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63 Cards in this Set
- Front
- Back
Epidemiology: Ca. (40/60/80%)
of ped. pts. diagnosed b/w ages of 0-10 |
80%
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60% of PBTs occur in the ________ fossa, vs. adults who usually get tumors that are ______tentorial
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posterior; supratentorial
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The posterior fossa is the “back vault” of the brain, and contains the ______ and ______.
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Cerebellum and brainstem (midbrain, pons, medulla)
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What is the overall 5 yr. survival rate for PBTs?
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50 of children with PBTs survive 5 yrs, but there is great variability.
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Name 3 factors that effect the survival rate in PBTs.
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3 factors that affect prognosis are:
Age Tumor type Tumor location |
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Name three common types of brain tumors in children.
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1. Low-grade astrocytomas
2. Primitive Neuroectodermal Tumors (PNETS) 3. High-grade gliomas (Less common in children, more in adults) |
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Low-grade Astrocytomas: How are they commonly treated?
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Frequently treated by surgery alone
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Low-grade Astrocytomas: What is the prognosis?
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If entire mass is resected (“gross total resection”), px is very good. In this case, 90% survive 10-20 years
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Low-grade Astrocytomas: When are they more likely to be fatal?
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If located in the brainstem (& therefore less likely to be "resectable") they are much more likely to be fatal
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Primitive Neuroectodermal Tumors (PNETS):How malignant are they?
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Often fairly malignant, therefore requiring more aggressive treatment
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Primitive Neuroectodermal Tumors (PNETS): Name the most common type of PNET.
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medulloblastoma
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Primitive Neuroectodermal Tumors (PNETS): What is the prognosis for the tumor type mentioned in the previous card, the most common PNET (m___________a)? 5 year survival rate of __to__%.
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“standard risk” medulloblastoma has 5-yr survival rate of 50-80% after surgery, chemotherapy and radiotherapy
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High grade gliomas: Name a type of high grade glioma. This type is most common in (kids/adults).
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Glioblastoma multiforme; adults
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G________ m_________ tumors are often fatal and therefore require aggressive treatment
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Gliblastoma multiforme (plural, multiformae)
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Without treatment, prognosis for gliblastoma multiformae is ca:
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3 months
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With aggressive treatment, prognosis for gliblastoma multiformae is ca:
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1-2 years, typically
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What is the first step in the neurosurgical process?
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Surgery is preceded by a biopsy of the tumor.
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In the case of acute obstructive _____________, a _________ is placed.
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A shunt or stent is placed in the event of acute obstructive hydrocephalus.
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What is the relationship between percent of tumor resected and cognitive outcome?
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There is no consistent relationship between % of tumor resected and NP outcome
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What impact does surgery for PBTs typically have on NP outcome?
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Surgery may increase risk of NP deficits, but often only slightly
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While surgery may often increase risk of NP deficits only slightly, surgical _______ are assoc. with poorer outcome
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complications
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Name 2 common types of chemotherapeutic agents (broadly, not specific chemicals).
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Antineoplastic treatments and steroids
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What are an___________c treatments?
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Antineoplastic treatments are what we usually think of as “chemotherapy”.
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Like an_________c treatments, s_______s may have NP effects
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antineoplastic treatments; steroids
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Most agents administered into the _____________, but methotrexate may be administered___________ (i.e. directly into CSF)
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bloodstream; intrathecally
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NP effects of chemotherapy ____ by agent, some are more ____ than others
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vary, benign
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Possible short-term effects of Chemotherapy sequelae may include lower _____ ____ speed/_______, and ________ ability. This may be due to at least partially reversible p________ n_________
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fine motor speed/coordination; graphomotor ability; peripheral neuropathy
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Long-term sequelae: how does chemotherapy compare to radiation treatment?
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Chemotherapy sequelae less marked than radiation, but variety of agents/combos/ delivery means variety in outcomes
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Name one type of chemotherapy that is known to heighten long-term effects of radiation
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Methotrexate may heighten long-term cognitive effects, moreso if administered intrathecally
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Long-term steroid use may affect performance in ________ and _______(academic skills), as well as the NP abilities of __________ and _____________.
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Long-term steroid use may affect reading and math, as well as immediate attention and visual/constructional and drawing skills.
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Name four types of radiotherapy:
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Craniospinal; Focal; Craniospinal with local boost; Stereotactic radiosurgery (aka “gamma knife”
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________ ___________ is a very precise form of radiotherapy; it is less useful if tumor margins indistinct or mets are likely
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Stereotactic radiosurgery (aka “gamma knife”
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_______ radiotherapy minimizes exposure of healthy tissue
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Focal
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_______ radiotherapy targets the whole ______ ______. This targets the tumor and also helps reduce metastases.
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Craniospinal; CNS axis
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__________ radiotherapy with a ________ _________ both strongly targets the tumor and gives a lowered dose to the ____________ axis to reduce ____________.
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Craniospinal radiotherapy with local boost; CNS; metastases
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What is the effect of radiotherapy on IQ?
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IQ may drop 5-7 points per year (variable though)
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When does the effect of radiotherapy on IQ begin and end?
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Delayed onset -- 1-2 years;
Unclear when decline stops |
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How does the effect of radiotherapy on IQ differ based on pt. age?
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The younger the child, the more severe; not a phenomenon seen in adults (though adults may still have some NP effects, e.g. complaints of memory or attention difficulties)
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How might radiotherapy sequelae be reduced?
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Lowering the dose to the whole brain and using a focal boost may improve outcome
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What are common NP effects of radiotherapy in children?
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No single NP profile, but may affect: memory, attention, fine motor speed and coordination, math skills, visual-spatial & visual-construction skills
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What are some of the mechanisms that lead to changes in cognitive functioning with radiotherapy in children? (4 factors)
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White matter degeneration, poor myelination-- (partly why this a developmental issue); Vasculo-occlusive changes;
Skill stagnation adding to IQ drop; Mood factors may also have negative impact on performance |
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Which have greater likelihood of long-term NP impairment? Midline and infratentorial or supratentorial tumors?
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Supratentorial tumors in cerebral hemispheres gen. assoc. w/ greater long-term NP impairment than midline and infratentorial tumors.
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Are initial tumor size and residual volume consistently associated with NP outcome?
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No, not consistently
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Does recency of sx onset relate to outcome?
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Recenty of sx onset may be predicted of cog. outcome; recent sx onset and rapid decline may reflect more aggressive tumors requiring more aggressive treatments
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Does treated acute obstructive hydrocephalus relate to NP outcome?
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No. This differs from outcome with chronic hydrocephalus.
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Which types of tumors are most likely to cause seizures?
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Hemispheric tumors are most likely to cause seizures.
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What effect do seizures 2ary to tumors have on inter-ictal functioning?
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Seizures’ efffect on inter-ictal functioning is unclear.
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Do AEDs (anti-epilepsy medications) have cognitive effects?
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AEDs (anti-epilepsy medications) do have varying cognitive effects.
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Does treated endocrine dysfunction from cancer treatment have NP effects?
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Treated endocrine dysfunction from cancer treatment doesn’t appear to have measurable NP effects.
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Brain tumors are classified based on tumor site, tissue type, benign vs. malignant. Childhood nervous system tumors may be _____tentorial (located below the _____ _____) or ______tentorial.
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infratentorial; tentorium cerebelli; supratentorial
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The most common childhood brain tumors are ________, __________, _______, and _____ _____ _____.
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astrocytoma, medulloblastoma, ependymoma, and brain stem glioma.
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Cerebellar astrocytoma are usually benign, c_______. They grow (slowly/quickly).
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cystic, slowly
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Presenting signs of a (tumor type) usually include clumsiness of one hand, gait changes (stumbling to the left or right), vomiting, and headache.
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cerebellar astrocytoma
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Presenting symptoms of a __________ may include headache, vomiting, ataxia, lethargy.
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medulloblastoma
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Medulloblastomas may metastasize into this region:
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spinal cord
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Presenting symptoms for a(n) ________ include headache, vomiting and lethargy. Tumors of this type are located in the brain ventricles and obstruct the flow of CSF:
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ependymoma
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A (tumor type) occurs in the midbrain, pons or medulla. It occurs almost exclusively in children. Presenting signs may include double vision, facial weakness, vomiting, and difficulty in _______.
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brainstem glioma; walking
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(tumor type) is located near the pituitary _____. Though often benign, ______ is difficult due to its proximity to vital structures. Presenting signs include changes in _______, weight _____, headache, and change in _______ function.
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craniopharyngioma; pituitary stalk; resection; vision, weight gain, endocrine function
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This tumor type has a 40-90% chance of cure depending on subtype.
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cerebellar astrocytoma
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About 30-50% of children with (tumor type) are disease-free within 10 years. If relapse occurs it is likely to happen in the first 5 years. Children under 3 have a poorer prognosis b/c of likelier mets and lower doses of radiation.
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medulloblastoma
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High grade (tumor type) may be fatal, and overall childhood survival is less than 30%. If low-grade, 5-year survival rate of 80% is seen
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ependymoma
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Overall survival rate for (tumor type) is 20-30%.
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brainstem glioma
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(Treatment type) may lead to psychosis in a small proportion of individuals. This is expected to remit in the great majority of individuals after treatment completion.
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Steroid administration (high dose)
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