Metastasis to the CNS Flashcards
Cerebral metastases are the most common brain tumors seen clinically. Increasing incidence of cerebral metastasis is due to which factor?
● A. Increasing length of survival of cancer patients as a result of improvement in treatment of primary cancer
● B. Enhanced ability to diagnose CNS tumors due to availability of CT and MRI
● C. Many chemotherapeutic agents do not cross blood–brain barrier providing a heaven for tumor growth there
● D. Some chemotherapeutic agents may transiently weaken the blood–brain barrier and allow CNS seeding with tumor
● E. All of the above
E. All of the above
All of the following tumors spread commonly through the CNS pathways except?
● A. Oligodendroglioma
● B. High-grade gliomas
● C. Embryonal tumors like medulloblastomas
● D. Ependymomas
● E. Pineal region tumors like pineocytoma, germ cell tumor, and pineoblastoma
A. Oligodendroglioma
A solitary lesion in the posterior fossa of an adult is considered metastasis until proven otherwise. What is the most common location of cerebral metastasis in the supratentorial region parenchyma?
● A. Occipital lobe
● B. Parietal lobe
● C. Temporal lobe
● D. Behind sylvian fissure near the junction of occipital, parietal, and temporal lobe
● E. Near internal capsule
D. Behind sylvian fissure near the junction of occipital, parietal, and temporal lobe
The most common source of cerebral metastasis in an adult is lungs (44%), which is followed by breast (10%), kidney (7%), and GI (6%). All of the following are sources of cerebral metastasis in pediatric patients except?
● A. Melanoma
● B. Neuroblastoma
● C. Rhabdomyosarcoma
● D. Wilm’s tumor
● E. There is zero incidence of cerebral metastasis in pediatric patients
A. Melanoma
Small cell lung cancer is more likely to produce cerebral metastasis than any other bronchogenic cell type. Which of the following statements is incorrect regarding management of these tumors?
● A. These are radioresistant tumors
● B. Prophylactic cranial irradiation with whole brain irradiation reduces the incidence of symptomatic brain metastasis and increases survival with 25 Gy in 10 fractions
● C. Surgical resection is considered for immediately life-threatening large lesions
● D. For multiple small cell lung carcinoma brain lesions, 30 Gy radiotherapy in 10 fractions plus chemotherapy is given
● E. For recurrent brain metastasis after failure of initial treatment, radiotherapy with 20 Gy in 10 fractions is given
A. These are radioresistant tumors
Non–small cell lung cancer includes adenocarcinoma, and large cell, squamous cell, and bronchoalveolar tumors. What are the staging studies for known primary lung cancer?
● A. PET scan
● B. Chest scan
● C. Bone scan
● D. Brain CT or MRI
● E. All of the above
E. All of the above
What are the surgical indications in a patient with metastatic melanoma to the brain?
● A. Patients with one to four CNS metastases that can be completely resected when systemic disease is absent or slowly progressive
● B. For symptomatic relief, for example, lesion causing painful pressure
● C. Life-threatening lesion, for example, large posterior fossa lesion causing painful pressure
● D. For hemorrhagic lesions causing symptoms by mass effect due to clot
● E. All of the above
E. All of the above
Following are the predictors of poor outcome in a patient with metastatic melanoma of brain except?
● A. Less than three metastatic lesions within the brain
● B. Development of brain metastasis after the diagnosis of extracranial disease
● C. Elevated lactate dehydrogenase by more than twice the normal
● D. Presence of bone metastasis
● E. Multiple brain metastasis and extensive visceral disease
A. Less than three metastatic lesions within the brain
A patient presents with brain metastasis in neurosurgical OPD. What metastatic workup is needed in this patient?
● A. CT of the chest, abdomen, and pelvis
● B. Radionuclide bone scan
● C. Mammogram in women
● D. Prostate-specific antigen in men and PET scan in all patients with metastasis
● E. All of the above
E. All of the above
Which of the following is a highly radioresistant brain metastasis?
● A. Small cell lung cancer
● B. Germ cell tumors
● C. Thyroid cancer
● D. Lymphoma
● E. Leukemia
C. Thyroid cancer
What is the most common primary CNS tumor responsible for extraneural spread mostly to lung, bone marrow, lymph nodes, and abdomen?
● A. Medulloblastoma
● B. Ependymoma
● C. Butterfly tumor
● D. Teratoma
● E. GBM
A. Medulloblastoma
Which of the following has the highest incidence of parenchymal cerebral metastases?
● A. Corpus callosum
● B. Posterior to sylvian fissure
● C. Middle frontal gyrus
● D. Gyrus rectus
● E. Hypophysis
B. Posterior to sylvian fissure
What is the most common source of cerebral metastases in adults?
● A. Lung carcinoma
● B. Breast carcinoma
● C. Renal cell carcinoma
● D. Melanoma
● E. Prostate adenoma
A. Lung carcinoma
Small-cell lung cancer (SCLC) was established as the primary source for a patient admitted with cerebral metastases. He was treated with chemotherapy and radiotherapy with total radiotherapy dose of 25 Gy. Recurrent brain metastases after failure of this initial treatment will be treated with how much total
radiotherapy dose?
● A. 20 Gy
● B. 30 Gy
● C. 50 Gy
● D. 54 Gy
● E. 60 Gy
A. 20 Gy
What is the upper limit of number of melanoma mets that can be surgically removed in patients without systemic disease?
● A. 4
● B. 6
● C. 8
● D. 10
● E. Number is irrelevant
A. 4
