neuro-oncology Flashcards
what is neuro-oncology?
cancer of the NS
define cancer
a group of diseases caused when cells divide and grow in an uncontrolled manner
what is a tumour?
a mass of cancerous cells
how are intracranial tumours graded?
-histopathology
-grade
-site
how are CNS classified briefly?
-neuroepithelial
-meninges
-nerve sheath cells
-blood vessels
what is? supratenorial vs infratentorial?
supratentorial - in the cerebrum - adult brain tumours
infratentorial - around the cerebellum - more common in children
what is a primary brain tumour?
mass of abnormal cells that arises from within the brain parenchyma
what is a secondary brain tumour?
-spread of cancer cells from a primary tumour outside the brain
what are intrinsic brain tumours?
tumour cells within the brain tissue
what are extrinsic brain tumours?
tumour cells located outside the brain tissue eg meninges etc
what is “mass effect”?
compression caused by increased ICP from a space occupying lesion
what is a space occupying lesion?
describes a mass of unknown history on MRI - called this until we know what it is
describe the clinical features of a brain tumour
-insidious, gradual onset
-exact presentation depends on site and tumour grade
-raised ICP - headache, papilloedema
-mass effect with brain shift - vomiting, deteriorating consciousness
-epilepsy in 30%
-neurological deficits depend on site
what’s the pathway of “work-up” for brain tumours?
-imaging - CT, MRI,
-surgical interventions - biopsy +/- debunking/ decompression / excision
-histopathology - frozen section and histology
-medical or radio-oncology management depending on pathological classification
how are brain tumours managed?
-steroid therapy - reduce swelling etc - dexamethasone
-surgery - craniotomy - patient may be awake
-radiotherapy - destruction of cancer cells with xray
-chemotherapy - temozolomide
describe gliomas
-most common
-arise from glial cells - oligodendrocytes etc
-peak incidence 40-60 years
-equal incidence in frontal, temporal, parietal and thalamic regions
-graded 1-4 (4=most invasive)
what typically can be q grade 4 for gliomas?
glioblastoma
describe a meningioma
-arises from the arachnoid granulations
-tends to compress rather than invade tissue
-generally a low grade
-can also occur in the skull base, orbit and spinal canal
-can cause significant neurological deficit
describe schwannoma tumours
-non invasive tumour
-slow growing
-usually occur in middle age 40-50 years
-more frequent in females
describe haemangioblastomas
-vascular origin
-generally low grade lesion
-mainly occurs in middle aged people
-most common primary brain tumour of the cerebellum in adults
-70% association with presence of a cyst
what kind of surgery can be seen with brain tumours?
-burrhole biopsy
-craniotomy
-craniectomy
-debulking or decompression
how does radiotherapy work?
-uses high energy rays to target and destroy cancer cells
-beams conform with the shape of the tumour to minimise the adverse effects on normal tissue
what are the adverse effects of radiotherapy?
-oedema
-fatigue
-cognitive impairment
-radiation induced tumours eg meningioma
why is temozolomide used as chemotherapy?
as it can cross the blood brain barrier
-given orally
how would we assess a brain tumour patient?
in terms of physiotherapy management, what are important factors to consider?
-impact of ongoing treatment
-steroid dependency
-extent of surgical removal
-discharge planning
what are examples of neurological impairments seen in people with primary brain tumours?
-limb weakness
-ataxia / co-ordination difficulties
-sensory - perceptual deficit
what are the different types of spinal tumours?
intra dural
extra dural
what is malignant spinal cord compression?
when secondary tumours grow in spine and compress spinal cord
-5-10% of people with advanced cancer
-particularly if they have a primary tumour in breast, prostate, lung, myeloma, renal etc
