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67 Cards in this Set
- Front
- Back
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Name the two major categories of cancers that affect the CNS? |
1. Primary Neoplasms of the CNS
2. Cancers of other organ systems a. Metastases b. Treatment effects c. Paraneoplastic Syndrome
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What are primary brain tumors? |
Those that originate in the CNS
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Who is more likely to have primary brain tumors, children or adults? |
Children |
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What are the most common cancers that spread to the nervous system in adults? |
1. Breast 2. Colon 3. Lung (most common with 50%) 4. Unknown primary |
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Where are metastases typically found in the CNS? |
80% are found in the cerebral hemispheres AT THE GRAY -WHITE JUNCTION |
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What percentage of adults with cancer have it spread to the CNS? |
20-40% |
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What are the most common cancers in adults? |
1. Lung 2. Prostate 3. Breast |
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What are the most common cancers in children? |
1. Acute Lymphoblastic Leukemia 2. Brain Tumors |
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What are the 5 physical locations of Primary Brain Tumors?
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1. Neuroepithelial Tumors (e.g., glial tumors, choroid plexus tumors).
2. Tumors of cranial and peripheral nerves.
3. Germ cell tumors.
4. Tumors of the sellar region (e.g., pituitary)
5. Tumors of the meninges.
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What is the most common site for tumors in the CNS? |
The meninges (34%) |
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What percentage of tumors are found in the lobes of the brain? Order the lobes in terms of susceptibility to tumor. |
22% of tumors are in the lobes. 1. Frontal (9%) 2. Temporal (7%) 3. Parietal (5%) 4. Occipital (1%) |
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What tumors are Women more susceptible to? Men? |
Females have higher rates of: 1. Primary brain tumors. 2. Meningiomas (twice as likely) 3. Pituitary Men have higher rates of: 1. Neuroepithelial 2.Gliomas Basically, Men get the higher grade tumors more often. |
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What is the most common brain tumor in adults aged 45 or older? Second most? |
Meningioma Glioblatoma |
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What is the most common tumor for people aged 15-34? |
Pituitary
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What is the most common tumor for ages 5-14? |
Pilocyctic Astrocytoma |
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What adult age group is diagnosed with the most PRIMARY brain tumors? |
60-69 year olds; with a 5-year survival rate of 6% |
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What is the correlation between age and 5-year survival rate for primary brain tumors in ADULTS? |
Negative correlation. Increased age leads to a lower survival rate. Rate is 64% for ages 20-29 and 1% for those over 80. |
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What age group has the worst survival rate for children? |
Those 1 year or younger. |
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Which two cancers have the worst survival rates? |
Glioblastoma multiforme Those with multiple metastases |
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What genetic diseases are risk factors for tumor?
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1. Neurofibromitosis 1 and 2 2. Tuberous sclerosis |
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What is the most common presenting symptom of tumor? |
New-onset Headaches that are worse in the morning
Usually with nausea
(associated with mass effect and increased ICP) |
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Besides headaches, what are common presenting symptoms of tumor? |
1. Seizures 2.Progressive neurologic deficts 3. Endocrinopathies 4. Cognitive and behavioral changes |
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Children are susceptible to posterior fossa tumors. How do they present?
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1. Ataxia 2. Nausea |
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What tumors in children can cause obstructive hydropcephalus of the 4th ventricle? |
Posterior fossa tumors. 10-35% require post-surgery shunting |
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What type of tumors can cause obstructive third ventricle hydrocephalus? |
Tectal Gliomas Pineal tumors |
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What is cerebellar mutism syndrome? |
Complication of posterior fossa surgery that resolves over days to months. Symptoms include:
1. Mutism. 2. Emotional lability 3. Ataxia 4. Cranial nerve problems |
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What age groups are particularly susceptible to the negative developmental effects of radiation? |
Ages 3 and younger (Radiation is usually deferred in this group). The Very Old (Due to poor cellular repair). |
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When do the acute effects of radiation therapy (i.e., Acute radiation encephalopathy) develop?
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About 2 weeks after treatment.
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What are the symptoms of acute radiation encephalopathy? |
1. Somnolence 2. Worsening of prior neurologic deficits 3. Headaches |
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What class of drugs are used to treat acute radiation encephalopathy? |
Corticosteroids |
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What is the neuropathological cause of radiation encephalopathy? |
Reversible demyelination that typically returns to baseline in 12 months. |
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If radiation symptoms persist past 12 months, what are the most common neuropsychological deficits observed?
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Recent memory loss Reduced attention (Deficits range from mild to severe) |
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What is the most awful, nasty, CNS-Destroying chemotherapy? |
Intrathecal methotrexate |
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What part of the CNS does methotrexate damage?
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White matter (i.e., Leukoencephalopathy)
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What are some common side effects of chemo in kids? |
1. Seizures 2. Leukoencephalopathy 3. Cardiovascular problems 4. Seizures 5. Hearing loss 6. Neuropathies 7. Organ dysfunction 8. Cognitive problems |
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What medical and social risks are present for adults who survive childhood cancer? |
1. Seizure onset later in life 2. Stroke later in life 3. Second malignancy 4. Sensory/Motor deficits 5. Neuroendocrine dysfunction 6. Lower rates of employment and marriage |
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What white matter areas/structures are most affected by radiation? |
1. Corpus callosum 2. Internal capsule 3. Frontal white matter |
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What structure does cranial radiation tend to damage? |
Hippocampus |
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What is paraneoplastic syndrome? |
Indirect immune system reaction to cancer, usually associated with small lung cancer.
A RARE neurological complication of cancer (5% of patients with systemic cancer). |
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What are the CNS symptoms of paraneoplastic syndrome? |
1. Cerebellar degeneration 2. Seizures 3. Amnesia 4. Mental status changes |
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What percentage of childhood cancer survivors experience late effects? |
60% |
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What is the overall survival rate for childhood cancers? |
80% |
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What are the risk factors for late neuropsychological deficits in childhood cancer? |
1. Younger treatment age 2. Higher doses of radiation 3. Female gender |
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What qualitative FSIQ range do kids treated for medulloblastoma with radiation tend to fall in? |
Low average, BUT it tends to decline over time. |
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What are the four most common neuropsychological deficits observed in kids with cancer? |
1. Attention 2. Working memory 3. Processing speed 4. Social skills deficits |
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What treatment for cancer tends to have the lowest impact on cognition in kids? |
Surgery |
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What is the rate of decline in IQ points for kids treated with radiation and chemo? |
2-4 points per year. Reevaluate them every 3 years |
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What effect does radiation and chemo have on IQ in adults? |
None. Kids get the raw deal here. |
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What cognitive function is most disrupted in adults and children?
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Processing speed. This is regardless of treatment approach (including surgery); although, radiation treatment seems most highly correlated. |
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Who usually develops visuospatial problems related to cancer? |
Children; especially those with Neurofibromatosis 1 |
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Tumors in what region tend to produce memory problems? |
Those affecting the region of the third ventricle.
Also localized tumors in the temporal lobe
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What are common sensorimotor changes in tumor? |
Reduced motor speed and coordination (especially noticable in kids with posterior fossa tumors) |
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What academic disability is most often seen in kids with cancer?
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Mathematics
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What type of tumor is most common in Neurofibromatosis? |
Optic glioma |
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What CNS cells tend to produce tumors? |
Glial Only 1% arise from neurons |
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Which type of metastatic tumors have worse prognosis, breast or colon? |
Breast is better |
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What type (not location) of tumor is most common in kids? |
Medulloblastoma |
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What demographic factors are most associated with CNS tumors? |
Developed Nations Males Older Age Whites |
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List the 5 common paraneoplastic syndromes. |
1. Brain and cranial nerves: Cerebellar degeneration, optic neuritis 2. Spinal cord or dorsal root ganglia: Motor neuron disease, sensory/motor neuropathies 3. Peripheral Nerves: Guillian-Bare Syndrome, Peripheral Neuropathy, 4. Neuromuscular junction: Lambert-Eaton myasthetic syndrome, myastenia gravis 5. Unknown: Stiff person syndrome, neuromyopathy. |
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What is the best imaging method for tumors? What is needed for diagnosis? |
MRI Biopsy |
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List examples of tumors for each of the WHO Grading Levels for Tumors. |
Grade I : Meningioma and Pilocytic Astrocytoma
Grade II: Pineocytomas and Oligoastrocytomas
Grade III: Anaplastic astrocytoma and anaplastic oligodendroglioma
Grade IV: Medulloblastoma and Glioblastoma Multiforme |
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What do the different WHO tumor grades mean? |
Grade I: Slow growing, low infiltration, well defined, non-recurring Grade II: All characteristics of Grade I BUT may RECUR Grade III: Fast growing, high infiltration, poor definition, high recurrance Grade IV: All characteristics of Grade III BUT also FOUND IN MULTIPLE BRAIN REGIONS. |
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Where are medulloblastomas found?
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Cerebellar vermis |
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What type of radiation is used in metastases? |
Whole brain. |
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What are common neuropsychological problems in kids following chemothearpy? |
Attention and executive functioning |
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What percentage of patients report persistent fogginess, fatigue, and neuropsychological problems after chemotherapy? |
20% This is known as chemobrain |
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What are the symptoms of posterior fossa syndrome in kids? |
Mutism Ataxia Emotional Lability |
