Neuro-oncology Flashcards
Name 2 situations in which neuropsychology comes to place in neuro-oncology
1) Brain tumors
2) Treatment effects
What is the definition of a brain tumor?
A brain tumor is:
- a solid, neoplastic (=abnormal growth of tissue) mass of genetically dysregulated cells
- that divide at elevated rates,
- have lost their function
- and rapidly transform surrounding cells and tissues
Name 5 risk factors for developing a brain tumor
1) Serious head injury decades before tumor diagnosis (meningioma)
2) prior radiation exposure decades before tumor diagnosis
3) immune suppression leading to lymphomas
4) genetic disorders
5) (suspected) environmental carcinogens (kankerverwekend) and viruses
What are the most common;
1) type of primary brain tumor in adults
2) benign tumor in children
3) malignant tumor in children
1) Diffuse, fibrillary astrocytomas
2) low-grade astrocytomas
3) medulloblastoma
What is metastasis or secondary cancer
Cells move away from the original (primary) cancer site and spread to other organs and bones where they can continue to grow and form another tumor at that site. (Only in malignant tumors).
Name the 4 levels of the tumor grading system
1) Well-diferentiated and low-grade
- > tumor cells grow slowly, rarely grow into surrounding tissue
2) Moderately differentiated and intermediate grade
- > still benign. Greater chance of de-differentiation and transformation into a more malignant tumor.
3) Poorly differentiated and high grade
- > Anaplastic. Has likely spread to surrounding tissue. Malignant.
4) Undifferentiated and high grade
- > highly malignant and aggressive.
What could be an explanation for the high variability of cognitive effects of brain tumors with similar histology and location?
There is evidence that functional brain tissue remains intermingled with tumor tissue, and this conveys with unpredictability in knowing the nature of neurocognitive impairment caused by a tumor in a specific location in any one individual.
Do tumor histology and tumor grade influency severity of cognitive deficits?
Tumor histology does not appear to influence the severity or type of cognitive impairment
Tumor grade is associated with the severity of cognitive impairment
Do tumors cause regional cognitive effects?
No big differences, in general:
- right cerebellar tumors result in greater linguistic and sequential processing dysfunction,
- left cerebellar tumors affect greater visuospatial impairment
Memory & attention: no hemispheric effects
Verbal fluency: multiple brain regions are involved (not just left)
Are measures of reaction time or accuracy rates in neurocognitive tests more sensitive to the effects of brain tumors?
Measures of reaction time are more sensitive than accuracy rates
What is the general course of cognitive decline in:
- slow growth tumor
- stable tumor
+ when recected
Slow growth tumors: the faster the tumor is growing, more cognitive decline
Resected: may be followed by reduced cognitive recovery
Stable tumor: stable cognitive function
Resected: stability can be dramatically disturbed
What is the explanation for no malignancy effect on cognitive impairment after resection of the brain tumor? (Scheibel & colleagues)
The lack of greater impairment in the glioblastomas (malignant) was thought to have been reduced or eliminated when the mass volume was reduced through neurosurgery
What are the most predictive neuropsychological measures of tumor recurrence? (Christina Meyers)
Two indices of verbal memory (recall & recognition of a word list) correlate positively with longer survival.
(Patients with the largest and most aggressive tumors had a tendency to achieve poor maintenance of cognitive set (TMT))
What are common effects of neurosurgery on cognitive function? (3)
- Tumor effects on sensation, motor function, and cognition can be worsened following surgical resection.
- New impairments after surgical resection (can be immediately, even without surgical complications): often sudden-onset disruptions in speech, motor function, cognition and affect
- Sometimes resection causes improvement in cognition. personality or mood, depending on the location.
Name 6 syndromal neuropsychiatric disturbances associated with brain tumors
1) Depression and fatique:
- twice as prevalent in cancer patients than in all other medical inpatients combined
- depression levels are lowest at the time of emergence of tumor symptoms and diagnosis but may intensify at later time points (due to fears of relapse, prolonged side effects, and loss of vocational standing and social support)
