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Heme / Onc > SM_279b: CNS Cancers > Flashcards

SM_279b: CNS Cancers Flashcards

1
Q

Most brain tumors are ___

A

Most brain tumors are secondary (metastatic)

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2
Q

Describe presentation of brain tumors

A

Brain tumors presentation

  • Neuro-anatomical localization determines presenting symptoms and signs
  • Generalized symptoms: headache, nausea, vomiting
  • Localized symptoms: weakness, sensory symptoms, gait ataxia, visual changes, or language dysfunction
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3
Q

___ is gold standard imaging modality for diagnosing brain tumor

A

MRI with IV contrast is gold standard imaging modality for diagnosing brain tumor

  • Normal contrast enhanced brain MRI excludes a tumor
  • Surgical biopsy or excision is necessary for histologic diagnosis b/c imaging characteristics are not definitive
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4
Q

Most common metastases to brain come from ___, ___, and ___

A

Most common metastases to brain come from lung cancer, breast cancer, and melanoma

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5
Q

___ as sole presenting symptom of brain tumor is rare

A

Headache as sole presenting symptom of brain tumor is rare

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6
Q

Describe the classical brain tumor headache

A

Classical brain tumor headache

  • Mild at onset, begins when patient awakens in morning and disappears shortly after he or she rises, recurs the following morning
  • Gradually increases in frequency, duration, and severity
  • Later become constant and associated with other signs of increased ICP such as drowsiness, nausea, and vomiting
  • Headache may worsen with changes in ICP such as Valsalva, head shaking, or straightening from a bent position
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7
Q

Describe gliomas

A

Gliomas

  • Arise from neuro-epithelial tissue
  • Glial cells account for 90% of cells in the brain
  • Morphologically and biologically heterogeneous
  • Main histologic subgroups: astrocytoma, oligodendroglioma
  • Graded (1-4) but not staged
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8
Q

Describe astrocytic tumors

A

Astrocytic tumors

  • Astrocytes are star-shaped supporting cells of brain and spinal cord: form key component of BBB via foot processes and play active role in creating microenvironment for neurons
  • Tumors can be identified by staining for glial fibrillary acidic protein (GFAP)
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9
Q

Describe astrocytoma grading and naming

A

Astrocytoma grading and naming

  • Low grade: grade 1 (pilocytic astrocytoma), grade 2 (diffuse astrocytoma)
  • High grade: grade 3 (anaplastic astrocytoma), grade 4 (glioblastoma multiforme)
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10
Q

Describe glioblastoma multiforme

A

Glioblastoma multiforme

  • WHO grade IV
  • Thought to arise from astrocytes or their precursors
  • Most common malignant primary brain tumor
  • Poor prognosis, noncurative
  • Median age of onset is 64
  • Usually localized to cerebral hemispheres: patients present with symptoms of increased ICP and/or focal neurologic symptoms
  • Seizures occur but less frequently than low grade tumors
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11
Q

GBM is managed with ____, ____, ____, and ____

A

GBM is managed with surgery, medical treatment / chemo, radiation, and tumor-treating fields

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12
Q

Radiation for GBM involves ___

A

Radiation for GBM involves conventional fractionated external beam radiation therapy with daily temozolomide

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13
Q

Patients with GBM receive post-radiotherapy ___

A

Patients with GBM receive post-radiotherapy temozolomide chemo for 6 cycles

Fatigue is a side effect

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14
Q

Treatment for GBM involves ____ -> ____ -> ____

A

Treatment for GBM involves surgery -> temozolomide + RT -> adjuvant temozolomide

  • Not curative
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15
Q

Oligodendrogliomas may present with ___

A

Oligodendrogliomas may present with seizures

  • Location and histologic grade correlate with risk
  • Low grade, slow growing tumors, and those located in superficial gray matter associated with highest risk
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16
Q

Describe oligodendrogliomas

A

Oligodendrogliomas

  • Usually supratentorial, arising in frontal lobes
  • Arise primarily in white matter but tend to infiltrate the cortex more than astrocytomas of a similar grade
  • Diffuse infiltration of normal brain prohibit surgical care
  • May be heavily calcified
  • Histology: fried egg cells
17
Q

Oligodendroglioma appears as ___ on histology

A

Oligodendroglioma appears as fried egg cells on histology

18
Q

Oligodendrogliomas often have ____

A

Oligodendrogliomas often have 1p19q codeletion

WHO grade II (low grade) and III (anaplastic)

19
Q

Oligodendrogliomas most commonly present as ____

A

Oligodendrogliomas most commonly present as focal seizure in young adult

  • Median age at diagnosis is 41 years
  • May be prolonged period of symptoms (usually focal seizures) prior to diagnosis
20
Q

Describe treatment / prognosis for oligodendroglioma

A

Oligodendroglioma treatment / prognosis

  • Maximal surgical resection is feasible
  • Can see a marked shrinkage of tumor and resolution of symptoms following chemotherapy
  • Transformation to anaplastic oligodendroglioma over time: cause of death in most
  • Median overall survival is 15 years
21
Q

Describe meningioma

A

Meningioma

  • Intracranial tumors arising from meningothelial arachnoid cap cells of meningies
  • Most are benign (Grade I) slow growing tumors that compress underlying brain but rarely invade it
  • Median age at diangosis is 64 years
  • Genetic predisposition (NF2) and exposure to ionizing radiation are the only known risk factors
  • Focal seizures and neurologic deficits from brain or cranial nerve compression are common
22
Q

MRI of meningioma shows ____

A

MRI of meningioma shows diffuse contrast enhancement since meningiomas are outside the BBB

  • If patient is asymptomatic or has medically controlled seizures: can be followed without resection
  • If treatment indicated, surgery
23
Q

Vestibular schwannomas are ___ and usually present with ___

A

Vestibular schwannomas are slow-growing and usually present with gradual unilateral hearing loss, sometimes preceded by tinnitus and vague feeling of dizziness

24
Q

Bilateral vestibular schwannomas are pathognomonic for ___

A

Bilateral vestibular schwannomas are pathognomonic for NF-2

  • NF-2 is defect on chromosome 22 (merlin protein)
25
Q

Describe vestibular schwannoma

A

Vestibular schwannoma

  • Surgery can be curative
  • Operative morbidity high: hearing loss, facial paralysis
  • CN 7 dysfunction seen with large tumors
  • Headache often occurs after surgery
26
Q

Describe CNS lymphoma

A

CNS lymphoma

  • Secondary: metastasis from systemic disease
  • Primary: non-Hodgkin’s lymphoma, arises within and is restricted to CNS, immunocompetent patients, immunocompromised patients (EBV)
27
Q

CNS lymphoma occurs due to ___ and ___

A

CNS lymphoma occurs due to CNS sanctuary and inflammatory process

  • CNS sanctuary: hematopoetic tumor develops outside of CNS, seeds brain, grows b/c CNS is immunologically privileged
  • Inflammatory process: lymphocytes traffic into CNS as part of inflammatory process and become transformed into malignant cells
28
Q

Describe CNS lymphoma clinical features

A

CNS lymphoma clinical features

  • Median age is 66
  • Predominantly involves frontal lobes, corpus callosum, deep periventricular brain structures
  • Multifocal > 30%
  • Cognitive impairment or behavioral change are most common presenting features
  • Other symptoms include headache and lateralizing signs
  • Symptoms progress over weeks to months
  • Classic B symptoms absent
29
Q

Describe evaluation of CNS lymphoma

A

CNS lymphoma

  • Ocular involvement in 20%: often misdiagnosed as uveitis
  • Demonstratable leptomeningeal disease
30
Q

___ are often used to treat CNS lymphoma

A

Corticosteroids are often used to treat CNS lymphoma

  • Decrease edema
  • Exert apoptotic effect on lymphoid cells
  • Disease recurs despite continued steroids
31
Q

Describe treatment of primary CNS lymphoma

A

Primary CNS lymphoma treatment

  • Induction chemotherapy (methotrexate based) followed by consolidation therapy
  • Chemosensitive: high dose systemic methotrexate based therapy
  • Consolidation therapy: radiosensitive so whole brain RT
32
Q

Summarize CNS tumors

A

Heme / Onc (41 decks)

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