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Neurology > Neuro Oncology > Flashcards

Neuro Oncology Flashcards

1
Q

Arise from different cell types in CNS

*wide prognosis variety

A

Primary Brain Tumors

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2
Q
  • tumor from other part (breast, lung, skin)

* Tx = ex. BREAST cancer Tx, not brain cancer tx

A

Secondary / Metastatic Brain Tumor

  • if Brain tumor, always look at rest of body first
  • ALWAYS STAGE 4
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3
Q

Primary Brain Tumors

Who?

A

*Caucasions >

  • Men = MORE malignant , LESS menigiomas (SMOKING LINK)
  • Women = MORE meningiomas, LESS malignant
  • up w/ age
  • HIV + = primary brain lymphoma
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4
Q

Brain Tumors

Risk factors

A
  • Ionizing radiation
  • HIV + (primary brain lymphoma)

PROTECTIVE: asthma/allergies,
fruits/veg

NO PROOF: cell phones, pesticides, smoking/alcohol (but metastatic risk)

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5
Q

ID tumor with scan 100%?

A

NO

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6
Q

Primary Brain Tumor

Types

A
  • Glial
  • Meningiomas
  • Pituitary Tumors
  • Primary Brain Lymphoma
  • Peds tumors
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7
Q
  • kids
  • cerebellum (also brain stem/optic nerve)
  • slow grow, curable if resectable
A

Astrocytomas/Gliomas
Pilocytic astrocytomas

Grade I LOW
*good prognosis

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8
Q
  • invasive
  • difficult to resect
  • slow grow
A

Astrocytomas/Gliomas

Grade II LOW
*tx - chemo, steroids, surgery, radiation

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9
Q
  • fast grow

* poor cell differentiation

A

Astrocytomas/Gliomas

Tx: debulking surgery (LIFE-EXTENSION), radiation, temozolomide chemo

Stage III HIGH
*poor prognosis

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10
Q

*FINGER-LIKE PROJECTIONS

Unresectable

A

Astrocytomas/Gliomas

*Tx: Debulking surgery, radiation, temozolomide chemo

Grade IV HIGH (GLIOBLASTOMA)
*Median survival time: 2 years

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11
Q
  • ependymal lining of ventricles

* who: children/young adults

A

Ependymomas

*prognosis = variable (location, tissue invasion, biopsy : genotype tumor)
= recurrent tumors : poor

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12
Q
  • CALCIFICATION IN TUMOR
  • well-differentiated (good), diffusely infiltrating (bad)
  • ADULTS
A

Oligodendrogliomas

PROGRESS from low to high

  • low grade= “classic”
  • high grade = “anaplastic”
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13
Q
  • VERY slow-growing

* meninges= brain surface, spinal cord, maybe ventricles

A

Meningiomas
*BENIGN (but watch ICP)

*excellent prognosis

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14
Q

Meningioma

Risk factors

A
  • Neurofibromatosis Type 2
  • Female + Estrogen exposure (obese)
  • Ionizing radiation
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15
Q

**Brain tumors worse during… (time of day)

A

Morning

*laying down raises ICP, rising lowers

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16
Q

*WIDE DISSEMINATION (resection difficulty)

IMMUNODEFICIENCY -(HIV, EBV)

A

Primary Brain Lymphoma

IMMUNODEFICIENCY - Find cause!! (HIV, EBV)
*HIV defining

17
Q

Brain images = TUMOR:

Watch for

A
  • Midline deviation

* Smaller ventricle (also watch turning of head during imaging)

18
Q
  • Headache
  • Seizure
  • Elevated ICP (N/V, papilledema)
  • Focal neuro deficits

S/S?

19
Q

Brain Tumor

Headache

A
  • bifrontal

* RED ALERT = wakes from sleep, progressively worsening

20
Q

Brain Tumor

Seizure

A

Vary on location

*RULE-OUT = Syncope (some twitching) from UP ICP

21
Q

Seizure characteristics

A
  • NOT crossing midline

* repeated firing of one muscle/group, going one way, NOT COORDINATED

22
Q

Brain Tumor

Elevated ICP from

A
  • Mass Effect
  • Obstructive Hydrocelphalus. = ventricle draining blocked (epyndoma?)
  • TRIAD = HA, Nausea, Papilledema
  • vomiting w/ position change
  • syncope
23
Q

Brain Tumor

General Evaluation

A
  • MRI (CT fast)
  • Give radiologist Good Hx summary to localize s/s
  • Evaluate for 2ndary metastasis from otherwhere
  • Brain Biopsy
  • LP = ONLY for primary brain lymphoma
24
Q

Tumor

Management

A
  • Reduce Edema = Steroids
  • Obstructive hydrocephalus = Urgent (next few hours) surgery
  • anti-convulsants
  • Urgent referral Neurosurgery/Brain Tumor team
25
Q

Tumor

Tx

A
  • Surgery , radiation, chemo (hard to cross BBB)
  • meningioma = surgery
  • glioblastoma = nothing
  • tumor DNA markers
  • BRAIN TUMOR TEAM
26
Q

Spinal tumors

Tissue type

A

Bone OR Neural tissue

27
Q

Metastases to the Spine

A

LUNG, Breast, renal cell, melanoma, lymphoma

28
Q

Back pain, leg tingling + cancer risk factors

Think…

A

Metastases to Spine!!

29
Q

Spinal Tumor

History RED FLAG

A

*loss of bowel/bladder control (ER - need surgery now)

30
Q

Spinal Tumor

PE

A

Complete Neuro (focal vs systemic?)

Rectal exam

Try to localize level of lesion

31
Q

Spinal Tumor

Imaging

A

MRI w/ gadolinium contrast

IF CAN’T = CT (id acute spinal cord compression)

32
Q

Spinal Cord

Tx

A
  • surgery
  • chemo
  • focused radiation
33
Q

Radiation evolution

A

Gamma knife –> Stereotactic –> Proton radiation

34
Q

*TRIAD = HA, Nausea, Papilledema

S/S?

A

Elevated ICP

Neurology (20 decks)

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