Chapter 19: Cancers Flashcards
What are the most common cancers in Adults?
Prostate
Breast
Lung
What are the most common cancers in Children (0-19 years)?
Acute Lymphoblastic Leukemia
Brain Tumors
What is the incidence of Primary Brain and CNS Tumors in adults?
26 per 100,000 person / year
What is the incidence of Primary Brain and CNS Tumors in Children?
5 per 100,000 persons per year
What is the 5 year Survival Rate for Brain Tumors in Adults?
24%
What is the 5 year Survival Rate for Brain Tumors in Children?
75%
Describe the characteristics and histologic types of a Grade I cancers?
Characteristics
- well-differentiated
- noninfiltrative
- Low proliferative potential
- slow growing
- good possibility of cure with surgery
Histologic Types
- Pilocytic astrocytoma
- Ganglioglioma Craniopharyngioma
- Meningioma
Describe the characteristics and histologic types of a Grade II cancers?
Characteristics
- Moderately differentiated
- somewhat infiltrative
- low proliferative potential
- can progress to higher grades
Histologic Types
- Low-grade diffuse astrocytoma
- fibrillary astrocytoma
- ependymoma
- oligodendroglioma
Describe the characteristics and histologic types of a Grade III cancers?
Characteristics
- Poorly differentiated
- brisk mitotic activity
- infiltrative
- typically require adjuvant chemotherapy and/or radiation
- tend to progress to higher grade
Histologic Types
- anaplastic astrocytoma
- anaplastic ependymoma
- anaplastic ganglioglioma
Describe the characteristics and histologic types of a Grade IV cancers?
Characteristics
- Undifferentiated
- widespread infiltration, propensity for craniospinal dissemination
- high degree of anaplasia, mitotically active
- high degree of necrosis
- require multimodality treatment
- rapid recurrence
Histologic Types
- Glioblastoma
- Medulloblastoma
- Primitive neuroectodermal tumor (PNET)
- Pineoblastoma
- Choroid plexus carcinoma
- atypical teratoid rhabdoid tumor
DEFINITION:
Endoscopic third ventriculostomy (ETV)
an alternative procedure to shunt placement to treat hydrocephalus. It involves using an endoscope and making a small perforation in the floor of the third ventricle, which allows for CSF to flow out of the blocked ventricular system.
DEFINITION:
Glioblastoma multiforme
An aggressive glioma; its incidence increases over the course of middle age and older adulthood. It is called multiforme b/c it is composed of a heterogeneous mixture of neoplastic astrocytes
DEFINITION:
Increased intracranial pressure (ICP)
Increased ICP is a rise in the pressure inside the skull; it can be caused by a rise of CSF pressure or by increased pressure within the brain caused by a mass lesion, edema, or bleed
DEFINITION:
Intrathecal chemotherapy
intrathecal chemotherapy delivers therapeutic agents directly into the CSF surrounding the brain and spinal cord. This method of delivery is used to circumvent the blood-brain barrier and is administered via lumbar puncture
DEFINITION:
Leukeoencephalopathy
Cerebral white matter injury; can be cased by radiation and/or chemotherapy
DEFINITION:
Methotrexate
Methotrexate is an antineoplastic agent classified as an antimetabolite. It is a folic acid antagonist and causes folic acid deficiency in cancer cells, causing their death
DEFINITION:
Neurofibromatosis type 1 (NF-1)
Neurofibromatosis type 1 (NF-1) is an autosomal dominant genetic disorder and one of the most common inherited tumor predisposition syndromes. Individuals with NF-1 have a higher risk of developing brain tumors, particularly optic glioma.
DEFINITION:
Paraneoplastic syndrome or paraneoplastic neurological disorders
Neurological complications of systemic cancer caused by immune reaction to antigens expressed by tumors and common to the nervous system; associated with several different antineural antibodies.
A 65-year-old patient with lung cancer presents with the onset of seizures, amnesia, and confusion. Possible etiology of cognitive dysfunction is _______.
A) Paraneoplastic Syndrome
B) Malignant nerve sheath tumor
C) Stroke
D) “Chemobrain” from chemotherapy treatment
A - paraneoplastic syndrome
This constellation of symptoms suggests possible autoimmune reaction to cancer; cognitive dysfunction from chemotherapy treatment is typically associated with mild problems with working memory and attention and not with the onset of seizures or amnesia.
A side effect of intrathecal chemotherapy with methotrexate is _____.
A) leukoencephalopathy
B) peripheral nerve deficits
C) ataxia
D) hemiparesis
A - Leukoencephalopathy
leukoencephalopathy is cerebral white matter damage. It is one of the neurotoxic side effects of methotrexate therapy. The frequency and severity is related to the dose, cumulative exposure, and other factors. It is noted as white matter hyperintensities on T2-weighted MR imaging, which may be transient or persistent.
Cerebellar mutism or posterior fossa syndrome is _____.
A) more common in adults than children after brain tumor surgery.
B) a type of aphasia that occurs after cerebellar stroke
C) a transient complication of surgery that resolves completely
D) characterized in part by loss of speech and cranial nerve deficits
D - characterized in part by loss of speech and cranial nerve deficits
Cerebellar mutism is a complication of posterior fossa surgery and seen more commonly in children than adults. Symptoms gradually resolve over time, but motor coordination and cognitive/psychological issues may persist.
Brain metastases occur most commonly in which region of the brain?
A) cerebellum
B) cerebral hemispheres
C) brainstem
D) meninges
B - cerebral hemispheres
80% of brain metastases occur in the cerebral hemispheres; the common location is at the gray-white matter junction, where vasculature changes in caliber and traps emboli.
Which patient is most likely to demonstrate pronounced cognitive deficits after treatment for childhood acute lymphoblastic leukemia?
A) male treated in adolescence with chemotherapy only
B) male treated in middle childhood with radiation and chemotherapy
C) female treated in early childhood with chemotherapy and radiation
D) male treated in early childhood with chemotherapy only
C - female treated in early childhood with chemotherapy and radiation therapy
Younger age at treatment, female gender, and radiation therapy have been identified as factors associated with more severe neuropsychological impairment after treatment for childhood leukemia.
Adult survivors of childhood brain tumors are at increased risk for ______.
A) kidney disease
B) second tumors and encephalitis
C) second tumors, late-onset seizures, and stroke
D) late-onset seizures and heart disease
C - second tumors, late-onset seizures, and stroke
In a study of long-term survivors of childhood brain tumors, 25% reported seizures, and 6.5% developed seizures more than 5 years after diagnosis. Survivors of childhood brain tumors are at increased risk for strokes and secondary malignancies.
Which of the following disorders is associated with an increased risk of brain tumors?
A) fragile X
B) tuberous sclerosis
C) Prader-Willi
D) Sturge-Weber
B - tuberous sclerosis
Tuberous sclerosis complex (TSC) is one of the hereditary genetic syndromes associated with a predisposition for brain tumors. Central nervous system manifestations of TSC include subependymal giant cell astrocytomas. These are considered benign tumors and treated with surgical resection. Neurologic complications can occur due to intraventricular location.
Meningiomas are most common in ____.
A) adult females
B) children under 6 years of age
C) adolescents
D) adult males
A - Adult females
Meningiomas are twice as common in females than males: most common in females in their 60s and 70s
A 13-year-old treated for a brain tumor with surgery, craniospinal radiation, and chemotherapy at age 6 demonstrates substantial decline in IQ scores compared to prior evaluation at age nine. These findings suggest _____.
A) relapse of brain tumor
B) loss of previously acquired skills (regression)
C) late effect of radiation therapy on brain development
D) significant emotional adjustment difficulties interfering with learning
C - late effect of radiation therapy on brain development
Studies of children treated for medulloblastoma with surgery, craniospinal radiation, and chemotherapy demonstrate a decline in IQ (approximately a 10 - 20-point decline in scores 5-10 years after treatment) that has been related to loss of normal-appearing white matter.
An adolescent undergoing cranial radiation for treatment of leukemia suddenly develops excessive sleepiness within 2 months of initiating therapy. This symptom is most likely related to _____.
A) emotional adjustment difficulties and depression
B) relapse of leukemia
C) sleep apnea
D) acute radiation toxicity
D - acute radiation toxicity (causing somnolence syndrome)
Radiation toxicity can develop early on after treatment and can include somnolence, presumably related to transient demyelination.
