Neuro-Oncology

Question 1

What are primary vs. secondary brain tumors and which is more common?

Answer 1

Primary - arise from different cell types in the CNS
Secondary - arise from other parts of the body (breast, lung, skin, etc) and metastasize to the brain
Secondary brain tumors are much more common, indicating Stage IV cancer

Question 2

Are men or women more likely to have meningiomas?

Answer 2

Women are more likely to have meningiomas

Men are more likely to have malignant brain tumors

Question 3

What population of patients are at highest risk for primary brain lymphoma?

Answer 3

Patients + for HIV

Question 4

Astrocytomas, Glioblastomas (grade IV astrocytomas), Ependymomas and Oligdendrogliomas arise from what type of cells?

Answer 4

Glial cells

Question 5

Which tumors are most common in children?

Answer 5

Neuroblastoma

Medulloblastoma

Question 6

Why is debulking surgery used for Grade IV Astrocytomas (Glioblastomas)?

Answer 6

They have finger-like projections so resection very unlikely to remove all the tumor

Question 7

Brain MRI shows a tumor with irregular shape and central necrosis. What are you suspicious of?

Answer 7

Glioblastoma

Question 8

Which astrocytomas have a 5 year survival rate 50% or above?

Answer 8

Low Grade Astrocytomas have 50% or above.
Grade I Astrocytoma 90%
Grade II Astrocytoma 50%
Grade III Anaplastic Astrocytoma 20%
Grade IV Astrocytoma - Glioblastoma 5%

Question 9

Where would you suspect to find an ependymoma in an adult? Child?

Answer 9

Adults - 75% in spinal cord
Children - 90% in brain
Ependymomas arise within or adjacent to ependymal lining of ventricles or spinal cord

Question 10

What are oligodendrogliomas?

Answer 10

Well differentiated diffusely infiltrating tumors in cerebral hemispheres composed of oligodendroglia, almost always in adults

Question 11

What feature on CT is basically pathognomonic for oligodendrogliomas?

Answer 11

Calcifications within the tumor

Question 12

Why are meningiomas typically not found until they are large?

Answer 12

They are very slow growing

Question 13

How does time course of progression of symptoms differ in low grade vs high grade tumors?

Answer 13

Low grade - symptoms progress over months to years

High grade - symptoms progress in days to weeks

Question 14

How to brain tumors present?

Answer 14

Headache
Seizures
Signs of ICP (nausea, vomiting, papilledema)
Focal neurologic deficits

Question 15

What characteristics of headache should alert you to think of brain tumor?

Answer 15

Dull, constant
Typically bifrontal
Worse overnight and in morning
HA wakes pt from sleep
Progressively worsening
Lack of hx of HA

Over 50% of pts with brain tumor have increasing HA

Question 16

What are the signs and symptoms of elevated ICP?

Answer 16

HA
Nausea
Papilledema
Vomiting triggered by position change
Syncope (clear hx needed to differentiate from seizure)
New focal neuro deficit

Question 17

What imaging study is preferred for assessing for brain tumor?

Answer 17

MRI with contrast

Question 18

What are the 3 main methods of treating brain cancer?

Answer 18

Surgery
Radiation
Chemotherapy

Question 19

What is most common primary cancer in patients with metastatic spine tumors?

Answer 19

50% of metastatic spinal tumors have lung cancer as primary source

Question 20

60 yo male presents with 1 month history of focal “gnawing” spinal pain and LE weakness. He has 30 pack year hx. What study would you like to order?

Answer 20

MRI with contrast to assess for spinal tumor

Also, likely lung imaging to look for primary

Question 21

60 yo male presents with new onset of urinary and bowel incontinence. He has 1 month history of focal “gnawing” spinal pain and LE weakness. What is your next step?

Answer 21

Call neurosurgery due to high likelihood of patient requiring emergency surgery