CNS Tumors Flashcards by Alex Stein

CNS tumors - 5 year survival rate

34.2%

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CNS tumors - ___ leading cause of cancer death in children

2nd (first is lymphomas or leukemia)

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2/3 of CNS tumors in adults tend to be where

in the cerebral hemispheres

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2/3 of CNS tumors in children tend to be where

in the cerebellum and brainstem

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Medulloblastoma - most common at what age

0 to 9

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Glioblastoma - most common at what age

Incidence increases with age

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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)

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Classification - Anatomic location may be clue as to the type - Cerebral hemispheres

Gliomas (malignant)

Meningiomas (benign)

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Classification - Anatomic location may be clue as to the type - Midline

Pituitary adenomas - benign but often have benign malignancy

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Classification - Anatomic location may be clue as to the type - Spinal cord - extramedullary

Meningioma

Schwannomas

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Classification - Anatomic location may be clue as to the type - spinal cord - intramedullary

Astrocytomas

Ependymomas

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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

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Clinical manifestations - depends on what

Location
Type - aggressive or not
Level of structural displacement 
Edema due to vasogenic effects
CSF blockage
Inflammatory mediators

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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

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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

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Clinical manifestations - s/s can include what

Inc ICP
HA
Visual impairment
Papilledema
Mental status changes
N/V
Seizures

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Gliomas - how common

most common, particularly in adults

45%

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Glial cells are what

support structures of the neurons

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Gliomas - grades

Range from grade 1 astrocytoma to a glioblastoma multiforme (GBM) which is a grade 4 astrocytoma

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Gliomas - other types of gliomas include

Oligodendrogliomas (myelin)

Ependymomas (CSF)

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Grade 1 and 2 Astrocytomas - how common

12% primary tumor in adults

25% in children

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Grade 1 and 2 astrocytomas - ages

Bimodal - 5 to 15, 30 to 40

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Grade 1 and 2 astrocytomas - description

Well differentiated

Slow growing

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Grade 1 and 2 astrocytomas - tx

surgical resection is the tx of choice

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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