L13 Brain Tumors Flashcards
How common is brain cancer?
accounts for 1.3% of all new cancer cases in the US
about 2% of brain cancer will be children
Naming of brain/spinal cord tumors
based on type of cell they form in
Most common primary brain tumors
Astrocytic tumors (mal) 38% of all
Meningeal Tumors (ben), 27% of all
Pituitary Tumors (ben)
Schwannomas (ben)
Primary CNS Lymphoma (mal)
Staging System for Brain Tumors
no standard staging system
brain tumors rarely metastasize
Adults survival rate
32.5%
Survival Rates of Children
70% of children will survive more than 5 years
Presenting symptoms based on
where tumor is located
size of tumor
number of tumors
rate of tumor growth
(developmental age of child)
Diagnosis of Brain Tumors
CT, MRI, PET CT
biopsy are then performed to identify type of cancer and its immuno/genetic characteristics
Treatment overview
high dose steroids to reduce CNS edema
medical treatment will include surveillance, surgery, radiation, chemo, targeted therapy
Glioblastoma
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
Treatment of Glioblastoma
combo of steroids, surgery, radiation, chemotherapy (temodar). Surgery won’t be performed if in fragile area or if its moved to the brain.
Glioblastoma treatment has a better outcome if
methylation of MGMT, a gene that encodes a DNA repair enzyme.
Effects of Gliobastoma surgery on mobility
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
Effects of steroids for glioblastoma on mobility
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
Effects of Temodar for glioblastoma on mobility
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
Cycles of Temodar
1 cycle = 28 days, 5 days on and 23 days off
completed after radiation is done
Radiation effects on mobility in glioblastoma
6 weeks is normal
most commonly experience fatigue
functional mobility worsens due to intensity of fatigue
Treatment for childhood brain tumor
variable, dictated by tumor type
usually receive platinum and vincalkloid chemo which is toxic to PNS
Adult survivors of childhood brain tumor
debilitating effects on growth and neuro development after radiation
secondary tumors are common
persistent chemo effects
long term impact of radiation necrosis
Childhood cancer survivor study
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
Balance Impairments in Children after cancer
observed in 48% of survivors
associated with brainstem/cerebellum tumor location, increased body fat, hearing loss, CIPN, cognitive impairments
Radiation Necrosis of Brain
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
Metastatic Brain Tumors
more common than primary brain tumors
up to 1/2 of met brain tumors are from lung cancer
Cancers that commonly met to brain
lungs
melanoma
breast
colon
kidney
nasopharyngeal
Leptomeningeal Met Cancer
cancer that spreads to the two most innermost membranes covering the brain and spinal cord
Most common cancers that spread to leptomeninges
breast
lung
leukemia
lymphoma
CP Of Mets in Brain
symptoms depends on where it is present
cortex vs cerebellum vs brainstem vs SC (has a myotome/dermatome pattern)
Treatment when there are 1 to 4 Met tumors
radiation to whole brain
sterotactic radiosurgery
chemo or immuno
tx can extend life by months/years
Treatment when tumors have spread to leptomeninges
chemo that is systemic or intrathecal
radiation
supportive care
difficult to tx and often w/poor prognosis
PNS Chemo CP
numbness and tingling in hands/feet
cramping of hands and feet
diminished DTR
diminished sensation
painful gait
fine motor impaired
drop foot
CIPN is temporal…
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
Coasting
noted in platinum compounds of chemo
S/S progress for weeks to months after end
Predictors of severe CIPN
higher BMI
pre-existing peripheral neuropathy
combo of several toxic chemo drugs
bumps detection test
Ototoxicity and Vestibular Toxicity
associated with platinum chemo
little is known about this
recommended screen for those that have received platinum
Resolution of CIPN
most pts improve, if not resolve completely after chemo is completed
many will have persistent neuropathy
1” a month for recovery
Predictors of Fall with CIPN
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
Paresthesia treatment
gloves and protective clothing
sheet cradles
Decreased fine motor function
assistive devices
retraining activities
Spasmed foot intrinsics
trigger point release
stretching of intrinsics and calf
arch supports
strengthen
Integrative Balance Training
balance training involving all types of training can help improve balance in CIPN patients
CIPN Aerobic Exercise
decreases pain
improved mobility
decreased severity
Aerobic Exercise in Diabetic PN
improved nerve conduction
lower incidence of impaired vibration sense
increased epidermal nerve fibers
