NP ch.15: Cancer Flashcards
General Notes
What is Cancer?
Cancer is a group of diseases involving abnormal cell growth with the potential to spread or invade other parts of the body
What is the cause of Cancer?
DNA Errors that accumulate in our cells throughout life
What are some general numbers/statistics on cancer?
- 1/2 of us will be diagnosed with cancer in our lifetimes
- Survival rates since 1970’s has doubled
- Survival rates are continuing to increase
What are the 3 types of cancers?
- Primary brain tumor: Tumors that come about from mutation in CNS cells (2% of all cancers)
- Secondary brain tumor: Tumors that have spread from tumors located outside the brain (brain metastasis tumors) (20% of all cancers)
- Cancer outside the CNS
What is the mean survival rate for each type?
Survival for 5 years in non-malignant primary brain tumors = 92%
Survival for 5 years in malignant primary brain tumors = 36%
For patients with glioblastoma the 5-years-survival is 5%
What is glioblastoma?
Most aggressive and most common type of brain cancer.
- 15% of all brain cancers
- Arises from mutation in the glial cells
What is the cognitive impairment arising from each type of cancer?
- In-CNS cancer: 75% of patients have cognitive impairment
- Non-CNS cancer: 30% of patients have cognitive impairment
How does WHO classify brain tumors?
- Grade:
~ 1: non-malignant, 2-4: ,malignant
~ Low-Grade (low danger): 1-2, High-Grade (High danger): 3-4
What are some factors that must be taken into account when diagnosing or treating brain tumors/cancer?
- Molecular parameters: changes in genes and proteins
- Mutations in the IDH gene
- Deletion of the short arm of chromosome 1 and the long arm of chromosome 19, leads to the patient having a prognosis of a better response to chemo/radio therapy
- Methylation of the MGMT makes tumor cells more sensitive to treatment
Primary Brain Tumors
What are the two types of primary brain tumors and what is their prevalence?
- Non-malignant (benign): 68%. Most common ones are Meningioma’s 9brain tumor that forms from the meninges - membranous layers between brain and skull
- Malignant: 32%. Most common are Glioma’s (e.g. (glioblastoma)
What are the causes of cognitive impairments in primary brain tumor patients?
- Tumor
- Cancer treatments and other medication
- Distress
- Fatigue
What does the type of cognitive impairment depend on?
Location
In general, Worse cognition comes about from damage to:
- Left-side brain tumors
- More aggressive tumors
Also, if a tumor causes diaschisis (one tumor influences many other regions after), there are multi-domain impairments
Tumor - How can it cause cognitive impairment in primary brain tumor patients?
- Affects healthy brain tissue
- Affects blood flow
- Edema
- (In Meningioma): pressure on brain and nearby nerves and vessels
In Glioma patients, what cognitive impairments are observed if the right or left temporal lobes are affected?
- In both RTL and LTL: 75% of patients have learning, memory, executive function problems
- in 74% of LTL patients: attention and language problems
- Disorders in RTL have generally milder symptoms than LTL
Cancer Treatments: Surgery - How can it cause cognitive impairment in primary brain tumor patients?
- In Glioma’s: There can be a permanent cognitive decline if healthy functional
brain regions are injured with the lesion as well
–> In awake surgery, healthy brain areas are spared
Cancer Treatments: Radiotherapy - What is the goal of radiotherapy?
Cause damage to the DNA of cancer cells to overwhelm their ability to repair themselves, leading to cell death (affects also healthy cells)
According to the phase of radiotherapy, what might be the possible negative side effects?
- Acute: first 1-3 weeks of RT: Edema, focal deficits, steroids
- Subacute: 1-6 months post RT: Demyelination, subcortical profile
- Late: >6 months post RT: White matter injury, necrosis, irreversible
cognitive impairment (learning, memory, information processing speed)
Cancer Treatments: Radiotherapy - How can it cause cognitive impairment in primary brain tumor patients?
- Vascular damage
- Inflammation and microglial dysregulation
- Oligodendrocyte injury
- Neuronal damage and altered neurogenesis
Cancer Treatments: Chemotherapy - What is the goal of Chemotherapy?
Chemotherapy kills dividing cells (can also kill dividing cells)
affect healthy cells
Cancer Treatments: Chemotherapy - How can it cause cognitive impairment in primary brain tumor patients?
- Kills various cell types in an abundance
- If Blood-Brain Barrier is not intact, Chemotherapy is even more neurotoxic
Other treatments - How can medication cause cognitive impairments in primary brain tumor patients?
- Epilepsy occurs often in patients with Glioma: Anti-epileptic medication helps but has many side effects
- Corticosteroids: long-term use, emotional problems, sleep disturbance, anxiety, behavioral changes
What are some interventions to improve cognitive impairment?
- Pharmacological treatments
- Technological treatments
- Behavioral interventions:
~ Cognitive training
~ Cognitive strategy training
What is the aim of cognitive training?
- Regain cognitive functions
- Often appealing to patients but not effective
What is the aim of cognitive strategy training?
Teach strategies to compensate for and cope with (rather than resolve) cognitive impairments
- External compensatory strategies (electronic organizers, to-do-lists etc.)
- Internal mental strategies: re-teaching the brain to retain information using different mental strategies
