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Neuro > CNS neoplasms > Flashcards

CNS neoplasms Flashcards

1
Q

How common are primary malignant brain tumors?

A
  • 2% of all cancers in US adults
  • over 120 types of brain tumors
  • incidence higher in men than women
  • peaks b/t 65-79 years
  • more in children and older adults
  • 2nd leading cause of death in children behind leukemia
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2
Q

RFs of primary malignant brain tumors?

A
  • genetic mutation
  • neurofibromatosis (assoc of tumors all over body)
  • exposure to high dose ionizing radiation:
    radiation therapy
    atomic bomb survivors
    CT scans, dental xrays

-studies show slight increase in these groups:
lab researchers, healthcare professionals
electric workers
prior head trauma

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3
Q

Classification of CNS neoplasms?

A
  • based on cellular origin and histologic appearance:
    grade 1-IV:
    I: benign (still dangerous)
    II: malignant
    III: malignant tissue that has cells that are actively growing
    IV: malignant tisue has cells that look most abnormal and tend to grow quickly
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4
Q

Tumor classification?

A 
- neuroglial (glioma):
astrocytoma
oligodendroglioma
ependymoma
-meningioma
-schwannoma: acoustic neuroma
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5
Q

What is glial tissue? How common are gliomas?

A
  • is supportive tissue of the brain
  • derived from astrocytes, oligodendrocytes, or ependymal cells
  • encompasses 30% of all primary brain tumors and 80% of malignant brain tumors
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6
Q

Astrocytic tumors?

A
  • glioblastomas
  • astrocytomas
  • together these make up 76% of gliomas
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7
Q

Grading of astrocytic tumors?

A
  • grade I: benign (excision is curative) almost always dx in childhood
  • grade II: slow growing and invade surrounding tissue
  • grade III: rare and require aggressive tx due to tentacle like growth are hard to resect
  • grade IV: called glioblastoma, aggressive fast growing cancer
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8
Q

Glioblastoma -location, tx, and survival?

A
  • generally located within cerebral hemispheres of brain
  • usually HIGHLY malignant
  • most common malignant brain tumor
  • 60-75% of all astrocytomas
  • very difficult to remove due to finger like tentacles
  • survival is about 2 years
  • tx: surgery, radiation and chemo (debulk tumor - cause less sxs, if inoperable - chemo/rad)
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9
Q

What are oligodenrogliomas?

Grade? Growth?

A
  • 2% of primary brain tumors
  • can be grade II-III (malignant)
  • most common in frontal or temporal lobes
  • can have areas of hemorrhage
  • generally slow growing and present for years before dx
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10
Q

Most common presenting sxs of oligodendrogliomas?

Tx?

A
  • most common: seizure
  • if frontal lobe tumors - may cause:
    weakness on one side of body, personality changes, behavior changes, difficulty with short term memory
    (TBI sxs)
    Tx:
    surgery
    radiation
    chemo
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11
Q

Prognosis of oligodendrogliomas?

A
  • better prognosis compared to astrocytic tumors

- from time of dx to median time of surviva; 4-10 years

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12
Q

Ependymoma occurrence?

A
  • ependymal cells line ventricles and center of spinal cord
  • relatively rare in adults (2-3% of brain tumors)
  • more common in children
  • bimodal distribution peaks at age 5-6 and 20-30 years
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13
Q

Most common in kids? spinal cord or intracranial? sxs assoc with this?

A
  • intracranial more common
  • poor prognosis
  • sxs are from IICP:
    hydrocephalus
    HA
    N/V
    ataxia
    strabismus
    irritability
    altered mental status
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14
Q

Most common ependymoma tumor in adults? sxs?

A
  • spinal cord
  • better prognosis
  • may cause cord compression sxs: paralysis, weakness, herniated disc sxs, won’t present with seizures or other UMNL sxs,
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15
Q

What is a meningioma? How common is this?

A
  • derived from meningothelial cells that arise from coverings of brain and spinal cord
  • 20-30% of primary brain tumors
  • most common primary brain tumor
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16
Q

Meningioma characteristics?

Tx?

A
  • more common in women
  • often benign
  • usually grow inward putting pressure on brain and spinal cord
  • can grow outward and cause thickening of skull
  • tx: surgery and radiation
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17
Q

Meningioma prognosis?

A
  • est 5 year survival rate is 73-94%
    diff to estimate due to many people found to have meningiomas die from other causes
  • tx: surgery and radiation
18
Q

Sites where meningiomas can develop? Sxs?

A

suprasellar, optic sheath, paranasal/olfactory, foramen magnum, clivus

sxs:

  • irritation: seizures
  • compression: HA, focal weakness, dysphagia, apathy, somnolence
  • stereotypic: CN deficits, change in mentation, visual changes, anosmia, exopthalmos, tongue atrophy
  • vascular: compression of cerebral arteries
  • misc: hydrocephalus, panhypopituitarism
19
Q

Tumors of the cranial and paraspinal nerves?

A
  • schwannoma
  • neurofibroma
  • perineurioma
  • malignant peripheral nerve sheath tumor
20
Q

What are schwannomas?

A
  • nerve sheath tumor composed of schwann cells
  • relatively slow growing
  • mostly benign and less than 1% become malignant
  • tumor cells always stay on outside of nerve (tumor itself may either push the nerve aside and/or up against a bony structure thereby possibly causing damage
21
Q

Most common schwannoma?

A
  • acoustic neuromas
22
Q

Characteristics of acoustic neuromas?

A
  • arises from 8th CN
  • benign
  • usually slow growing
  • can cause serious complications and even death if they grow and exert pressure on nerves and eventually on brain
  • other locations include spine and more rarely along nerves that go to the limbs
23
Q

Sxs of acoustic neuromas?

A
  • unilateral hearing loss
  • tinnitus
  • occasional dizziness
  • difficulty swallowing
  • impaired eye movement
  • taste disturbance
  • unsteadiness
  • HA
24
Q

Tx of acoustic neuromas?

A
  • surgical excision
  • stereotactic radiation surgery to arrest growth
  • in some cases tehy are followed by observation for growth:
    small tumor size, not sig sx, elderly, poor surgical candidates or pt declines other tx
25
Q

Outcome and prognosis of acoustic neuromas?

A
  • tinnitus:
    up to 60% of pts it is relieved
  • recurrence:
    less than 5% but observe for up to 10 years
  • hearing: can be preserved in up to 80% of pts
  • facial nerve dysfxn: incidence of facial nerve paralysis post surgery is variable
    depends on tumor size
26
Q

Primary CNS lymphomas are common in what populatons? How common are these?

A
  • pts with immunodeficiency syndromes: organ transplant, HIV, autoimmune disease
  • 2% of all primary brain tumors
  • derived from B lymphocytes
  • most often occurs in cerebral hemispheres:
    may involve eyes, CSF, or spinal cord
27
Q

Tx of CNS lymphoma?

A
  • steroids to decrease brain edema: may cause tumor regression
  • chemo and or radiation
  • usually inoperable due to location deep in brain

*** don’t give steroids until dx imaging done - b/c steroids can change tumor cells and make it undx

28
Q

Most common cancers to met to brain?

A
  • met tumor: most common brain tumor
  • can spread to brain from any peripheral tumor
  • most common:
    lung (16-20%)
    RCC (7-10%)
    malignant melanoma (7%)
    breast (5%)
    colon (1-2%)
29
Q

Tx of met brain tumors?

A
  • radiation and or chemo
30
Q

What type of dx imaging should you order for eval of neoplasm in brain?

A
  • MRI with contrast
31
Q

Presentation of CNS tumors?

A
  • sxs start with focal neuro signs and move to more generalized sxs as tumor size increases
32
Q

Generalized sxs of CNS tumors?

A
  • HAs
  • seizures
  • N/V
  • depressed LOC
  • neurocog dysfxn
33
Q

Focal sxs of CNS tumors?

A
  • seizures
  • weakness
  • sensory loss
  • aphasia
  • visual spatial dysfxn
34
Q

Overall - Sxs of CNS tumor?

A
  • HA
  • seizures
  • syncope
  • N/V
  • numbness, tingling, weakness
  • balance issues
  • cognitive dysfxn: personality changes, changes in memory, attention, altered language ability, problems with executive fxn, change in daily patterns of eating and sleeping
35
Q

Tumor HA characteristics?

A
  • dull, constant
  • usually bilateral, and not throbbing
  • occipital or frontal lobes
  • increased with coughing or straining
  • worse with change in body position or after lying down to rest
  • tend to be worse at night and may awaken pt from sleep
  • N/V
  • change in pattern from usual HA
  • 48% of pts with brain tumors have HAs
36
Q

Most common sxs of gliomas and cerebral mets?

A
  • seizures

- HA is also very common

37
Q

Medical management of HA/brain edema and seizure?

A
  • HA/brain edema: steroids (Decadron)

- seizures: anti-seizure meds: valproic acid, carbamazepine, (lorazepam for status epilepticus)

38
Q

Tumors and bleeding?

A
  • brain tumors bleed
  • bleed a lot when given anticoagulation
  • CI to thrombolytics
  • in pts with known cancer (RCC) always be on lookout for signs and sxs of cerebral mets or hemorrhage
39
Q

Workup for brain tumors?

A
  • Hx
  • PE to include complete neuro exam - visual, stereognosis, graphesthesia, testing of CNI
  • imaging: MRI with gadolinium, CT not as detailed and difficult to see posterior fossa structures
  • +/- LP to examine cells in certain cases
  • +/- cerebral angiogram
  • bx
40
Q

Tx of brain tumors?

A
  • surgical resection
  • chemo
  • radiation
41
Q

Tumor staging?

A
  • no std staging

- primary brain tumors stay within the CNS

Neuro (19 decks)

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