Neoplasms: Classification, ICP and Characteristics

Question 1

What are primary tumors

Answer 1

Originates in the brain itself, SC or supporting tissues

CNS neoplasms in children are largely 1° in nature

Do not typically metastasize due to the lack of a lymphatic system in the brain

Question 2

Why does a primary tumor not metastasize very well?

Answer 2

Because the brain is a closed system and the lymphatic system does not transport in to the CNS that is why these tumors do not usually metastasize outside the CNS. This does not mean that they cannot just that they usually do not

Question 3

What is the difference between the deficits of a brain tumor and other brain pathologies?

Answer 3

You will see progressive focal deficits depending on where in the brain the tumor is located the only difference that we see is that those symptoms become progressive - same symptoms increase is severity

Question 4

2° Metastatic Brain Tumor: origin and prognosis

Answer 4

Origin: outside the brain

Prognosis: Variable

Question 5

Do you see focal deficits with secondary brain tumors?

Answer 5

You do not see focal deficits to the same degree that you see with primary. Secondary has already metastasized that means tumor can spread throughout parts of the brain. So you do not see the focal deficits that you would typically see with primary. You will see deficits depending on what part of the brain is affected

Question 6

What is the difference between predominant location of brain tumors in adults and children

Answer 6

60% of CNS tumors in adults are supratentorial

Brain tumors in children are infratentorial in location

Question 7

Why is treatment of brain tumors complicated

Answer 7

There are many different types (120)

Question 8

How is the prognosis of a brain tumor and age different from a concussion?

Answer 8

The younger a person is the more likely they are to recover because the brain continues to develop and can develop around the injury with a concussion, the brain is damage

Question 9

Tumor Nomenclature: Adenoma

Answer 9

Benign tumor arising from a gland (pituitary adenoma)

Question 10

Tumor Nomenclature: Blastoma

Answer 10

Malignant tumor with undeveloped (embryonic) cellular characteristics (ie. medulloblastoma or glioblastoma multiforme)

Blastoma can spread

Question 11

Tumor Nomenclature: Glioma

Answer 11

A benign or malignant tumor that arises from supportive tissue of brain (ie. astrocytoma or oligodendroglioma)

Gliomas can be benign or malignant - come from glia cells

Question 12

Tumor Nomenclature: Carcinoma

Answer 12

Malignant tumor arising from skin or lining of the GI/GU/Resp systems; ie. lung cancer (small cell carcinoma) or colon cancer (adenocarcinoma)

Question 13

Tumor Nomenclature: Sarcoma

Answer 13

Malignant tumor arising from connective tissue, blood vessels, or the lymph system; ie. osteosarcoma.

Question 14

Effects of CNS Tumors

Answer 14

Mechanical displacement of brain and SC

Blockage of CSF circulation

Causes neurologic effects by
Compression of cerebral tissue including cranial nerves
Invasion or infiltration of cerebral tissue
Erosion of bone

Also lead to 2° changes such as cerebral edema and elevated ICP

Question 15

Why would mechanical displacement of brain and SC with a tumor

Answer 15

As the mass grows you have potential mechanical displacement of the brain and spinal cord depending on where it is located. Basically you have a mass and the larger it grows, it pushes areas of the brain out of the way. Can cause disruption of electrical conductivity

Question 16

What is Vasogenic Cerebral Edema and what can it cause

Answer 16

Vasogenic means the ability to absorb and release fluid

Leads to seepage of plasma into the extracellular space between the layers of the myelin sheath and axon - if there is extra fluid in there the NTs need to cover a greater surface area to promote electrical mobility —> conduction is impaired

Impairs cellular activity and causes electrochemical instability

Vasogenic cerebral edema may also develop from alterations in the BBB, as in the tumor-facilitated release of vasoactive & endothelial destructive compounds

Question 17

Cerebral edema causes

Answer 17

inflammation and brain compression

Overtime the brain adapts and the brain tissue actually gets smaller to compensate. Also the CSF decreases and blood flow decreases to the brain.

↓ in the amount of brain tissue (slowly over time in the presence of elevated ICP)
↓ CSF volume
↓ cerebral blood flow volume

Question 18

Which type of tumor allows brain to adapt to cerebral edema?

Answer 18

This usually happens with slow moving tumors because brain has the time to adapt around it

Question 19

When will you start to see symptoms of Cerebral Edema?

Answer 19

Few signs and symptoms may be noted initially, but when the brain can no longer compensate, the ↑ ICP leads to more evident symptoms

(Once the brain reaches its ability to adapt then you will really start to see symptoms develop.)

Question 20

*What are Signs of Elevated ICP

Answer 20

1) Headache
2) Seizures
3) Other signs include vomiting, mental clouding, lethargy & alteration of consciousness

Question 21

Headache from elevated ICP location and symptoms

Answer 21

Retro-orbital or generalized:

Intensified by activities that raise ICP: Straining, stooping, exercising

May improve during the day

Caused by irritation, traction or compression of pain sensitive structures including blood vessels, venous sinuses, cranial nerves & the dura mater

Often accompanied by nausea, vomiting and papilledema

Question 22

Seizures and elevated ICP:
Is it common?
Why would it happen
Which type of tumor is it? associated with?

Answer 22

A common initial sign

Produced by discharges from hyperactive cells because you are interrupting the electoral conductivity within the brain

More likely to accompany slow growing tumors

Question 23

Why are seizures more common with slow growing tumors?

Answer 23

This usually happens with slow moving tumors because brain has the time to adapt around it and you do not develop those immediate symptoms that fast growing tumors show right away

Question 24

Progression of Signs and Symptoms of CNS neoplasms

Answer 24

Focal deficits may start to appear over time
Will reflect encroachment on the anatomic region

It is the progressive nature of neurologic sx that are the hallmark of CNS neoplasms
a progressive, usually non-variable, character

Question 25

What are the hallmarks of CNS neoplasms

Answer 25

a PROGRESSIVE, usually NON-VARIABLE, character

Question 26

Tumor Characteristic: Differentiation

Answer 26

Histologic grade of a tumor
Tumors tend to mimic normal tissue and cellular architecture
Refers to how much the tumor resembles normal cells of the same tissue type

Question 27

How is differentiation described and which one has a better prognosis

Answer 27

Well-differentiated:
Structure is nearly normal and likely to be benign in nature - looks normal (good sign)

Poorly or un-differentiated:
Structure is abnormal and likely to be malignant - (bad sign)

Question 28

Benign Tumors are:

Answer 28

Slow growth rate
Non-invasive
Well-differentiated
Low risk recurrence

Question 29

Malignant Tumors are:

Answer 29

Fast growth rate
Invasive - different parts of brain
Poorly differentiated
High risk recurrence

Question 30

How are tumors graded

Answer 30

Once a type of cancer is dx, it is graded as to its aggressiveness

Level of differentiation is obtained by biopsy to compare the resemblance to normal cells

Question 31

What are the 3 Types of grading systems

Answer 31

I-IV grading system

Gleason system

TNM System