neuro- oncology Flashcards
____ is benign or malignant expanding lesion whose constituent cells multiply without restraint and form a mass
neoplasm
what is the difference between primary anf secondary tumors
primary arise from the CNS cells and secondary metastatic from other primary sites
what are the most common cancer type in children
brain and CNS
t/f: most CNS tumors are metastases
true
Pilocytic astrocytoma, choroid plexus tumors, neuronal tumora, pineal region tumors, germ cell tumors… these tumors are common in who
children
Meningioma and Glioblastoma… these 2 tumors are common in who
adults
men have higher incidence for what kind of tumor ? what about women
brain tumor for mena and meningeal tumor for women
where is the localization of CNS tumors for children adn adults
children’s is 70% in posteior fossa
adults is 70% in cerebral hemisphere
symptoms of a tumor is produced by what 3 things and how do u categorizes symptoms
-tumor
-edema surrounding tumor
- injury to normla brian tissue
categorize them into focal or generalized
what are symptoms of a brain tumor
• Focal Neurologic Symptoms – based on location.
• Seizures
• Headaches
• Symptoms of elevated ICP
if a pateints has a brain tumor and presents with personality changes , nonfluent aphasia (dominant) , urinary frequency and urgency, seizures and hemiparesis where do u think the tumor is
frontal
if a patient has a brain tumor anf they presents with hemiparesis , hemisenosry loss and non fluent aphasia where is the tumor site
frontoparietal
if. a pateint has a brain tumor and presents with hemisneosry loss , nonfluent aphasia , hemineglect (non dominant) , anosognosia (non dom) , hemiparesis , and homonymous hemianopsia where do u think the tumor is
parietal
what are symptoms of increase ICP
• Headache – Dull
– Worse in the am
– Worse if bending over
– Seen in 50% of pts with brain tumors
• Nausea
• Papilledema (swelling of optic disc)
what is the herniation syndrome , monro kellie doctrine
-brian enclosed in hard skull
- sum of volume of CSF , blood and brain is constant
what is the thing that divides the intracranial comparemtns and play a key roll in hernimation syndromes
dural septa
• Expanding lesion presses cerebral hemisphere under falx to contralateral side
• Compression of branches of ACA that run along falx can cause infarction and further swelling
what herniation is this
subfalcine (cingulate) herniation
what is uncal herniation
hippocampus and uncus of the temporal lob herniate down
uncal herniation symptoms are due to pressure on ___ ____ and what are they
tentorial notch ( kernohans notch phenomenon)
• Ipsilateral fixed and dilated pupil (CN III)
• Impaired consciousness
• Hemiparesis
• PCA infarcts 16
what is tonsillar herniation
cerebellar tonsils push down foramen magnum
compress 4th ventricle and medulla
during th etonsillar herniation the Cerebellar tonsils pushed down foramen magnum and Compress 4th ventricle and medulla which leads to what
stiff neck progressing to decerebrate posturing and coma
what does an MRI w/o contract see for CNS tumor
little study for postieor fossa
what does a CT w/o contrast assessment for CNS tumors
assess cranial bones, vertebral column and hemorrhage
what imagining for a CNS tumor determines blood supply and embolize
angiography
what are the 2 brain locations for CNS tumors
• Supratentorial (above cerebellum)
• Infratentorial
what are the 3 spinal locations for CNS tumors
• intradural, intramedullary
• intradural, extramedullary
• extradural
Ependymoma and astrocytoma are examples of what kind of spinal cord tumors
intramedullaruy -within the SC
meningioma and neurofibroma are what kind of spinal cord tumors
extramedullary intradural - lying on surface of cord arising from roots or meninges
metastases and lymphoma are what kind of SC tumors
extradural - in epidural space , bit able to compress upon SC
____ resemble glial cells (astrocytes, oligodendrocytes, and ependymal cells)
gliomas
Meningiomas arise from ___ cells
arachnoid
Neuroblastomas, neurocytomas: derived from
____
neurons
Medulloblastomas arise from ____ cells
primitive
what grade on the historical glioma classification is a pilocytic astrocytoma and what is its characteristics
grade 1 and benign , slow growing
what grade on the historical glioma classification is a glioblastoma and what is its characteristics
grad 4 (bas bas ) and vascular proliferation and necrosis
for a Astrocytoma: IDH mutation & 1p/19q intact.. where is its usual locations and what does it commonly present with
grade 1
location cerebral hemisphere
present with seizures and HA
what is the treatment and prognosis for astrocytoma
- Treatment
– Surgical resection
– +/- radiation
– +/- chemotherapy
good his prognosis
what is a favorable prognosis for a Astrocytomas
– Younger age
– Seizure as only symptom – Smaller tumor size
- Incidence 3:100,000
- Higher incidence in men
- Median age at diagnosis is 59
- Median survival 1.5years
* Presenting symptom–focal signs,cognitive changes, increased ICP
* Risk factors:
– ionizing radiation
– genetic cancer syndromes
what tumor do u think
glioblastoma
what symptoms and risk factors foes a glioblastoma presents with
focal sings
cognitive changes
increase CP
RF: ionizing radiation , genetic cancer syndrome
treatment from glioblastoma
-steroids
-sx
- radiation
-chemo
-CT/MRI monitor
if you are > ___ then u have a poor prognosis for glioblastoma
70
what helps the prognosis for a glioblastoma
higher level functioning
- 23% of tumors in children
- Peak incidence age 6
- Located in cerebellum
- Tumor can cause CN deficits or obstruct 4th ventricle -> hydrocephalus
- Drop metastases in CNS
what tumor do u think
medulloblastoma
where is medulloblastoma located in and most common in
cerebellum and kid
medulloblastoma tumor can causes ___ deficits or obtrstuc ___ ventricles leading to ____
CN ‘4th ‘hydrocephalus
treatment for medulloblastoma
-sx
-mod dos rad
- chemo w ct or mri
where is recurrence come in for medulloblastoma
postioer fossa
bc remeber most location of tumors for kids is in the postieor fossa and adults is cerebral hemisphers
how is the prognosis for medulloblastoma
good ish with sx and rad but extra cranial metastases is worse
- Most common 1° brain tumor
- Incidence increases with age
- F>M
- Arise from arachnoid cells
* Benign, slow growing tumors - Calcification common
what thumor do u think
meningiomas
what is the most common primary brai tumor
meningiomas
what are the primary sites for metastases to CNS
• Lung (50%)
• Breast (15%)
• Melanoma (10%)
• GI, prostate, ovary (10%)
what is seizures treated w for metastistc disease
antipeileptic drugs usually LEVTIRACATEM (keppra) or LACOSAMIDE (vimpat)
which SC region is most likely to metastases
thoracic then lumbar then cervical
what is the primary tumor site for SC metastases
lung , breast. , prostate , kidney , thyroid ,gut
what are the symptoms for SC metastases
back pain
tenderness
paraparesis
incontinence
what do u treat SC metastases with
high dose steroid , radiation
what is the prognosis of spinal metastatic disease
if walking then will remain walking if not walking then 1 year to survive
what is the common primary cancers from leptomeningeal metastases
– Breast
– Lung
– Melanoma
what are the sites for-of invovlment for leptomeningela metastases and what does it show
– Basal cisterns
• Ataxia
• CN deficits
– Cauda equina
• polyradiculopathy
- Heterogeneous group of disorders associated with cancer
- Mechanism thought related to autoimmunity
– Antibodies to receptors/proteins on cell surface
– Antibodies to intracellular tagets
what disorder is this
Paraneoplastic Disorders
• Polyneuropathy
• Polymyositis or dermatomyositis
• Cerebellar degeneration
• Limbic and brainstem encephalitis
• Necrotizing myelopathy
• Lambert Eaton myasthenic syndrome
theses are examples of what disorder
Paraneoplastic Disorders
– Neuropathy
– Delirium
– Dementia
– Seizures
– Headaches
– Visual Loss
– Cerebellar dysfunction’
these are complications for what treatment for tumors
chemo
– Headache
– Worsening of neurologic symptoms
– Radiationnecrosis
• Leukoencephalopathy
• Corticalatrophy
– Cognitive impairment
– Neuropathy
– Myelopathy
– Vasculopathy
– Endocrinopathy
these are complications fot what treatment for brain tumors
rad
