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Elsa AACN > Ch 25 Cancers > Flashcards

Ch 25 Cancers Flashcards

1
Q

Cancers in 2 major areas

A

primary neoplasm of the CNS
cancers of other organ systems that can affect CNS directly (e.g. brain metastases) or indirectly (e.g. radiation and chemo)

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2
Q

how do Brain Tumors develop

A

consequence of abnormal replication of cells inside the skull cavity due to genetic alterations that allows cells to circumvent normal cell regulatory functions and avoid immune system targeting

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3
Q

Two types of brain tumors

A

Primary brain tumors

Metastatic brain tumors

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4
Q

Primary brain tumors originate where

A

CNS

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5
Q

Do primary tumors occur more frequently in children or adults?

A

more common in children than adults

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6
Q

Metastatic brain tumor

A

Primary cancer is outside the nervous system and spreads to the brain
Most common intracranial tumor in adults

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7
Q

% of people who have cancer resulting in metastatic brain tumor

A

20 to 40% of adults with cancer

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8
Q

Name malignancies that commonly spread to the brain

A

melanoma
breast CA
lung CA
colon CA

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9
Q

% of metastatic tumor in CNS that seed in the cerebral hemisphere?

A

80%

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10
Q

most common location of metastatic brain tumor

A

gray and white matter junction

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11
Q

how are brain tumors classified?

A

cell of origin
proliferation potential
molecular genetic features

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12
Q

how many tumor grading

A

I to IV

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13
Q

how is tumor graded

A

based on the degree of histological malignancy and molecular genetic characteristics

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14
Q

definition of benign or malignant is useful or not useful in the context of brain tumors?

A

not useful because benign tumors can have high morbidity due to critical structures in the brain and confined space

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15
Q

Tumor grade I characteristics

A 
Well differentiated 
non-infiltrative 
low proliferative potential 
slow growing
good possibility of cure with surgery
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16
Q

Tumor grade I histologic types and example

A 
Pilocytic astrocytoma 
ganglioglioma 
craniopharyngioma 
meningioma 
pituicytoma
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17
Q

Tumor grade II characteristics

A

Moderately differentiated
somewhat infiltrative
Low proliferative activity
can progress to higher grades

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18
Q

Tumor grade II histologic types and example

A

Diffuse astrocytoma
ependymoma
ogliodendroglioma

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19
Q

Tumor grade III characteristics

A 
Poorly differentiated 
brisk mitotic activity 
infiltrative 
typically require adjunctive chemo or radiation 
tend to progress to a higher grade
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20
Q

Tumor grade III histologic types and example

A

Anaplastic astrocytoma
anaplastic ependymoma
choroid plexus carcinoma

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21
Q

Tumor grade IV characteristics

A 
Undifferentiated 
widespread infiltration 
high degree of anaplasia 
high degree of necrosis 
requiring multi modality treatment 
rapid recurrence
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22
Q

Tumor grade IV histologic types and example

A

glioblastoma
medulloblastoma
pineoblastoma
atypical teratoid rhabdoid tumor

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23
Q

How are brain tumors categorized by cell origin

A

glial
neuronal
embryonal
mixed or other

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24
Q

diffuse astrocytic and ogliodendroglial tumors

A

glioblastoma
diffuse astrocytoma
anapestic oligodendroglioma

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25
Q

incidence rate of primary brain and CNS tumor

A

23.03/100,000

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26
Q

highest incidence rate of brain tumor in which age group

A

older adults 85+

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27
Q

most common tumor site for primary brain tumors in the CNS is

A 
meninges 36%
lobes of the brain 18.7%
- frontal 8.2%
- temporal 6%
- parietal 3.5%
- occipital 1%
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28
Q

most common types of tumor from ages 0-4

A

1 - embryonal tumor

2- pilocytic astrocytoma

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29
Q

most common types of tumor from 5-14

A

1 - pilocytic astrocytoma

2 - malignant glioma

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30
Q

most common types of tumor from 15-19

A

1 - pituitary

2- pilocytic astrocytoma

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31
Q

most common types of tumor from 20-44

A

1- pituitary

2- meningioma

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32
Q

most common types of tumor from 45-54

A

1-meningioma

2-pituitary

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33
Q

most common types of tumor from 55+

A

1-meningioma

2-glioblastoma

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34
Q

gender differences in brain tumors overall

A

females > males

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35
Q

types of brain tumor that are higher in female than male

A

meningioma (2x more in F)

pituitary tumor

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36
Q

types of tumor that are higher in male than female

A 
neuroepithelial tumor (1.4x more in M)
glioma and germ cell tumor
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37
Q

which racial group has highest incidence rate of brain tumor

A

whites

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38
Q

which racial group has highest incidence rate for non malignant tumor?

A

blacks

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39
Q

how common are childhood brain tumors?

A

second most common

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40
Q

childhood brain tumors account for ? % of all CNS tumors

A

6%

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41
Q

mortality in brain and CNS tumor

A

5 year survival rate - 62% in adults 20-44

5 year survival rate - 6% age 75 or above

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42
Q

brain tumor type that has the poorest survival rate?

A

glioblastoma for all age groups

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43
Q

survival rate for patients with multiple brain metastases?

A

odds of 6+months of survival are low

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44
Q

age group that has the lowest survival rate with primary brain tumor?

A

under 1 years

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45
Q

risk factors for brain tumor

A

exposure to ionizing radiation
genetic cancer disposition (e.g. TSC, NF1,2, Li Fraumeni, nevoid basal cell carcinoma, Von hippo Lindau)
HIV (higher rate of CNS lymphoma)

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46
Q

which determines brain tumor severity?

A

location

mass effect

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47
Q

presentation of brain tumors

A

headache (most common sx in all groups)

  • new onset HA with nausea and vomiting esp in the morning
  • persistent HA

signs of Increased ICP

progressive neurologic deficits
- sensory motor deficits, ataxia, cranial nerve palsy posterior fossa tumor, pineal tumor, diplopia

endocrinopathy
- hormonal disruption (usually with pituitary tumor)

seizure

  • 15-20% of children have seizures
  • 25-30% present with seizures
  • 40-60% adults have seizures some time

cog and behavioral changes

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48
Q

endocrinopathy

A
  • hormonal disruption (usually with pituitary tumor)

- tumor in the cellar region are related with neuroendocrine dysfunction such as Diabetes, hypogonadism, growth delay

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49
Q

Diagnosis of brain tumor

A

CT

  • show most tumors, calcifications and hemorrhage
  • may not show posterior fossa tumors or low grade glioma

MRI - BEST CHOICE

  • dx and monitoring tumor
  • can tell location and characteristics
  • contrast can indicate breakdown of blood brain barrier, information about type and degree of malignancy
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50
Q

Treatment of brain tumor

A

*surgery
radiation
chemo

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51
Q

Surgery

A

first line of treatment!
some areas not good for surgery (e.g. brainstem)
good for low grade tumor and extra axial tumor (eg meningioma, pituitary tumor)

management of hydrocephalus and edema

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52
Q

tumor types that are good candidate for surgery

A

meningioma
pituitary tumor
posterior fossa tumor (obstructs 4th ventricle)

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53
Q

surgical complications of brain tumor

A

perioperative stroke
motor sensory deficit
damage to pituitary structure
posterior fossa or cerebellar mutism syndrome
- can cause mutism, emotional lability, cranial nerve deficits, ataxia
- mutism and motor deficits resolve over weeks or months

54
Q

radiation therapy for brain tumor, used for?

A

whole brain or craniospinal radiation is used to treat tumors with potential for spreading (e.g. medulloblastoma)

55
Q

how does radiation therapy help?

A

target dividing tumor cells by depositing high frequency energy in tissue
creating ionization and free radicals
damaging tumor DNA

56
Q

why are cancer cells are more vulnerable to effects of radiation

A

because they are more involved in replication rather than maintenance and repair

57
Q

why is radiation therapy contraindicated in age 3 or under or in older adults

A

young - can impair growth of normal tissue and subsequent brain development

old - toxicity is very high because of less robust cellular repair mechanism associated with aging

58
Q

complications of radiation therapy

A

acute radiation encephalopathy (early on)

  • headaches, somnolence, worsening of neurologic deficits
  • responds to corticosteroids

early radiation encephalopathy (1-6 months post radiotherapy treatment)

  • associated with reversible demyelination related to disruption of blood brain barrier and neuroinflammation
  • 12 months back to baseline

late complications (>12 months after) in adults

  • not reversible
  • can consist of local radionecrosis or diffuse leukoencephalopathy
  • cog deficits can be mild to very severe
  • attention and short term memory
  • incontinence
  • gait disturbance
  • MRI shows ventricular enlargement, atrophy, white matter changes

late complications (>12 months after) in kids

  • neuropsych deficits
  • neuroendocrine dysfx, infertility
  • vascular complications
  • hearing loss
  • cataracts
  • impaired growth and development
59
Q

Why is there cog dysfunction in children who are treated with radiation

A

because it damages developing white matter
younger children are more at risk for neurocognitive toxicity
radiation injuries ogliodendrocyte precursor cells and brain microvasculature
reduced diffusivity in corpus callous, internal capsule, frontal white matter
damag to hippocampal progenitor cells

60
Q

Chemotherapy - how does it work to treat

A

targets rapidly dividing cells by disrupting DNA and interfering with transcription and replication

61
Q

treatment of medulloblastoma in kids

A

surgery
radiation
maintenance chemo

use intrathecal chemo and bone marrow transplant to avoid radiation therapy

62
Q

combined chemo and radiation can have positive or negative impact on cognition?

A

negative impact on late effects

higher risk of cognitive impairment

63
Q

late complication and effects of chemo in adult

A 
cerebral white matter damage (leukoencephalopathy)
hearing loss
peripheral neuropathy
secondary cancer
fatigue
neuropsych deficits
64
Q

late complication and effects of chemo in children

A 
cerebral white matter damage
endocrine dysfunction (infertility)
cardiovascular problems
seizures
hearing loss
neuropathy
cerebellar symptom
organ dysfunction
secondary cancer
neuropsych deficits
65
Q

inpatient hospitalization for brain tumor

A

children can recover quickly from surgery if complications are few

66
Q

how is radiation therapy administered?

A

in fractions over 6 weeks

67
Q

how is post radiation chemo administered?

A

delivered in cycles

overall course of treatment can be a year or longer

68
Q

NP assessment during treatment

A

NP testing post surgery and before additional therapy can be helpful to understand functional status

defer testing until after radiation therapy or tx is completed

69
Q

outpatient rehab in brain tumor treatment

A

recovery from tx is variable

70
Q

adult survivors of childhood brain tumors are at more risk for more problems such as

A 
late occurring seizure
neuroendocrine dysfunction
sensory motor deficits
late occurring stroke
increased risk of death (13x)
psychosocial factors
71
Q

if treated with cranial radiation of strong dose, what may be a consequence

A

stroke

72
Q

how often should NP assessment be done for children with treated brain tumors?

A

periodically every 3 years or more frequently

late effects can emerge over time

73
Q

Non CNS cancers and paraneoplastic syndrome

A

-

74
Q

5 year survival rate for all non CNS cancer

A

70%

75
Q

cancer death rates are increasing or decreasing

A

decreasing

76
Q

most common CA type in adults?

A 
breast CA in female
lung CA
prostate CA in males
colorectal
melanoma of skin
77
Q

cancer disparities in race

A

blacks have higher mortality in breast CA, advanced state ovarian CA, advanced stage prostate CA, colorectal CA

black males higher rate than whites to die from lung CA

78
Q

paraneoplastic syndromes

A

rare neurological complication of cancer
remote effects of cancer on nervous system
can cause severe neurological disability

79
Q

incidence of paraneoplastic syndrome

A

less than 5%

80
Q

what is paraneoplastic syndromes caused by

A

indirect immune system reaction to cancer

81
Q

3 types of paraneoplastic syndromes

A

progressive encephalomyelitis
cerebellar degeneration
opsoclonus myoclonus

82
Q

associated cancer of progressive encephalomyelitis

A

lung, hodgkin’s

83
Q

sx of progressive encephalomyelitis

A

seizure
amnesia
mental status change
affective change

84
Q

associated cancer of cerebellar degeneration

A

lung, gynecologic cancer, hodgkins

85
Q

sx of cerebellar degeneration

A 
motor incordination leading to progressive gait ataxia
dysarthria 
nystagmus
vertigo
diplopia
cognitive changes
86
Q

associated cancer of opscolonus myoclonus

A

neuroblastoma in children
chest/lung cancer in children
lung cancer in adults

87
Q

sx of opscolonus myoclonus

A 
arrhythmic saccades (eye movement)
myoclonus of trunk limb head diaphragm palate larynx pharynx
88
Q

paraneoplastic syndromes that affect CNS and neurological fx

A

Lambert eaton myasthenia syndrome
3% of patients with small lung cancer

progressive encephalomyelitis

cerebellar degeneration

89
Q

common childhood non CNS Cancer in children

A 
leukemia
lymphoma
soft tissue sacroma
neuroblastoma
kidney tumor
90
Q

5 year survival rate for all childhood cancer

A

83%

91
Q

most common malignancy of childhood is?

A

acute lymphoblastoma leukemia (ALL)

92
Q

acute lymphoblastoma leukemia (ALL) 5 year survival rate?

A

90% with treatment

93
Q

what is acute lymphoblastoma leukemia (ALL)

A

cancer of blood and bone marrow
lymphocytes proliferate and crowd out healthy and functional cells
diagnosed mostly in preschool years

94
Q

when is acute lymphoblastoma leukemia mostly diagnosed

A

diagnosed mostly in preschool years

95
Q

% of people who have cognitive dysfc during chemo

A

13-70% during chemo

17-75% have cognitive dysfx prior to tx

96
Q

NP complaints during and after chemo of non CNS cancer?

A

processing speed
attention
working memory
EF

97
Q

chemobrain after breast CA

A

persistent changes in 30% of people (1 yr post)

decreased gray matter densities and white matter changes

98
Q

risk factors for cog impairment with breast CA

A

old age
low cog reserve
genetic contribution

99
Q

cog changes post cancer tx?

A

accelerated aging

100
Q

age of bone marrow transplant and effect on NP functions?

A

younger age at dx and treatment has more problems

101
Q

NP effects after bone marrow transplant

A

EF

memory

102
Q

endocrine therapy for tx of what cancers?

A

breast, prostate, thyroid

103
Q

how does endocrine therapy work?

A

block, add, remove hormones that can slow or stop the growth of cancer

surgical excision of the gland responsible for producing the hormone

take meds to prevent cancer from using the hormones to grow

104
Q

endocrine therapy can be used with other tx

A

surgery
radiation
chemo
immunetherapy

105
Q

side effects of endocrine therapy

A

hot flashes, low libido, fatigue, nausea, mood changes

106
Q

use of tamoxifen and NP results

A

word list generation

verbal memory

107
Q

% of childhood cancer survivors that experienced at least one late effect of tx?

A

60%

108
Q

% of childhood cancer survivors developed a chronic disease

A

40%

109
Q

increased risk in childhood cancer survivors in the following conditions

A 
reduced life expectancy
endocrine dysfunction
fertility problems
NP impairment (esp intrthecal chemo or radiation)
cardiopulmonary dysfx
hearing loss, cataracts
gastrointestinal disorder
secondary malignancy
110
Q

risk factors for cog impairment after treatment for non CNS cancer

A

young age
high dose of radiation
female
girls under 6

111
Q

NP characteristics for brain tumors in adults

A

cog deficits usually present before tx
deficits related to tumor, tumor progression, neurocomplications, seizures
cog problems more diffuse in brain tumors than strokes
ICP can lead to structural shifts and produce features suggest involvement of sites distant from the tumor

112
Q

neurocognitive late effects of radiation and chemo implication dysfunction in which part of the brain

A

frontal subcortical brain systems

113
Q

NP should focus on assessing

A

attention, EF, language, memory and learning, VS, psych

114
Q

NP characteristics for brain tumor in peds

A

deficits can be delayed and progressive
mild to severe cog deficits
low average IQ in medulloblastoma with radiation
surgery only - average IQ (but below average people more than normal)

affects attention, working memory, processing speed
fluid cog skills MORe vulnerable to disruption

115
Q

Non CNS Cancers NP characteristics in adults

A

attention, concentration, learning memory, EF, speed of processing, mood, adaptive functions

116
Q

chemo NP results for childhood leukemia

A

average IQ
deficits in attention, memory, EF, processing speed
VS, working memory

117
Q

NP findings for non CNS cancer - IQ

A

adults
IQ generally preserved for chemo
IQ significant decline for brain tumor

kids
radiation and chemo early age = high risk for decline in IQ (2-4 points per year from diagnosis)
craniospinal radiation therapy - learn new skills at a slower rate

118
Q

NP findings for non CNS cancer - attention

A

attention problems common in all ages
chemo and radiation compromise attention and affect memory
sustained attention difficulty
working memory difficulty

119
Q

NP findings for non CNS cancer - processing speed

A

most common deficit in all ages

in kids - cranial radiation therapy most affected
in adults.- radiation for brain cancer

120
Q

NP findings for non CNS cancer - language

A

children treated at a very young age show problems
foundational language preserved
later dx and tx better outcome
mild to mod problems with retrieval

adults with cortical brain tumor - language deficit/aphasia

121
Q

NP findings for non CNS cancer - VS

A

often compromised in childhood cancer
NP type 1

decline VS in men with prostate cancer tx

122
Q

NP findings for non CNS cancer - memory

A 
more problems when tx in 
third ventricle region
childhood leukemia
cranial radiation
earlier tx and dx

problems with learning and memory

123
Q

NP findings for non CNS cancer - EF

A

peds - problems with initiation, self regulatory capacity, organizational skills

EF very vulnerable in adults and children treated for tumor and CA

124
Q

NP findings for non CNS cancer - Sensorimotor

A

chemo have peripheral neuropathy as a side effect
lymphedema can impact motor speed
reduced fine motor speed and output
motor coordination, motor planning, speed of output, balance (posterior fossa tumor)
handedness change

125
Q

NP findings for non CNS cancer - mood

A

depression
anxiety
suicidality in brain tumor in adolescents and young adults

regulation problems exist with steroid
social skills problems more frequent in children and adolescents

126
Q

NP findings for non CNS cancer - PVT SVT

A

fatigue
energy level
misattribution bias

127
Q

NP findings for non CNS cancer - achievement/adaptive

A

math problems:
brain tumor or childhood leukemia, NF type 1

language and reading difficulties

adaptive skills can be compromised a lot even if IQ is ok

128
Q

intrathecal chemo

A

delivers therapeutic agents directly into CSF
to circumvent the blood brain barrier
administered via lumbar puncture

129
Q

leukoencephalopathy

A

cerebral white matter injury that can be caused by radiation or chemo

130
Q

methotrexate

A

antineoplastic agent classified as an antimetabolite

folic acid antagonist and causes folic acid deficiency in cancer cells so THEY CAN DIE!

131
Q

NF1

A

autosomal dominant genetic disorder

higher risk of developing brain tumors, OPTIC GLIOMA

132
Q

vasculopathy

A

any disease affecting blood vessels and includes vascular abnormalities caused by a number of conditions and disorders

Elsa AACN (35 decks)

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