Chapter 16: Primary Brain Tumors

Question 1

Malignancies of the brain are called ________ rather than “cancer” because benign growths can be just as disabling/life threating

Answer 1

Tumors

Question 2

There are over ______ different types of Primary brain tumors

Answer 2

120

Question 3

What type of classification system do PBT use?

Answer 3

Histology (type of cell) and grade (how differentiated the cell is)

i.e. G4 tumors reproduce rapidly

Question 4

T/F: Brain tumors rarely metastasize to other parts of the body

Answer 4

True

Question 5

_______ is the largest risk factor for PBT development, however most have no apparent cause

Answer 5

Radiation exposure

Question 6

T/F: There is a positive association w/ brain tumor incidence and diet quality

Answer 6

True

Question 7

___________ is the most aggressive type of brain cancer

Answer 7

Glioblastomas

Question 8

These are the 2 most common types of brain cancer in adults

Answer 8

Astrocytomas and glioblastomas

Question 9

Treatment for brain cancers

Answer 9

Surgery low grade

Adjuvant chemoRT for higher grade

Question 10

Most common side effects of brain radiation

Answer 10

Loss of appetite, N/V, hypogeusia, fatigue

Question 11

Why are anti-epileptic drugs often ordered w/ PBTs?

Answer 11

Seizure activity
*Best to avoid those that do not interfere with chemo

Question 12

________ ______ fields are low-intensity, electric fields are newly used for treatment of glioblastoma. Minimal side effects.

Answer 12

Tumor Treatment

Question 13

Most common NIS for malnourished pts with brain tumors

Answer 13

N/V, dysphagia, headache, weight loss, fatigueh

Question 14

What is the Prognostic Nutritional Index (PNI)

Answer 14

Derived from albumin & lymphocyte counts

(not a validated screening or assessment tool but has shown some interesting relationships)

Question 15

Why is hyperglycemia common with PBTs

Answer 15

Steroids (dexamethasone) is often used to decrease peritumoral edema & reduce radiation side effects

*Hyperglycemia management usually isnt a goal d/t poor prognosis

Question 16

_________ is often used as an adjuvant therapy to chemoRT but it isn’t the standard of care

Answer 16

Ketogenic Diets
(Promising results in animals but more studies needed in humans)

90, 8, 2
80,15, 5

Question 17

When does the KD diet show most promise

Answer 17

When started during radiation for PBT

Question 18

What are 2 contraindications for KD?

Answer 18

1. Malnutrition
2. Metabolic conditions (i.e. carnitine deficiency)

*steroids are not contraindicated but ketone levels may be lower w/ steroids)

Question 19

KG diet equation

Answer 19

Fat grams: [grams pro + grams CHO]

Question 19

Ratios usually used to achieve ketosis

Answer 19

4:1 or 3:1 (~90 energy from fat)
*must use food scale for accuracy

Question 19

T/F: The Keto Diet is usually started inpatient

Answer 19

True, the modified atkins diet is usually started outpatient though

Question 20

Ratios normally used for modified Atkins

Answer 20

2:1 or 1:1

(10-20 g CHO/day)

Question 21

Websites used for Keto recipes & Modified Atkins

Answer 21

KetoDietCalculator through the Charlie Foundation

ruled.me & Cronometer mobile app & Modified Keto Cookbook

Question 22

Many side effects from treatment for brain cancer is similar to those who experience ___________________

Answer 22

Traumatic Brain Injuries

Question 23

T/F: Depression, fatigue, and impaired memory/reasoning are common with PBTs and may impact intake

Answer 23

True

Question 24

_________ often assume burden for patients of PBT d/t impairments and this should be addressed

Answer 24

Caregivers

Take breaks, have a backup person, have people bring food, serve foods that are easy to eat with a spoon/hands, keep a notebook/log, use a pill organizer

Question 25

Tips for memory

Answer 25

Using all 5 senses (touching, smelling foods), using word play, limiting overstimulation

Question 26

An MCT supplement may be beneficial for managing _________ (side effect) of KD

Answer 26

Constipation

Question 26

You may wish to decrease the KD ratio if

Answer 26

Experiencing N/V, losing too much wt