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PT 680 Clinical Medicine > CNS Neoplasms/Tumors > Flashcards

CNS Neoplasms/Tumors Flashcards

1
Q

the tumor begins in normal CNS tissue

A

primary tumors

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2
Q

give examples of the cell types primary tumors develop on in CNS

A

neurons
glial cells - astrocytes, oligodendrocytes, microglia

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3
Q

tumor begins in other tissue and then spreads (metastisis) to the CNS

A

secondary tumors

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4
Q

what are some common areas in which secondary tumors develop and then travel to the brain

A

breast
lung
kidney
melanoma
gastrointestinal

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5
Q

usually slow growing, may compress other tissues but not typically invasive and list examples

A

benign tumors
meningioma, neurinoma, hemangioblastoma

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6
Q

usually more rapidly growing, may spread by invading other tissues or spreading to distant areas and list examples

A

malignant tumors
astrocytoma, glioblastoma, oligodendroglioma

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7
Q

do primary CNS tumors typically metastasize outside the CNS

A

no
due to lack of lymphatic system to the CNS to transport cancer cells

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8
Q

what is it called when a CNS tumor infrequently travels through CSF to the spinal cord and causes spinal cord complications

A

drop metastasis

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9
Q

how are brain tumors classified

A

via light microscopy
based on neuroembrologic cell type and aggressiveness of the tumor

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10
Q

what is the system called that is used to classify brain tumors and describe it

A

Ringertz system
1 = least aggressive
4 = most aggressive

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11
Q

what is the medial survival rate for glioblastoma

A

8 months

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12
Q

what is the most common primary malignant tumor of the brain

A

glioblastoma

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13
Q

what is the median age for the dx of primary brain tumors

A

61 y/o

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14
Q

most neoplasms in children are ______ (typically in cerebellum and brainstem)

A

intratentorial

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15
Q

another name for tumor

A

neoplasms

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16
Q

neoplasms in adults are _____ (typically in cerebral hemispheres)

A

supratentorial

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17
Q

how do brain tumors affect the CNS

A
  • effects vital functionals of brain and/or spinal cord
  • confined space becomes even more crowded by space occupying lesion (intracranial herniation)
  • may block CSF and reduce blood flow resulting in tissue ischemia
  • results in increased ICP
  • compression of neural tissues results in neurological deficits
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18
Q

lists some signs of CNS tumors

A

(depends on location of tumor and degree of compression on surrounding tissues)
headache, N/V, cognitive/behavior change, seizure activity, visual changes/papilledema, language and speech deficits, syncope, weakness, CN palsy

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19
Q

what is the most common clinical presentation of CNS tumor

A

headache that is generalized and retro-orbital and that is worse in the morning (ICP increases when laying flat)

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20
Q

optic disk inflammation

A

papilledema

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21
Q

list ways to diagnose brain tumor

A
  • MRI/CT
  • cerebral angiography
  • PET scan
  • needle biopsy
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22
Q

is the most informative way to dx brain tumors; can detect very small tumors when contrast is used; important in posterior fossa tumor detection

A

MRI

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23
Q

is effective to dx large tumors that are producing cerebral edema, midline shift, ventricular compression

A

CT scan

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24
Q

looks are metabolism and how the brain feeds (tumors require a lot of nutrients, so will see an increase in metabolic activity in pts with brain tumors)

A

PET scan

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25
Q

list medical management techniques for brain tumors

A
  • surgery: most important form of initial therapy to provide histologic confirmation of tumor and basis for determining tx and prognosis
  • radiation
  • chemotherapy
  • immunotherapy
  • palliative care
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26
Q

describe surgical tx for brain tumor

A
  • histological dx may require stereotaxic biopsy
  • performed through craniotomy
  • goal is 100% removal with minimal surgical brain trauma
  • if not possible, removing as much tumor as possible will relieve pressure and minimize residual tumor size
27
Q

lists complications following brain tumor surgery

A

increased ICP with bleeding and/or edema
infection - meningitis
CSF fluid leak or buildup
endocrine abnormalities
temperature fluctuation
DVT occurs in 1/3 pts

28
Q

what is normal ICP

A

0-15 mmHg

29
Q

ICP above what level requires emergency tx

A

2- mmHg

30
Q

how to help minimize increased ICP following brain surgery

A

HOB elevated 20-30 deg
avoid coughing, sneezing or blowing nose

31
Q

positioning precautions following brain surgery

A
  • avoid extreme flexion of legs (can increase ICP)
  • check head positioning - varies with type of surgical procedure
32
Q

often used following surgery; localized delivery of gamma rays; prove effective in malignant brain tumors; persons with deep inoperable tumors; 5x/week for 34-36 weeks; sterotaxic (gamma/cyber knife)

A

radiation

33
Q

list some negative effects of radiation therapy

A
  • acutely following radiation, increased neurologic deficit and increased ICP
  • post-irradiation syndrome - 1-3 months later, delayed inflammatory process
  • radiation necrosis - severe and irreversible
  • survival time increased but long term effects occur due to damage to cerebral vessels
34
Q

what are the two types of chemotherapy infections

A
  • intrathecal (into CSF)
  • intravenous
35
Q

what is the chemotherapy drug of choice for gliomas

A

temozolomide (TMZ)

36
Q

most frequently used and least-proven tx; infusion of interfersons or interleukin-2

A

immunotherapy

37
Q

pt receive dopamine agonists to control prolactin (reduces signal for cell production); if successful, will be able to avoid surgery or radiation

A

hormone therapy

38
Q

sx management for brain tumors

A
  • anti-inflammatories to control brain edema
  • if increased intracranial pressure is sudden, may need quick acting agents
  • anticonvulsants to manage seizure activity (phenytoin)
  • pain management
  • psychosocial support
  • rehabilitation
39
Q

what are some s/s of increased ICP

A

HA
vision loss
speech
nausea
changes in vitals
seizures
mood
balance/coordination deficits

40
Q

cancer specific quality of life outcome measures

A
  • eastern cooperative oncology group performance status scale
  • cancer quality of life questionnaire 30
  • functional living index - cancer
  • brief fatigue inventory to assess pt fatigue
41
Q

account for 30-40% of all brain tumors - most common; list examples

A

gliomas
astrocytomas, oligodendroglioma, ependymoma

42
Q

often very large tumors and infiltrative

A

astrocytoma

43
Q

what grades of astrocytomas are usually benign

A

1 and 2

44
Q

what grades of astrocytomas are usually fast spreading and malignant

A

3 and 4

45
Q

prognosis for astrocytomas

A
  • good for low grade tumors with complete surgical excision and in pts younger than 40
  • very poor for high grade tumors almost universally fatal and eventually recur if excised
46
Q

slow growing, solid tumor, usually calcified; good long term survival rate with surgical resection and radiation however late recurrence is common

A

oligodendroglioma

47
Q

where are oligodendroglimoas typically found

A

frontal lobe

48
Q

initial sx of oligodendrogliomas

A

headache and seizures
may bleed and present with stroke like presentation

49
Q

very low incidence, usually only 2% of gliomas; more common in children; cause increased ICP or cerebellar dysfunction; 80% 5 year survival rate

A

ependymoma

50
Q

common location of ependymoma

A

posterior fossa and around 4th ventricle

51
Q

most common malignant brain tumor of children; rapidly growing; may metastasize to other brain areas via subarchnoid space; 5 year survival rate is over 50%

A

medulloblastoma

52
Q

where does medulloblastoma arise from

A

cerebellar tissue

53
Q

what is the most common benign neoplasm in CNS

A

meningioma

54
Q

slow growing, s/s evolve over time; F > M; associated with history of breast cancer; genetic abnormality #22; close proximity to bone results in hyperostosis

A

meningioma

55
Q

thickening of skull in region of tumor

A

hyperostosis

56
Q

where does meningioma originate

A

arachnoid layer of meninges

57
Q

benign tumor of pituitary gland results in excessive secretions of pituitary hormones or insufficiency (metabolic/endocrine activity; galactorrhea, amenhorrhea, gigantism. acromegaly; cushing’s disease; hypopituitasm (fatgieu, weakness, hypogonadism); 3rd most common primary brain tumor in adults; 13% of intracranial tumors; F>M; usually middle aged or older

A

pituitary adenoma

58
Q

visual abnormalities associated with pituitary adenoma

A
  • local tumor pressure over optic chiasm
  • bilateral temporal field defects = loss of peripheral field of vision
  • diploplia
59
Q

may develop in any peripheral N; common on 8th CN (acoustic neuroma); slow growing well encapsulated; commonly associated with neurofibromatosis

A

neuroma schwannoma

60
Q

can present with involvement of any part of cord or nerve roots; primary tx is surgery; any known cancer pt with back pain should be a red flat for metastasis to SC until proven otherwise

A

primary and secondary spinal tumors

61
Q

spinal tumors inside the spinal

A

intrathecal/intradural
glioma

62
Q

inside the meninges/outside the cord and example

A

extrathecal/intradural
meningioma

63
Q

outside the cord and meninges and example

A

extrathecal/extradural
metastatic lung cancer to vertebral body

64
Q

clinical presentation of spinal tumors

A
  • poorly localized, deep, spontaneous pain - worse at night
  • pain aggravated by increased intrabdominal pressure - coughing, sneezing, bearing down
  • nerve root pain - LMN presentation
  • brown sequard presentation with sphincter deficits
  • sensory loss in dermatomal patterns
  • syringomelia - loss of pain/temp and paraparesis (a cyst formation within spinal cord)

PT 680 Clinical Medicine (18 decks)

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