Topic 1: neuro-oncology Flashcards
How is the WHO tumor grading?
low grade/1: cells are well differentiated and low-grade
low grade/2: cells are moderately differentiated and intermediate
Anaplastic/3: cells are poorly differentiated and high grade
high grade/4: cells are undifferentiated and high grade
What is the most predictive measure of tumor recurrence
Two indices of verbal memory (recall and recognition of a word list) -> positively correlated with longer survival
Which neuropsychiatric disturbances are associated with brain tumors?
Depression -> tumor in frontal lobes
Anxiety -> tumor in the right temporal lobe or left cerebellum
Asperger’s/mild Autism -> tumor in the cerebellum or the temporal lobes
Cognitive Affective Syndrome -> bilateral or large unilateral lesions in the posterior cerebellar lobes
OCD -> frontal lobes
Hypothalamic syndrome -> tumors in the hypothalamus (associated with disorders of eating behavior)s
What are the three known temporal phases of the side effects of radiotherapy on neuropsychological functioning?
- acute phase: nausea, depression
- early-delayed phase or subacute phase: weeks-6 months after radiation: temporary decline in memory
- late-delayed phase: 5 years after radiation -> irreversible decline in associative memory
What is the definition of chemo brain?
a constellation of cognitive deficits experienced by some individuals during and following chemotherapy
What are the risk factors for chemo brain?
- genetic make-up: E4 allele
- age: decreased levels of estrogen and progesterone have been associated with reduced attention, learning and memory
- type of chemotherapy
- treatment duration
- high dose regimens
Which 3 hypothetical mechanisms by which exposure to chemotherapy produces the clinical features of chemo brain are identified?
- direct neurotoxicity
- inflammatory or immune mechanisms may involve cytokine activity
- vascular mechanism in which injury obstructs the microvasculature, causing ischemia or infarction of dependent brain tissue
Pharmacotherapy may be used for neuroprotection or to decrease the negative effects of chemotherapy in vulnerable individuals. Which ones are commonly used?
- Erythropoietin (EPO): management of symptomatic anemia (bloedarmoede)
- Methylphenidate: improves concentration, psychomotor slowing, fatique and attention.
- Hormone replacement therapy
- Cholinesterase inhibitors: can stabilize memory capacity and improve cognitive function
- Gingko Biloba: may have neuroprotective, antioxidant and membrane-stabilizing effects. It also may inhibit loss of cholinergic receptors, known to be important in memory and cognition
Which cognitive domains are most impacted by chemotherapeutic agents?
visual and verbal memory, attention and psychomotor functioning
What is the greatest predictor of decline in IQ following RT?
That of IQ at baseline, which in interaction with age at baseline is a strong predictive model
What are important predictors of brain repsonse to RT?
total dose, dose per fraction and interval between fractions
What are the cognitive dysfunctions that are mostly associated with brain tumors?
problems of working memory, memory encoding and retrieval, attentional dysregulation, and slowed information processing
how damage brain tumors normal tissue?
by compression and infiltration
What dysfunction is associated with a tumor in the left hemisphere? And what about a tumor in the right hemisphere?
Tumor in the left hemisphere -> verbal dysfunction
Tumor in the right hemisphere -> visuospatial dysfunction
In neuropsychological evaluation in patients with brain tumors, what is important?
consistent neuropsychological batteries should be used with greater emphasis on component neuropsychological functions, rather than composite measures, such as for IQ or general memory indices
depression is related to tumors in the …
frontal lobes
What are the risks for developing a brain tumor?
- head injury before the tumor is diagnosed
- prior radiation exposure
- immune suppression leading to lymphomas
- genetic disorders
- environmental carcinogens
- viruses
Anxiety is related to a tumor in …
The right temporal cortex or the left cerebellum
What tumor characteristic is associated with the severity of cognitive impairment
Tumor grade is associated with the severity of the cognitive impairment
Tumor histology is not related to type and severity of cognitive impairment
Autism is associated with a tumor in the ….
In the cerebellum or the temporal lobes
The cognitive affective syndrome is defined by …
Significant deficits in executive function, spatial cognition, language, abstract reasoning, attentional regulation, memory and personality
The cognitive affective syndrome is associated with a tumor in the …
It is associated with bilateral or large unilateral lesions in the posterior cerebellar lobes
autism is related to tumors in the …
cerebellum or temporal lobes
OCD is related to tumors in the …
frontal lobes
the hypothalamic syndrome is related to tumors in the …
hypothalamus
which disorders are associated with the hypothalamic syndrome?
disorders of eating behavior
Which cognitive functions are most affected by radiotherapy?
multi modal memory functions, novel problem solving, attentional control.
cognitive impairment in radiotherapy is related to …
radiation dose
with regard to brain tumors, children are predisposed to deficits in …
fine motor coordination and novel problem - solving deficits due to the high rate of the location of tumors in the posterior fossa, in addition to the attention and memory impairments that are ubiquitously reported among all age groups
General toxicity of chemotherapy
chemotherapy can destroy healthy normally developing cells (hair), cells inside the bone marrow, and lower the number of circulating blood cells in one’s body. Also, effects on the gastrointestinal tract, fatigue and changes in smell and taste,
Why are corticosteroids (such as prednisone) used during cancer treatment with chemotherapy and/or radiotherapy?
corticosteroids are used to treat tumor - associated cerebral edema, with the hope of managing malignant tumors and reducing clinical symptoms
Deficiencies in estrogen and progesterone secretion have been associated with …
- attention
- memory
- learning
- psychomotor efficiency
Which cognitive domains are affected by chemo brain?
language ability, memory, concentration, attention and executive functions.
Which daily activities can be impaired due to a chemo brain?
- the inability to maintain or advance a career in the face of attention problems
- academic performance also may be impacted adversely
- social role fulfillment may be affected
Ritalin improves …
concentration, psychomotor slowing, fatigue and attention
gingko biloba is associated with ..
neuroprotective, antioxidant, and membrane - stabilizing effects. It may also inhibit loss of cholinergic receptors, known to be important in memory and cognition
