Neuro-psycho-oncology (Module 3) Flashcards
Who is in the Neuro-oncology team?
-Neurosurgeons
-Neuro-Oncologists
-Neuro-Oncology Clinical Nurse Specialists
-Neuro-Radiologists
-Neuro-Pathologists
-Neurologist
-Neuropsychologists
What are some primary brain tumours?
-Meningioma
-Glioma (about 5000 new cases/year)
Glioblastoma multiforme
Low-grade glioma – astrocytoma,
oligodendroglioma
Rarer subtypes - ependymoma
-Primary CNS Lymphomas
-Pituitary / craniopharyngiomas
Outline the WHO grading for meningiomas (extrinsic)
Meningioma - extrinsic
Grade I Majority
Grade II Atypical
Often post radiotherapy
Grade III Rare Very poor prognosis
Outline the WHO grading for gliomas (intrinsic)
Glioma - intrinsic
-Grade I Pilocytic astrocytoma
-Grade II Oligdendroglioma Astrocytoma
-Grade III Anaplastic astro/ anaplastic oligo
-Grade IV Glioblastoma multiforme
What is Tumour-Associated Epilepsy?
Seizure likelihood:
40 - 60% of patients with brain tumours
LGG 65 - 95% (astroctoma, oligodrendoglioma)
HGG 15 - 25%
Mets 25% (melanoma 67% >lung 48%> breast 33% )
Meningioma 25% (increases with increase grade)
What are characteristics of increased intracranial pressure?
-Changes in level of conciosuness
-eyes: papilledema, pupillary changes, -impaired eye movements
-headache
-seizures
-vomiting
-decreased motor function
-changes in vital signs (Cushing’s triad)
What is Focal Neurological Deficit?
-Focal loss of function over days – weeks
=Limbs (motor / sensory) – negative symptoms
-Eyes / face
-Cognitive decline /personality change
-Temporal and frontal lobes esp
What is gliolan?
a fluorescent dye, used in adult patients with malignant glioma (a type of brain tumour). Gliolan helps surgeons to see the tumour more clearly during an operation to remove it from the brain.
What are some advances in adjuvant therapy?
-Radiotherapy: Conformal/ intensity modulated radiation therapy/ tomotherapy/ hippocampal sparing
-Chemo: Temozolamide (oral), PCV (procarbazine, lomustine (CCNU), vincristine) Avastin (bevacizumab)
-Immunotherapy: DC Vaccine
Describe seizure management in tumour -associated epilepsy (TAE)
-Treat after first seizure
-Avoid enzyme-inducing AEDs
-No evidence for prophylaxis (EFNS-EANO taskforce 2010) BUT… new trial
-Peri-operative regimens
-Tumour treatment takes precedence
-Use AEDs from different groups
Give some examples of psychiatric effects of cancer
-Mass effect or destruction by a primary or metastatic tumour
-Systemic depletion of a substance (e.g. B12, niacin)
-Hormone secretion by an active tumour (e.g. pituitary)
-Paraneoplastic (ectopic) hormone secretion (e.g. ACTH)
-Onconeuronal antibodies (e.g. anti-Hu, anti-Yo)
-Cytokine release and pro-inflammatory action (e.g. IL-6, TNFa, IL-1, CRP a/w depression, cognitive change)
What are some psychiatric effects of treatment?
-Surgery to CNS
-Surgery to distant sites (e.g. GI > B12 deficiency)
-Radiotherapy to CNS or distant sites (e.g. hypothyroidism)
-Chemotherapy – indirect pathways or direct neurotoxicity
-Steroids
-Small molecular targets (e.g. tyrosine kinase inhibitors in CML)
-Monoclonal antibodies
-CAR-T immunotherapy
What is Cushing’s syndrome?
A syndrome of chronic, low level, hypercortisolaemia
What are psychiatric symptoms seen in Cushing’s syndrome?
-severe depression
-sleep disorders
-fatigue
-cognitive difficulties
-emotional instability
What are some steroid related problems in terms of psychiatry?
-Even short-term lower doses of steroids can cause depressed mood, anxiety, insomnia, agitation, or euphoria
-Risk of exacerbating underlying mental health problems
-Higher doses can lead to frank, severe psychosis or mania
