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Management of neuropsychiatric disorders > Neuro/Psycho-oncology > Flashcards

Neuro/Psycho-oncology Flashcards

1
Q

What are the most common types of brain tumour?

A
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2
Q

What is the neurooncology team composed of?

A

Neurosurgeon
Neuro-oncologist
Neuro-oncology clinical nurse specialist
Neuro radiologist
Neuro pathologist
Neurologist
Neuropsychologist

Legal requirement for all to be present in case discussion

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3
Q

What is the incidence of brain tumours?

A

15 per 100,000

11,000 new cases a year (5000 gliomas)

30% increase since 90s

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4
Q

What are primary brain tumours?

A

In situ

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5
Q

What are the most common brain tumours?

A

Meningiomas
Gliomas

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6
Q

What are the types of glioma?

A

Glioblastoma multiforme (grade 4)
Low grade gliomas - Astro Thomas and oligodendrogliomas

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7
Q

What is the WHO grading system for meningioma?

A

Grade I - benign
Grade II - atypical, often due to radiotherapy for childhood cancer
Grade III - rare, very poor prognosis

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8
Q

What is the WHO grading system for intrinsic tumours?

A

Grade I - pilocytic astrocytoma (childhood, curable)
Grade II - oligodendroglioma, astrocytoma
Grade III - anaplastic
Grade IV - glioblastoma multiforme (from astrocytoma)

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9
Q

What are the most common presentations of brain tumours?

A

Asymptomatic (found on investigation)
Seizure
Raised ICP
Focal neurological deficit
Cognitive decline
Change of personality

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10
Q

What are symptoms of raised ICP?

A

Headache
Vomiting
Double vision (from abducens nerve)
Hiccups
Drowsiness/ confusion
Cushing’s triad (fatal) (raised bp, lowered pulse & respiration)

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11
Q

How has prognosis of high grade glioma changed?

A

Previously 6 months
Now 2 years +

Improved surgical resection using gliolan and MRI
Stupp protocol (temozolamide/radiotherapy)
Safer radiotherapy
Molecular pathology

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12
Q

What does gliolan do?

A

Fluorescent tags tumour tissue - improves resection

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13
Q

What techniques are helping safer surgery?

A

fMRI
Awake craniotomy
Intra-operative neuromonitoring

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14
Q

What is the Stupp protocol?

A

6 weeks of radiotherapy 5 days a week (30 rounds) + temozolamide every day
6 months of temozolamide twice a month

2.5x more effective than radiotherapy alone

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15
Q

How does methylation status affect treatment?

A

Methylated genes in the GBM increased response to Stupp protocol
46% 2 year survival vs 14%

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16
Q

What is the significance of IDH in grading?

A

IDH positive - primary GBM
IDH negative - low grade glioma or secondary GBM

17
Q

How are low grade gliomas treated?

A

Radiotherapy + PCV

Median survival increased 5,5 years against watchful waiting

18
Q

How are seizures managed in tumour associated epilepsy?

A

Treat after first seizure (60-90% of patients will have seizures)
Avoid enzymatic AEDs
Levetiracetam is being trialled as prophylaxis
Tumour treatment takes precedence

19
Q

What are commonly found mental health difficulties for cancer patients?

A

Mood and anxiety symptoms (highest at first recurrence)
Insomnia (starts during treatment)
Cognitive symptoms (particularly during treatment)
Body image issues
Said esteem
Existential distress

20
Q

What factors increase the likelihood of mental health difficulties during cancer journeys?

A

Head and neck, pancreas, haematological cancers
Younger age
Lower socioeconomic background
Pain
Fatigue
Comorbidities
Severe illness
Poor prognosis

21
Q

What is the holistic needs assessment?

A

Government mandated KPI for oncology services
Addresses psychosocial factors

22
Q

What were the main emotional concerns expressed by oncology patients?

A

Worry/anxiety
Tiredness fatigue
Thinking about the future
Sex/intimacy
Sleep/tiredness
Sadness/depression

23
Q

What are the ways in which a tumour might cause psychiatric effects?

A

Structural effect of tumour
Systemic depletion of nutrients
Hormone secretion by an active tumour (pituitary, thyroid)
Paraneoplastic hormone secretion (ACTH by lungs)
Onconeuronal antibodies (anti-Hu, anti-Yo)
Cytokine release and inflammatory action

24
Q

What causes Cushing’s syndrome and how might this be caused by cancer?

A

Chronic low-level hypercortisolaemia

Corticosteroid treatment for cancer (GBM, haem cancers) - most common

Pituitary tumour may oversecrete ACTH

Paraneoplastic secretion of ACTH (lung cancer)

Thyroid medullary tumour secretion of ACTH

Adrenocortical tumour directly secreting glucocorticoids (rare)

25
Q

How might steroids cause psychiatric problems?

A

Depression and anxiety
Insomnia
Agitation
Cognitive difficulties
Exacerbation of underlying mental health issues
Psychosis and mania at higher doses

26
Q

How might hypothyroidism be caused in cancer patients?

A

Damage to hypothalamus or pituitary
Thyroid damage from surgery
Thyroid damage from radiation
Monoclonal antibodies targeting thyroid

27
Q

How might loss of oestrogen in cancer treatment affect psychiatric issues?

A

Higher depression risk
Higher dementia risk

Oestrogen increases serotonin synthesis and promotes neuroplasticity

28
Q

What antibodies produced by cancer cells can cause encephalitis?

A

Anti Hu (small cell lung cancer)
Anti NMDAr (teratomas)

29
Q

What antibody may cause degeneration?

A

Anti-Yo causes cerebellar degeneration
May happen in aggressive breast cancer
Coordination problems and CCAS

30
Q

What chemotherapy might cause folate deficiency?

A

Methotrexate (folate blocker)

31
Q

How might b12 deficiency present psychiatrically?

A

Mimics depression symptoms

32
Q

What are the neuropsychiatric effects of radiotherapy?

A

50-90% have cognitive deficits
Up to 10 IQ drop
Worse in a developing brain
Worsened by intrathecal chemotherapy

33
Q

What are possible underlying causes of chemo brain?

A

Neurotoxicity
Impaired neurogenesis
Oxidative stress
Immune deregulation
Vascular changes
Hormonal changes
Altered long term potentiation

34
Q

What immunosuppressants might cause proliferation of JC virus?

A

Monoclonal antibodies (rituximab)
Chemotherapy

35
Q

How might PML (from JC virus) present?

A

Progressive weakness
Speech problems
Cognitive deficit is
Personality change
Seizures
Death

36
Q

What neuropsychiatric syndrome might CAR T therapy causes

A

CAR related encephalopathy syndrome
(Caused by systemic cytokines release)

Symptoms similar to anti NMDAr
(Hallucinations, agitation, seizures, motor symptoms)

Management of neuropsychiatric disorders (22 decks)

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