NeuroOnc Flashcards
primary brain tumor
tumor that develops from normal tissues of the brain
Metastasis
spreading of malignant tumor to a remote part of body
meningioma
usually benign; tumor that develops from covering of the brain
glioma
tumor that develops from glial cells
astrocytoma
glial tumor that develops from astrocytes
anaplastic astrocytoma
high grade glial tumor that develops from astrocytes
glioblastoma multiforme
maligant glial tumor that develops from astrocytes
medulloblastoma
tumor that develops from primative neuroectodermal cells (usualyl in children)
ependymoma
glial tumor that develops from ependymal cells
drop metastasis
metastasis, usually from glioblastomas or ependymomas that occurs through cerebrospinal system
–typically occurs around lumbar nerve roots or lower spinal cord
sensory level
line on the trunk below which sensation is lost
myelopathy
damage to the spinal cord
radiculopathy
damage to nerve root
non-metastatic complications
those of cancer that dont result from direct invlvement of tumor
paraneoplastic syndrome
syndrome usually from development of an autoimmune reaction, where there is damage to neural structures
intracranial tumors/neoplasm classified by
cell of origin
where do childhood tumors go?
posterior cranial fossa
spinal cord
where do adult tumors commonly found
adults
lung cancer and CNS mets
found in about 1/4th
most common primary intracranial tumors
gliomas
most aggressive tumor
atrocytoma (glioblastoma multiforme
slow growing tumors- little dysfunction until very late in course
meningiomas
neurilemmomas
rapidly enlaring neoplasm
metastatic tumors/glioblastomas
progressive loss of fx over short time interval
edema mostly around
metastatic tumors
edema leads to
rapid apperance signs and symptoms
glioblastoma dysfunction
appears rapidly, but the tumor looks like it should cause more damage because the tumor infiltrates nerve tissue and leaves many neurons functional
surgical removal of glioblastoma
may increase patients neurological impairment, but it is usally necessary
intracranial space
closed chamber with ONE outlet (foramen magnum) and stiff dural membranes (falx verebri and tentorium) that divides into compartments
As herniation progresses
rostral-caudal deterioriation of neural functions
papilledema
swelling of optic nerve–>increased intracranial pressure
swelling of optic nerve head (associated with loss of retinal venous pulsations and nelargement of blind spot on visual field testing)
non-localizing manifestations of tumors are usually due to
expanding supratentorial masses
what are the non-localizing manifestations?
unilateral/bilateral sixth nerve palsies via rostral-cudal displacement of brainstem
third nerve dysfunction from compression of herniating temporal lobe (where the nerve passes forward at the edge of the tenortium)
compression of contralateral cerebral peduncle –>ipsuilateral to mass hemiparesis
posterior cerebral artery compression
hydrocephalus-occlusion of fourth ventricle
where are large meningiomas often found?
inferior to frontal lobe in olfactory groove
if meningiomas are producing symptoms, most are
surgically resectable
gliomas come from
supportive cells of NS- oligodendrogia, astroglia, ependyma cells
astrocytoma vs oligodendroglioma
astrocytoma more common
astrocytomas and removal
difficult to removal completely
most malignant and more common glioma
glioblastoma multiforme
what is special about glioblastoma multiforme
this tumor can met– usually by spreading through CSF
aggressiveness of oligodendroglioma
somewhat less aggressive than the other two
what do oligodendrogliomas present with
seizures rather than mass effect
can calcify!
prognosis of oligodendrocytes
better with chemo and radiation–but not completely curable
neurolemoma
dervied from coverings of nerves
most common neurolemoma
acoustic neuroma from vestibular nerve (but impinges on acoustic nerve, so gradual hearing loss)
MAY affect facial nerve–>facial weakness
why does acoustic neuroma cause vertigo?
slow growth so compensation
surgery on neurolemoma?
yes, usually resectable, but if large could still have deficit
ependymoma
derive from lining tissue of the ventricles and the central canal of spinal cord
who do we tend to see epndymoma in
younger individuals
treatment of ependyomoma
many are completely resectable, but most require adjuvant therapy
mets in ependymoma
can exceed the ventricular system and even subarachnoid space and so-called drop metastes are possible
deficits are from what in ependymoma
pressur eand local invasion
or frm treatment
primitive neuroectodermal tumors
midline tumors- posterior fossa (cerebellum, 4th ventricle area of tectum)–small blue tumors
who are PNTs mostly seen in
children and young adults
prognosis in PNTs
sensitive to chemo and radiation, but not completley curable in most cases–can spread to other areas of brain and spinal cord through spinal fluid
particular types of priminitive neuroectoermal tumors
pineal tumors
medulloblastomas
common cancers that met to brain and spine
lung cancer breast cancer colon cancer ovarian melanoma
less common
renal cancer
rare places to get mets from
prostate
radiation for mets is
usually only palliative
lymphoma
form of cancer that can either develop in brain (primary) or spread to brain
- -primary CNS lymphoma from patients with severe immunosuppression
- -secondary spready of lymphoma to NS-involvement of nerve roots and meninges (carcinomatous meningitis)
spinal tumors
most are metastatic, but some primary as well
what do spinal tumors often result in?
expanding extradural masses–>can compress cord or nerve roots
intradural, but extramedullary tumors
neurofibromas
meningiomas
schwanomas
intramedullary spinal cord tumors
gliomas
ependymomas
intramedullary tumors can
met in spinal gluid and result in extraaxial mass
treatment for spinal tumors
steroids, surgery/radiation
cerebellar tumors commonly found
children
most common cerebellar tumor
cerebellar astrocytoma
cerebellar astrocytoma prognosis
often surgically curable
if cerebellar astrocytoma develops in pons
not curable because the surgical procedures can produce intolerable deficits
medulloblastoma
severe and devastating form of cancer that develops in cerebellar region of children
–may occasionally respond to chemotherapy and radiation, but typically progresses fast and is fATAL
pituitary tumors
neoplasms involving pit gland, hypothalamus, or both
if pituitary tumor encroaches on____ you get ___
neighboring optic chiasm
visual field deficits (bitemporal hemianopia)
cranipharyngioma
benign cystic tumor that derives from remnants of rathke’s pouch that encroaches on optic chiasm
anterior pit tumors
positive humoral effects via increased secretion of pituitary hormones
- -eosinophilic adenomas
- -basophilic adenomas
eosinophilic adenomas
secrete growth hormone
basophilic adenomas
cushing’s hyperadrenal syndrome
routine procedure for all people suspected of having intracranial tumor
CT or MRI
MRI is more
sensitive! intracranial lesions that are the same radiographic density as brain can be missed with un enhanced CT scans
intravascular contrast helps
because many tumors have blood vessels that do not have normal BBB; excluded from normal brain, but often enhances apperance of tumor
MRI helps to
evaluation chemical constituents of mass; distinguish tumor frm other enhancing masses (abscesses)
PET
metabolic activity
CSF should be
negative
if test shows increased iCP
no LP because can cause rostralcaudal deterioration
LP only in prelim exam when
CNS infection (maningitis) is suspected pt has severe acute heache or other symptom or a history that suggests subarachnoid hemorrhage in teh absence of positve CT becaus eCT can miss small sub arac
major finding
elevation of CSFs
adults tend to get tumors
supratentorial
children tend to get tumors
infratentorial
cortical signs
aphasia, hemiparesis, homonymous, hemianopsia, sensory loss
dysinhition is a
frontal lobe sihn
incoordination is a
cerebellar sign
unilateral loss of pin and temperature sense on face
lateral brainstem
loss of upward gaze
dorsal brainstem
pineal region
bilateral hemianopsia
pituitary region tumor
paraplegia/sphnciter dysfunction
spinal cord
cushing response
increase BP with decrease pulse
symptoms and signs of increase ICP
awakened from sleep by headache
papilledema or loss of venous pulsations in fundus of eye
cushing response
transtentorial sign of herniation
dilating pupil (usually ipsilateral)
oculomotor palsy-III nerve (usually ipsilateral)
hemipareis (usually contralateral)
failure of upward gaze/parinaud’s syndrome
pineal/tectal region
edema responds to
steroids
glioblastoma multiforme is a grade 4 (worst)
astrocytoma
childhood tumors and prognosis
cerebellar astrocytoma- good prognosis
pontine glioma- bad prognosis
medulloblastoma- bad prognosis
most tumors of the spine are
metastatic
good for spine tumors
steroids, radiation
major surgery
rare tumors inside spinal cord
ependymoma
glioma
bbb limits
type of chemo
other approaches to treatment
black angiogenesis
small targeted molecules
immune targeting
paraneoplastic
remote effect of cancer, probably autioimmune
clinical manigestations vary according to nervous system structure affected
