Neoplasms Flashcards
what is a tumor
abnormal mass of tissue resulting from a DNA mutation
OR
cells not dying when its the usual time (failure of apoptosis)
what are the types of cancers
Carcinoma
Sarcoma
Blastoma
what are carcinomas
arise from epithelial cells, most common type of cancer, 80-90% of cancers
what are examples of carcinomas
adenocarcinoma
squamous cell carcinoma
basal cell carcinoma
what is a sarcoma
arise from connective tissue cells, including bone cartilage, fat, tendon, muscle
what are examples of sarcomas
osteosarcoma
myosarcoma
chondrosarcoma
liposarcoma
what is a blastoma
arise from immature cells of the cell line, “-blast”
what are examples of blastoma
glioblastoma
hepatoblastoma
retinoblastoma
what are benign/noncancerous lesion
generally less harmful
do not locally invade other tissues or parts of the body
do not spread via blood or lymph
can grow very large
cells are well differentiated
what is malignant/cancerous lesions
capacity to spread and form new tumors in other tissues or organs
can locally invade surrounding tissue
can spread via blood or lymph
grow quickly
cells are poorly differentiated
what is angiogenesis
growth of new blood vessels to feed tumor
what are the primary brain tumors
glioblastoma
astrocytoma
oligodendroglioma
ependymoma
meningioma
schwannoma
pituitary tumor
what is the most common primary malignant brain tumor in adults
glioblastomas
what is the most common benign brain tumor in adults
meningioma
what is the most common neoplasm in kids
primary neoplasms which originate in the CNS
what is the most common neoplasm in adults
metastatic or secondary neoplasms
what is our brain primarily made up of
Glial cell and Neurons
what falls under WHO low grade
Grade 1 and 2
less aggressive
what falls under WHO high grade
Grade 3 and 4
more aggressive
what are WHO grade 1 tumors
low grade
non-infiltrative
least malignant (benign)
possibly curable via surgery alone
long-term survival
slow growing
what are WHO grade 2 tumors
low grade
relatively slow growing
somewhat infiltrative
may recur as higher grade
what are WHO grade 3 tumors
high grade
malignant
infiltrative
tend to recur as higher grade
what are WHO grade 4 tumors
most malignant
rapid growth, aggressive
widely infiltrative
rapid recurrence
Necrosis prone
what grade tumor is a meningioma
WHO grade 4
what is important about the signs and symptoms of neoplasms
duration and intensity and progression
what are important imaging for neoplasms
CT is quick and dirty
MRI is gold standard (shows edema)
if tumor enhances with contrast on CT, that means chemo can also get through BBB
what is the gold standard for diagnosing a neoplasm
MRI - shows edema and lesions
what are treatment options dependent on for CNS neuroplasms
dependent on patients wishes, age, and type of tumor
what are the common symptoms of neoplasms
headaches
N/V
seizures (focal or localized depending on location)
cranial nerve palsies
neurocognitive disturbances
psychiatric symptoms
what are the mechanisms that cause symptoms of neoplasms
compression and destruction of health brain tissue
production of hormones
tumor growth
if a patient presents with CN deficits, incorrdination/imbalance, ataxia, hydrocephalus and possible coma - what location is most likely for a tumor
Cerebellum
if a patient presents with sensory loss, motor incoordination, agniosia, visuospatial processing, apraxia, visual field cut - what location is most likely for a tumor
Parietal lobe
what are the common symptoms for a frontal lobe tumor
hemiparesis
dysphasia
abulia
altered personality
what are the common symptoms with an occipital lobe tumor
visual field cut
if a patient presents with auditory/olfactory hallucinations, seizures, memory impairment, dysphasia and visual field cut - where is the most likely location for a tumor
temporal lobe
how are CNS neoplasms managed
control cerebral edema with steroid (dexamethasone)
ASM (only if applicable)
CSF shunt for hydrocephalus
surgery, radiation, chemo, embolize and shrink tumor pre-operatively or if not surgical candidate
what are the risk factors with treatment of CNS neoplasms
inoizing radiation exposure (radiation therapy for prior malignancy, diagnostic imaging, ? cellhpone)
immune compromise
genetic syndromes
what population is more likely to develop a meningioma
women > men
what genetic syndromes increase your risk of neoplasm
NF1 and 2, Tuberous sclerosis, Turcot syndrome, Van-Hippel-Lindau
what is supratentorial
cerebral cortex
what is infratentorial
cerebellum, brain stem, pituitary
what are gliomas
glial cell tumors - 1/3 of all brain tumors
what are the different types of gliomas
astrocytomas
brain stem gliomas
ependymomas
oligodendrogliomas
what is an ependymomas
rare, more common in kids. from ependymal cells lining ventricles and spinal cord.
associated with hydrocephalus when they block the flow of CSF. associated with drop metastases
what type of tumor is associated with drop metastases
ependymomas
what is the presentation of oligodendrogliomas
better prognosis than other gliomas, commonly in men, commonly present with seizures (50-80%)
what are the common symptoms of gliomas
mainly from mass effect and compression of brain tissue or spinal cord - Headaches, seizures, personality changes, weakness, numbness, problems with speech, N/V, vision loss, dizziness
what is glioblastoma multiforme
supratentorial and is the most common form of glioma, can cross corpus collosum into other hemisphere (butterfly)
WHO IV diffusely infiltrating astrocytoma (can occur anywhere in CNS but mostly cerebral)
median age of diagnosis is 65 (age is biggest risk factor)
INCURABLE
median survival 15 months with maximal therapy
what are the treatment options for glioblastomas
Incurable
surgery, chemotherapy, radiation therapies
greater the extent of resection, the greater the survival benefit
surgical techniques are progressing but still have very poor prognosis
where are meningiomas located
supratentorial
what are meningiomas
graded 1-3, usually slow growing and 85-90% are benign - often discovered incidentally
what population are meningiomas associated with
F>M (3:1), most frequently occur in people in 70s-80s
what are the risks of meningiomas
radiation therapy, prolonged use of certain hormones, neurofibromatosis type 2
what do meningiomas arise from
arachnoid mater of meninges, often occur on surface of brain under dura mater, attachment to dura via a dural “base” or “tail”
right beneath skull, so irritated adjacent bone may proliferate - hyperostosis
what is hyperostosis
irritated adjacent bone may proliferate
how are meningiomas treated
for benign and slow growing - observation and regular imaging
surgery and radiation for more aggressive tumors or ones that are causing symptoms
what is another name for schwannomas
acoustic neuroma
what are schwann cells
types of glial cell (myelin insulates axon) - electrical impulse/action potential propagation
where are schwannomas usually found
around peripheral nerves, usually benign and dont invade or metastasize
usually around CN8 - vestibulocochlear
what is the growth pattern for Schwannomas
grow very slowly, but can compress nerves, obstruct arteries, veins or flow of CSF
what are typical symptoms of Schwannomas
relate mainly to nerve compression and depend on location
acoustic neuroma -unilateral hearing loss, tinnitus, balance, facial weakness/paralysis if compressing facial nerve
pain can also be a symptom
how are schwannomas diagnosed
CT or MRI - also checking auditory brainstem response test (measuring evoked action potential from sound)
what is the treatment for Schwannomas
surgery
what is a pituitary adenoma
formed by the hormone secreting cells of the anterior pituitary
typically benign, do not invade neighboring tissues but can compress.
what are pituitary adenomas very close to
optic chiasm - can cause bitemporal hemianopsia (blindness in outer halves of both R&L visual fields)
how are Pituitary adenomas differentiated
by size
Microadenoma < 1cm
Macroadenoma > 1cm
what is the most common hormone associated with pituitary adenomas
Prolactinoma - functional adenoma
what is associated with growth hormone secreting adenomas
gigantism (kids)
acromegaly (adults)
what is associated with adrenocorticotropic hormone secreting tumor
excess cortisol - cushing disease
what is seen with cushings syndrome caused by tumor
moon facies, buffalo hump, truncal obestiy
what is a gonadotroph derived adenomas
most frequent non-functional tumors, clinically silent
how are pituitary adenomas diagnosed
MRI
how are pituitary adenomas treatede
depends on type and size
some managed medically others surgically
transsphenoidal resection
in nonfunctional, only treated if compressing
what are the primary 3 brain metastases from
lung cancer
breast cancer
melanoma
what are differential diagnosis of brain metastases
infection
abscess
demyelinating disease such as MS
Primary brain tumor
what is the prognosis factors for brain metastases
patient age
number and size of metastases
site of primary tumor
any other sites of metastases
sensitivity of the tumor to radiation or chemotherapy
presence of mass effect
what are potential complications of brain mets
mass effect
brain herniation
seizures
hydrocephalus
invasion of surrounding tissues
neurological deficit
death
what are the treatments for brain metastases
surgical resection
radiation (whole brain vs stereotactic)
chemotherapy
immunotherapy
