Cancers of the CNS Flashcards
CNS tumors include tumors of the? (2 answers)
Brain and Spinal Cord
CNS tumors can be under 4 different categories, what are they?
Primary, Secondary(Metastatic), Benign, Malignant
What are CNS tumor’s typical behavior?
Locally Invasive
Why are CNS tumors so deadly in regards to the structures they affect?
Structures affected cannot repair or regenerate themselves, which is the cause of permanent damage
Why would CNS tumors that are benign be considered Malignant?
Due to their close proximity to critical structures and inaccessibility
What is the 5-year survival rate for CNS tumors?
35%
What percentage of CNS tumors involve the brain?
85-90%
What percentage of CNS tumors involve the spinal cord?
15-20%
What is significant about brain tumors in pediatric patients?
Most common pediatric solid tumor
What age are CNS tumors most prevalent in?
50-80 yo
What are the two age groups affected most be CNS tumors?
3-12 yo and 50-80 yo
What percentage of CNS tumors involved the Cerebrum?
75%
What is the function of the cerebrum?
Sensory impulse interpretation and Voluntary muscle activity
At what age are gliomas most prevalent?
40-75 yo
(Look at Brain Diagram). What number correlates with the cerebrum?
1
(Look at Brain Diagram). What number correlates with the Corpus Callosum?
2
(Look at Brain Diagram). What number correlates with the Pons?
7
(Look at Brain Diagram). What number correlates with the Cerebellum?
5
(Look at Brain Diagram). What number correlates with the medulla?
6
What is the ratio of Primary brain occurrence to Secondary?
1:10
What percentage of patients will experience cerebral metastasis?
30%
What are cerebral mets significant to adults?
Most common brain tumors
How do cerebral Mets present location wise?
Hemispheres
What is the most common primary site of metastatic brain disease?
Lungs
What are etiologic factors that can be associated with brain tumors? (4 answers)
Occupational/Environmental, Lifestyle/Dietary, Medical Conditions, Genetic factors
What is the most common form of adult forms of brain tumors?
Glioblastoma Multiforme
What are the 3 most important prognostic factors?
Tumor type w/ grade, Performance status, Age
What is the issue with patients younger than 4 and using XRT?
Due to the on going development of the brain, there is a high sensitivity to XRT, therefore must be avoided.
What are the late effects of radiating CNS patients younger than 4?
Lower IQ as dosage increases
What is the purpose of the karnofsky performance score?
Measure neurologic and functional status
What does a KPS of 100-90 indicate?
Normal function, little to no presentation
What does a KPS of 80-70 indicate?
Function is still maintained with some symptoms, some activities are limited
What does a KPS of 60-50 indicate?
Occasional assistance, cares for most needs
What does a KPS of 40-30 indicate?
Disabled to severely disabled, needing special assistance
What does a KPS of 20-10 indicate?
Very sick, require supportive treatment and point of death
What is the PRIMARY prognostic indicator utilized?
Tumor grade with type
Benign tumors are what grade?
Low grade
Malignant tumors are what grade?
High grade
What is the composition of white and gray matter in the CNS?
40% gray matter and 60% white matter
What is the circulatory system within the brain called?
Circle of Willis
What is the risk implied on the circulatory system with tumor occurrence?
Invasion into the circulatory system causing physiological effects and blockage
The spinal cord is a continuation of what structure?
Medulla Oblongata
What are the parameters of the spinal cord?
Base of the brainstem to L1/L2
What is the significance of the blood-brain barrier?
It regulates the penetration of substance into the brain, essentially protecting the brain from harmful substance
What are the requirements to pass the blood-brain barrier?
Lipid soluble or carrier molecule needed if water-soluble
What is the difficulty of tumor cells within the Blood-brain barrier?
Chemotherapy drugs have difficulty trying to penetrate the barrier, leaving limited treatment options
What does CSF provide to the CNS?
buoyancy to protect and cushion the brain, intracerebral transport, and exchange of nutrients
What are the major patterns of spread for CNS tumors?
Local invasion and CSF Seeding
What is the clinical presentation of a brain tumor?
signs are unilateral, hemiplegia, paresis, ocular issues, seizures, balance issues, headaches
What is the clinical presentation of Spinal cord tumors?
Pain, loss of sensation, cord compression, weakness in distal structures, and loss of control (immediate treatment needed)
What is the most important prognostic factor in diagnosis?
Histopathology
What is the stage system used by AJCC?
GTM, Grade is most important
What does G1-G3 signify?
G1 is well-differentiated and G3 is poorly differentiated
What is important to know before considering surgical intervention for CNS Tumors?
Tumor size and extent
When is surgery primary utilized?
Symptomatic tumors or Completely resectable tumors
What are spinal cord tumors that are subjected to surgery?
Schwannomas, Meningiomas, Ependymomas
What are two options for spinal cord tumor treatment?
rapid surgical removal and XRT
Radiation therapy is best for what tumors?
Partially excised tumors, inaccessible tumors, metastatic disease
Dose factors include?
Tumor type, Grade, recurrence pattern, radio-responsiveness
What is the purpose of dose-limiting and whats it based on?
Dose-limiting is to limit the dosage to healthy tissue to prevent necrosis and is based on limiting surrounding structures
When is radiation therapy most optimal for brain tumor? (2 answers)
complete resection is impossible and treatment to residual disease
When is whole-brain tx given?
presence of metastatic disease
What is the flash used in WBRT?
1 cm flash
What does the WBRT technique consist of?
POF laterals, Base of brain border, half beam blocking (possible eye block), Isocentric or SSD, SAD is easier
What are the borders of WBRT?
Inferior (Supraorbital ridge and EAM), 1 cm of flash around rest of head
List WB dose restriction
20-40 gy
WBRT common guidelines
5-20 fx, Standard is 30 gy for 10 fx, 20 gy for 5 fx for poor performers
What is the treatment volumes from inner most to outer most?
GTV, CTV, ITV, and PTV
When does temporary hair loss occur?
2000 - 4000 cGy
When does permanent hair loss occur?
greater than 4000 cGy
What are some early delayed side effects of WBRT?
Erythema, drowsiness, lethargy, worsening symptoms
What are some late delayed side effects of WBRT?
necrosis, usually irreversible and progressive
Dose tolerances of WB, PB, and SPC?
WB (50 Gy), PB (60 Gy), SPC (45 Gy)
What is the chemotherapy drug used in the treatment of CNS tumors?
Temodar
What is the accuracy of Stereotactic radiosurgery?
1 mm
What are some of the roles of the therapist?
Emotional support, Monitor patient, Reassure patient about side effects, substitutions to normal life activities, baby shampoo, NO CREAM 4 HOURS BEFORE TX
What are the 5 tumor categories?
Adenoma, Blastoma, Carcinoma, Sarcoma, and Glioma
What is ADENOMA?
tumor in gland
What is BLASTOMA?
tumor with cells of undeveloped characteristics
What is CARCINOMA?
tumor from skin or lining of digestive, respiratory or uro
What is SARCOMA?
tumor from connective tissue, BV or LN
What is GLIOMA?
tumor from supportive tissues of brain
PNET tumors take origin from what cell type?
Primitive Embryonal Cells
What is the most common malignant CNS tumor in children?
Medulloblastoma
Helmet brain technique is used for what disease?
Malignant Lymphoma
How long do patients typically live without intervention?
17 weeks
How long do patients typically live with complete resection of CNS tumor?
70 weeks
