General Cancers

Question 1

General types of cancer

Answer 1

Primary neoplasms of the brain and central nervous system and cancers of other organ systems that can affect CNS directly (i.e., metastasis) or indirectly (treatment)

Malignancy refers to indication of local growth pattern and capacity to spread in the neuroaxis

Question 2

What is a brain tumor and how is it classified

Answer 2

Abnormal replication of cells

Brain tumor is based on cell of origin and proliferative potential

Question 3

WHO classification of severity

Answer 3

Grades I-IV based on degree of histological malignancy

Grade I: well differentiated, non-infiltration, low proliferative potential, slow growing, and good possibility of cure with surgery (pilocytic astrocytoma and craniopharyngioma

Grade II: moderately differentiated, somewhat infiltrative, low proliferative activity, and can progress to higher grades (fibrillary astrocytoma and ependymoma)

Grade III: poorly differentiated, brisk mitotic activity, infiltration, typically require adjunctive chemotherapy, and/or radiation, tends to progress to higher grade (anaplastic astrocytoma and ependymoma

Grade IV: undifferentiated, widespread infiltration, propensity for craniospinal dissemination, high mitotic activity, high degree of necrosis, requires multimodal treatment, and rapid recurrence (glioblastoma and medulloblastoma)

Question 4

Incidence, prevalence, demographics

Answer 4

75% survival at 5 years

Age 0-4: medulloblastoma/embryonal and pilocytic astrocytoma
5-14: pilocytic astrocytoma and malignant glioma
15-19: pituitary and pilocytic astrocytoma

Better outcomes for males. Females are more affected by tumors

15-20% of children with tumors present with seizures

Question 5

Risk factors for cancer

Answer 5

Ionizing radiation and various genetic conditions, HIV (lymphoma)

Question 6

Determinants of severity with tumors

Answer 6

Grade and location as it can cause mass effect, herniation, and hydrocephalus

Some tumors may not be respectable due to location

Question 7

Presentation with cancer

Answer 7

Headache is the most common symptom related to mass effect and signs of increased intracranial pressure (headache, nausea, and vomiting), progressive neurological deficits, sensory and motor deficits, ataxia, new onset seizure, endocrinopathies, and cranial nerve palsies