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6 Neurological Dysfunction > L13 Brain Tumors > Flashcards

L13 Brain Tumors Flashcards

1
Q

How common is brain cancer?

A

accounts for 1.3% of all new cancer cases in the US
about 2% of brain cancer will be children

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2
Q

Naming of brain/spinal cord tumors

A

based on type of cell they form in

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3
Q

Most common primary brain tumors

A

Astrocytic tumors (mal) 38% of all
Meningeal Tumors (ben), 27% of all
Pituitary Tumors (ben)
Schwannomas (ben)
Primary CNS Lymphoma (mal)

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4
Q

Staging System for Brain Tumors

A

no standard staging system
brain tumors rarely metastasize

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5
Q

Adults survival rate

A

32.5%

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6
Q

Survival Rates of Children

A

70% of children will survive more than 5 years

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7
Q

Presenting symptoms based on

A

where tumor is located
size of tumor
number of tumors
rate of tumor growth
(developmental age of child)

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8
Q

Diagnosis of Brain Tumors

A

CT, MRI, PET CT
biopsy are then performed to identify type of cancer and its immuno/genetic characteristics

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9
Q

Treatment overview

A

high dose steroids to reduce CNS edema

medical treatment will include surveillance, surgery, radiation, chemo, targeted therapy

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10
Q

Glioblastoma

A

WHO grade 4

most common malignant primary brain tumor
located in frontal, temporal, parietal, occipital lobes

usually in 64 year olds

cure rate is low, <5% of pts survive past 5 years

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11
Q

Treatment of Glioblastoma

A

combo of steroids, surgery, radiation, chemotherapy (temodar). Surgery won’t be performed if in fragile area or if its moved to the brain.

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12
Q

Glioblastoma treatment has a better outcome if

A

methylation of MGMT, a gene that encodes a DNA repair enzyme.

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13
Q

Effects of Gliobastoma surgery on mobility

A

initial period of worse mobility due to post surgery edema. should resolve

patients benefit from rehab post op if impairments are present

4-6 week period between end of surgery and chemoradiation

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14
Q

Effects of steroids for glioblastoma on mobility

A

started when tumor is identified, given before and after surgery

mobility improves once they start steroids

common and NORMAL to see regression in mobility, increase in fatigue, increase in cognitive S/S when steroids are tapered

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15
Q

Effects of Temodar for glioblastoma on mobility

A

constipation, fatigue, nausea, vomiting, headache are the most common S/S from chemo

taken daily for 6 weeks while pt is given radiation 5 day/week for 6 week. Followed by 6 cycles after radiation

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16
Q

Cycles of Temodar

A

1 cycle = 28 days, 5 days on and 23 days off

completed after radiation is done

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17
Q

Radiation effects on mobility in glioblastoma

A

6 weeks is normal

most commonly experience fatigue

functional mobility worsens due to intensity of fatigue

18
Q

Treatment for childhood brain tumor

A

variable, dictated by tumor type

usually receive platinum and vincalkloid chemo which is toxic to PNS

19
Q

Adult survivors of childhood brain tumor

A

debilitating effects on growth and neuro development after radiation

secondary tumors are common

persistent chemo effects

long term impact of radiation necrosis

20
Q

Childhood cancer survivor study

A

began in 1994, long term study

studied children who survived from 1970-1999

Kiri ness PT, PHD is an investigator

found persistent balance impairments and radiation necrosis of brain

21
Q

Balance Impairments in Children after cancer

A

observed in 48% of survivors

associated with brainstem/cerebellum tumor location, increased body fat, hearing loss, CIPN, cognitive impairments

22
Q

Radiation Necrosis of Brain

A

RARE but side effect of high dose radiation, >55 Gy

results in permanent death of brain tissue resulting in decreased brain function

can be seen within a year and as late as 6-7 years later

23
Q

Metastatic Brain Tumors

A

more common than primary brain tumors

up to 1/2 of met brain tumors are from lung cancer

24
Q

Cancers that commonly met to brain

A

lungs
melanoma
breast
colon
kidney
nasopharyngeal

25
Q

Leptomeningeal Met Cancer

A

cancer that spreads to the two most innermost membranes covering the brain and spinal cord

26
Q

Most common cancers that spread to leptomeninges

A

breast
lung
leukemia
lymphoma

27
Q

CP Of Mets in Brain

A

symptoms depends on where it is present

cortex vs cerebellum vs brainstem vs SC (has a myotome/dermatome pattern)

28
Q

Treatment when there are 1 to 4 Met tumors

A

radiation to whole brain
sterotactic radiosurgery
chemo or immuno

tx can extend life by months/years

29
Q

Treatment when tumors have spread to leptomeninges

A

chemo that is systemic or intrathecal
radiation
supportive care

difficult to tx and often w/poor prognosis

30
Q

PNS Chemo CP

A

numbness and tingling in hands/feet
cramping of hands and feet
diminished DTR
diminished sensation
painful gait
fine motor impaired
drop foot

31
Q

CIPN is temporal…

A

may be different depending on class of drugs

worse in pts with pre-exisitng peripheral neuropathy or being given combo of drugs

onset usually related to time of administration and dose

progresses and dose increases and plateaus around treatment end

32
Q

Coasting

A

noted in platinum compounds of chemo
S/S progress for weeks to months after end

33
Q

Predictors of severe CIPN

A

higher BMI
pre-existing peripheral neuropathy
combo of several toxic chemo drugs
bumps detection test

34
Q

Ototoxicity and Vestibular Toxicity

A

associated with platinum chemo
little is known about this
recommended screen for those that have received platinum

35
Q

Resolution of CIPN

A

most pts improve, if not resolve completely after chemo is completed

many will have persistent neuropathy

1” a month for recovery

36
Q

Predictors of Fall with CIPN

A

at 4 years post diagnosis, 26% of breast cancer and 23% of prostate cancer pts reported falls in 12 months

sensory impairment in feet is significant factor for breast cancer, not prostate

37
Q

Paresthesia treatment

A

gloves and protective clothing
sheet cradles

38
Q

Decreased fine motor function

A

assistive devices
retraining activities

39
Q

Spasmed foot intrinsics

A

trigger point release
stretching of intrinsics and calf
arch supports
strengthen

40
Q

Integrative Balance Training

A

balance training involving all types of training can help improve balance in CIPN patients

41
Q

CIPN Aerobic Exercise

A

decreases pain
improved mobility
decreased severity

42
Q

Aerobic Exercise in Diabetic PN

A

improved nerve conduction
lower incidence of impaired vibration sense
increased epidermal nerve fibers

6 Neurological Dysfunction (16 decks)

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