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Skin Radiation therapy > CNS > Flashcards

CNS Flashcards

1
Q

MOST COMMON Brain cancer type

A

glioma

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2
Q

where are most primary brain cancers located

A

cerebrum

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3
Q

most common area for palliative brain cancer

A

cerebral hemisphere

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4
Q

cerebrum functions

A

memory, reasoning, judgement, intelligence, emotions and voluntary muscle mvmnt

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5
Q

cerebellum functions

A

plays role in coordination and voluntary muscle mvmnt

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6
Q

3 most important prognostic factors

A

age, tumour type and performance status

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7
Q

HOW much CSF IS EXCREETED / DAY

A

.5L

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8
Q

where is CSF excreteed from

A

the ependymal cells in the choroid plexus

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9
Q

what seperates the the supratentorium from the infraentorium

A

tentorium

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10
Q

what portion of CNS is white matter? grey matter?

A

white is 60%

grey is 40%

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11
Q

what is the blood supply of the brain? spinal cord?

A

brain- circle of willis

SC- vertebral arteries

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12
Q

where is thed end of the spinal cord? T level?

A

L1-2`

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13
Q

WHAT type of substances are allowed past the BBB? which are not?`

A

lipid soluble substances are allowed past

water soluble substances are NOT allowed past unless accompanied by a transporter protein

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14
Q

ex of lipid soluble substances

A

alcohol, nicotine and heroin

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15
Q

ex of water soluble substances

A

glucose, amino acids and sodium

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16
Q

how much CSF is circulating through the CNS

A

3-5oz

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17
Q

cervical spine involvement S&S

A

arm weakness, - pain and temperature sensation in cervical region

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18
Q

thoracic spine involvement s &s

A

abdo muscle weakness, unilateral root pains, sensory changes

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19
Q

lumbarsacral spine involvement s&s

A

root pain in groin, impotence, bladder paralysis, - knee jerk

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20
Q

cauda equina involvement s&s

A

unilateral pain in back and leg, bladder and bowel paralysis

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21
Q

most common area of drop mets

A

the LS spine

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22
Q

initial symptom in Brain cancer

A

headache which is worse in the morning due to ambulation

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23
Q

brain cancer symptoms are usually ______

A

unilateral

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24
Q

spinal cord cancers are usually ______

A

bilateral

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25
Q

pattern of weakness in spinal cord cancer

A

starts distally and moves proximlly

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26
Q

outr most layer of brain meninges

A

dura mater

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27
Q

mid layer of brain meninges

A

arachnoid mater

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28
Q

innermost layer of brain mninges

A

pia mater

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29
Q

what area is responsible for speech

A

brocas area- in the frontal lobe

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30
Q

functions of frontal lobe

A

Voluntary movements, speech
Behavioural and cognitive decline
Reasoning, judgement emotional response and completion of complex actions and control of voluntary muscle movement
Frontal lobe holds Broca’s area- the area of the brain responsible for speech and movement

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31
Q

functions parietal lobe

A

Sensory input, body orientation, somatic centre
Sensory/motor disturbances
Temperature, touch pressure, vibration, pain and taste
Writing and some aspects of reading

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32
Q

Functions tempral lobe

A

Memory and auditory and smell
Memory and hearing deficits
Language functions

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33
Q

where is memory formed

A

amygdala and hippocampus located at the parahippocampal gyrus
which is in the temporal lobe

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34
Q

functions of occipital lobe

A

Perception of visual stimuli

Visual problems

35
Q

what part of the brain is responsible for vision

A

occipital lobe

36
Q

what part is responsible for hearig

A

temporal lobe

37
Q

what part of the brain is responsible for touch and sensatiob

A

parietal lobe

38
Q

what part of the brain is responsible for reasoning and behaviour

A

frontal lobe

39
Q

specific s&s for malignant astrocytoma

A

hadache
seizure
weakness and mental changes

40
Q

specific s&s of brainstem

A

n&v and ataxia

41
Q

meningioma s&s

A

headache and seizure

42
Q

medulloblastoma s&s

A

morning headache and n&v

43
Q

ependymoma s&s

A

morning headache and n&v

44
Q

chraniopharyngioma s&s

A

headache mental changes hemaplageia, seizure and vomiting

45
Q

olgiodendroglioma s&s

A

headache and mental changes

46
Q

pinealoma s&s

A

ocula, vertibular and endocrine

47
Q

hemangioma s&s

A

migrane

48
Q

if a 90atient has reading and writing comprehension difficulties where is their promary

A

parietal lobe

49
Q

pt has personalit changes, memory defects, gait and speech problems, where is the primary tumour

A

frontal lobe8u9

50
Q

what part of the brIain controls Controls BP, HR and breathing rate

A

the medulla oblongata

51
Q

i am part of the brain that Coordination center for motor functions maintains muscle tone, posture and balance

A

cerebellum

52
Q

what are the parts of the circle of willis

A

ant communicating artery, mid cerebral artery, post communicating artery, int carotid artery and post cerbral artery

53
Q

which lobe presents earliest

A

parietal lobe

54
Q

what lobes have vision changes

A

parietal and occipital lobe

55
Q

what lobe presents later than other lobes

A

frontal lobe

56
Q

speech disorders in the temporal lobe occur most commonly in what hemisphere

A

more commonly in left hemisphere

57
Q

temporary alopecia dose

A

20-40Gy

58
Q

what dose can cause perm alopecia

A

> 40Gy

59
Q

what cancers get CSI

A

meduloblastoma, germ cell tumours and ependymoma

60
Q

CSI procedure

A

pt is treated prone and has 2 lats for whole brain and 1 + spine fields

61
Q

beam divergence in CSI

A

“Feathering th gap”
-SHIFTS TH GAP between the brain and spine fields by 1cm every 1000 cgy
spine field is shifted superiorly to accomodate the gap and fs is expanded sup and inf
can also be changed by a couch kick to form a straight edge

62
Q

most common bening brain tumour

A

acoustic nueuroma

63
Q

how long does it take for dexamehasone to work

A

12-18hours

64
Q

do all patients get dexamethasone

A

no patients should not get dex until they have symptoms

65
Q

when is mannitol used for CNS patients

A

its done with dexamethasone to - peritumoral edema in steroid refactory pts (recurrence after initial response to dex)

66
Q

what medications can be used for seizures

A

benzodiazapenes and phenyotin

67
Q

when are stents placed

A

life threatening hydrcephalus, mass effect and neurologic impairement

68
Q

what is th treatment for boh hemispheres (XRT)

A

6 NONCOPLANAR BEAMS
2beams on the right
2 beams on the left
2 sup obliques

69
Q

for CSI XRT what is the inf portion of the spinr field (Tlvel)

A

s3

70
Q

CSI feathering the gap couch rotation typical angles

A

9-11

71
Q

drawbacks of couch rotation for junctioning field

A

the contralatral eye can not be blocked without blocking the frontal lobe this can also underdose the temporal lobe and cribiform plate

72
Q

what is CCNU chemotherapy

A

lomustine

73
Q

treatment of low grade glioma

A

surgery- maximal resection possible
adjuvant XRT 45-54Gy
stage 2 nonpilocytic cancer can get chemo (PCV or lomustine or TMZ)

74
Q

what is PCV chemotherapy

A

procarzabine, lomostine and vincristine

75
Q

treatment for high grade glioma

A

MSR -> chemorads (60Gy +TMZ) -> ADJUVANT XRT TMZ

76
Q

Dose for high grade glioma

A

tumour +edema to 46gy + 14Gy boost

40/15 for elderly pts

77
Q

margins high grade glioma

A

2-3cm

78
Q

most common location ependymoma

A

post fossa and cauda equina

79
Q

tumours of cauda equina ependymoma are what subtype

A

myxopapillary type (WHO GRADE1)

80
Q

Tumours of C/T spine ependymoma are wha subtype

A

cellulaR SUBTPE (Grade2-3)

81
Q

treatment ependymoma

A

MSR-XRT (CSI) 36-40gy with boost to 50-54Gy

82
Q

treatment brainstm glioma

A

not typically treated with surgery except for shunt placement for hydrocephalus
therefore chemo rads is tx of choice, TMZ + 54-60Gy

83
Q

mawrgins brainstem glioma

A 
CTV= GTV +1-1.5CM
PTV= CTV +3-5MM
84
Q

treatment meduloblastoma / pnt

A 
maximal surgical resection in all patients
followed by chemorads CSI (30-40gY + boost to post fossa 10-25gy with total dose of 50-55 + vincristine
adjuvant chemotherapy (lomusine + cisplatinum)

Skin Radiation therapy (40 decks)

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