CNS Tumors Flashcards
CNS tumors - 5 year survival rate
34.2%
CNS tumors - ___ leading cause of cancer death in children
2nd (first is lymphomas or leukemia)
2/3 of CNS tumors in adults tend to be where
in the cerebral hemispheres
2/3 of CNS tumors in children tend to be where
in the cerebellum and brainstem
Medulloblastoma - most common at what age
0 to 9
Glioblastoma - most common at what age
Incidence increases with age
Classfication of CNS tumors - most common
Most common classification is WHO
Based on neuro-embryonal origin (cell of origin) and the Behavior (grade 1-4, 4 being most aggressive)
Classification - Anatomic location may be clue as to the type - Cerebral hemispheres
Gliomas (malignant)
Meningiomas (benign)
Classification - Anatomic location may be clue as to the type - Midline
Pituitary adenomas - benign but often have benign malignancy
Classification - Anatomic location may be clue as to the type - Spinal cord - extramedullary
Meningioma
Schwannomas
Classification - Anatomic location may be clue as to the type - spinal cord - intramedullary
Astrocytomas
Ependymomas
What does it mean for something to have benign malignancy
They are benign in nature but have functional malignancy where they can produce or lead to other symptoms that may be fatal
Clinical manifestations - depends on what
Location Type - aggressive or not Level of structural displacement Edema due to vasogenic effects CSF blockage Inflammatory mediators
Clinical manifestations - early effects are usually
due to mechanical issues
mass occupying lesion that displaces or compresses structures and causes disruption to CSF or vascular structures
Clinical manifestations - later effects are usually from what
necrosis that is occurring from the inflammatory mediators - tumors take more blood supply so robs surrounding tissue
Clinical manifestations - s/s can include what
Inc ICP HA Visual impairment Papilledema Mental status changes N/V Seizures
Gliomas - how common
most common, particularly in adults
45%
Glial cells are what
support structures of the neurons
Gliomas - grades
Range from grade 1 astrocytoma to a glioblastoma multiforme (GBM) which is a grade 4 astrocytoma
Gliomas - other types of gliomas include
Oligodendrogliomas (myelin)
Ependymomas (CSF)
Grade 1 and 2 Astrocytomas - how common
12% primary tumor in adults
25% in children
Grade 1 and 2 astrocytomas - ages
Bimodal - 5 to 15, 30 to 40
Grade 1 and 2 astrocytomas - description
Well differentiated
Slow growing
Grade 1 and 2 astrocytomas - tx
surgical resection is the tx of choice
Grade 1 and 2 astrocytomas - survival rates
10 yr with complete resection 100%
10 yr with partial resection 30%
Grade 3 and 4 astrocytoma - how common
30% of all brain tumors (mainly adults)
Grade 3 and 4 asatrocytoma - age
40 to 60
M more than F
Grade 3 and 4 astrocytoma - description
Highly aggressive (usually multiple sites throughout hemispheres) Frontal and temporal are most common initial site
Grade 3 and 4 astrocytomas - survival
10% 5 yr Grade 3
Rare 5 yr if Grade 4
Grade 4 astrocytoma - median survival
12 months
Generally less than 3 months for 50-60% of patients with Grade 4
Oligodendrogliomas - how common
5% of all tumors
Oligodendrogliomas - age
most common 35-45 yo
Oligodendrogliom - description
Slow growing
Frontal lobes common
Spontaneous bleed so might see stroke s/s
Seizures or HA are often initial presenting manifestation
Oligodendroglioma - median surivial
17 years
Oligodendroglioma - often contain
solid mineral deposits
usually Ca
Ependymomas - how common
9% of all childhood tumors
Ependymomas - description
Cells lining ventricles and spinal canal
4th ventricle and LS junction are common sites
Inc ICP s/s
Ependymomas - prognosis
improving
5yr is 80%
Medulloblastomas are predominantly
malignant
Medulloblastoma - how common and ages
Children 2-10 is 20-30% (most common type in children)
Adults 45-55 yo is peak
Medulloblastomas - description
Rapid growth
CSF blockage and cbm involvement are common- hydrocephalus
Medulloblastoma - survivial rate
5 yr is 45-70%
Pituitary adenoma - how common
3rd most common primary intracranial tumor in adults
Pituitary adenoma - more common in who and what age
Females
Middle age and older adults
Pituitary adenoma - description
70% or more are functional so they can start to release more of a given hormone
Highly treatable!
Pituitary adenoma - s/s
endocrine in nature but can also impact CNS
Meningiomas - how common
15-27% of intracranial tumors in adults - more F
25% of spinal tumrors
Meningiomas - how old
20 to 60 yo with peak around 45
Meningiomas - common areas
Base of skull, thoracic spine
Meningiomas - presenting s/s
Compression - arm pain or pain btw scapulae and what we are doing as PTs is not getting them better - think of this as a possibility
Meningiomas - survivial
10 yr of 90% with complete resection but by the time they are found there might already be residual impacts
Metastatic tumors - how common
most common CNS tumor in adults! 8 times!
Metastatic - what percent of primary cancer pts metastasis to brain
20%
Metastatic - what percent of primary cancer metastasis to spinal cord
10%
What are the most common cancers to metastasize to the CNS
Lung and breast
What are the second most common cancers to metastasize to the CNS
Renal, malignant melanoma, GI
Lymphomas and leukemias tend to metastasize to where
meninges
Metastasis - treatment
Often to reduce size of metastatic tumor to decrease the effects rather than an actual cure
S/S based on location - brainstem
Cranial neuropathies
UMN signs
Ataxia
Late development of inc ICP
S/S based on location - Cerebral hemispheres
Hemiparesis Hemi sensory loss Hemi visual loss Cog changes Seizures
S/S based on location - midline
Visual impairment
Endocrinopathies
Changing personality
Non localizing signs of inc ICP (HA, nausea)
S/S based on location - Cerebellar
Trunal ataxia Extremity ataxia Scanning speech Hypotonia Nystagmus Early development inc ICP
S/S based on location - Supratentorial
Focal deficits HA Seizures Mental status change Visual field impairment Endocrinopathies
S/S based on location - Infratentorial
Hypdrocephalus s/s like HA, n/v, papilledema, vertigo, diplopia
Mass effect of ataxia, dysmetria, CN impair, intention tremors