present location wise?

A

Hemispheres

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24
Q

What is the most common primary site of metastatic brain disease?

A

Lungs

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25
Q

What are etiologic factors that can be associated with brain tumors? (4 answers)

A

Occupational/Environmental, Lifestyle/Dietary, Medical Conditions, Genetic factors

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26
Q

What is the most common form of adult forms of brain tumors?

A

Glioblastoma Multiforme

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27
Q

What are the 3 most important prognostic factors?

A

Tumor type w/ grade, Performance status, Age

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28
Q

What is the issue with patients younger than 4 and using XRT?

A

Due to the on going development of the brain, there is a high sensitivity to XRT, therefore must be avoided.

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29
Q

What are the late effects of radiating CNS patients younger than 4?

A

Lower IQ as dosage increases

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30
Q

What is the purpose of the karnofsky performance score?

A

Measure neurologic and functional status

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31
Q

What does a KPS of 100-90 indicate?

A

Normal function, little to no presentation

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32
Q

What does a KPS of 80-70 indicate?

A

Function is still maintained with some symptoms, some activities are limited

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33
Q

What does a KPS of 60-50 indicate?

A

Occasional assistance, cares for most needs

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34
Q

What does a KPS of 40-30 indicate?

A

Disabled to severely disabled, needing special assistance

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35
Q

What does a KPS of 20-10 indicate?

A

Very sick, require supportive treatment and point of death

36
Q

What is the PRIMARY prognostic indicator utilized?

A

Tumor grade with type

37
Q

Benign tumors are what grade?

A

Low grade

38
Q

Malignant tumors are what grade?

A

High grade

39
Q

What is the composition of white and gray matter in the CNS?

A

40% gray matter and 60% white matter

40
Q

What is the circulatory system within the brain called?

A

Circle of Willis

41
Q

What is the risk implied on the circulatory system with tumor occurrence?

A

Invasion into the circulatory system causing physiological effects and blockage

42
Q

The spinal cord is a continuation of what structure?

A

Medulla Oblongata

43
Q

What are the parameters of the spinal cord?

A

Base of the brainstem to L1/L2

44
Q

What is the significance of the blood-brain barrier?

A

It regulates the penetration of substance into the brain, essentially protecting the brain from harmful substance

45
Q

What are the requirements to pass the blood-brain barrier?

A

Lipid soluble or carrier molecule needed if water-soluble

46
Q

What is the difficulty of tumor cells within the Blood-brain barrier?

A

Chemotherapy drugs have difficulty trying to penetrate the barrier, leaving limited treatment options

47
Q

What does CSF provide to the CNS?

A

buoyancy to protect and cushion the brain, intracerebral transport, and exchange of nutrients

48
Q

What are the major patterns of spread for CNS tumors?

A

Local invasion and CSF Seeding

49
Q

What is the clinical presentation of a brain tumor?

A

signs are unilateral, hemiplegia, paresis, ocular issues, seizures, balance issues, headaches

50
Q

What is the clinical presentation of Spinal cord tumors?

A

Pain, loss of sensation, cord compression, weakness in distal structures, and loss of control (immediate treatment needed)

51
Q

What is the most important prognostic factor in diagnosis?

A

Histopathology

52
Q

What is the stage system used by AJCC?

A

GTM, Grade is most important

53
Q

What does G1-G3 signify?

A

G1 is well-differentiated and G3 is poorly differentiated

54
Q

What is important to know before considering surgical intervention for CNS Tumors?

A

Tumor size and extent

55
Q

When is surgery primary utilized?

A

Symptomatic tumors or Completely resectable tumors

56
Q

What are spinal cord tumors that are subjected to surgery?

A

Schwannomas, Meningiomas, Ependymomas

57
Q

What are two options for spinal cord tumor treatment?

A

rapid surgical removal and XRT

58
Q

Radiation therapy is best for what tumors?

A

Partially excised tumors, inaccessible tumors, metastatic disease

59
Q

Dose factors include?

A

Tumor type, Grade, recurrence pattern, radio-responsiveness

60
Q

What is the purpose of dose-limiting and whats it based on?

A

Dose-limiting is to limit the dosage to healthy tissue to prevent necrosis and is based on limiting surrounding structures

61
Q

When is radiation therapy most optimal for brain tumor? (2 answers)

A

complete resection is impossible and treatment to residual disease

62
Q

When is whole-brain tx given?

A

presence of metastatic disease

63
Q

What is the flash used in WBRT?

A

1 cm flash

64
Q

What does the WBRT technique consist of?

A

POF laterals, Base of brain border, half beam blocking (possible eye block), Isocentric or SSD, SAD is easier

65
Q

What are the borders of WBRT?

A

Inferior (Supraorbital ridge and EAM), 1 cm of flash around rest of head

66
Q

List WB dose restriction

A

20-40 gy

67
Q

WBRT common guidelines

A

5-20 fx, Standard is 30 gy for 10 fx, 20 gy for 5 fx for poor performers

68
Q

What is the treatment volumes from inner most to outer most?

A

GTV, CTV, ITV, and PTV

69
Q

When does temporary hair loss occur?

A

2000 - 4000 cGy

70
Q

When does permanent hair loss occur?

A

greater than 4000 cGy

71
Q

What are some early delayed side effects of WBRT?

A

Erythema, drowsiness, lethargy, worsening symptoms

72
Q

What are some late delayed side effects of WBRT?

A

necrosis, usually irreversible and progressive

73
Q

Dose tolerances of WB, PB, and SPC?

A

WB (50 Gy), PB (60 Gy), SPC (45 Gy)

74
Q

What is the chemotherapy drug used in the treatment of CNS tumors?

A

Temodar

75
Q

What is the accuracy of Stereotactic radiosurgery?

A

1 mm

76
Q

What are some of the roles of the therapist?

A

Emotional support, Monitor patient, Reassure patient about side effects, substitutions to normal life activities, baby shampoo, NO CREAM 4 HOURS BEFORE TX

77
Q

What are the 5 tumor categories?

A

Adenoma, Blastoma, Carcinoma, Sarcoma, and Glioma

78
Q

What is ADENOMA?

A

tumor in gland

79
Q

What is BLASTOMA?

A

tumor with cells of undeveloped characteristics

80
Q

What is CARCINOMA?

A

tumor from skin or lining of digestive, respiratory or uro

81
Q

What is SARCOMA?

A

tumor from connective tissue, BV or LN

82
Q

What is GLIOMA?

A

tumor from supportive tissues of brain

83
Q

PNET tumors take origin from what cell type?

A

Primitive Embryonal Cells

84
Q

What is the most common malignant CNS tumor in children?

A

Medulloblastoma

85
Q

Helmet brain technique is used for what disease?

A

Malignant Lymphoma

86
Q

How long do patients typically live without intervention?

A

17 weeks

87
Q

How long do patients typically live with complete resection of CNS tumor?

A

70 weeks

Principles and Procedures (27 decks)

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