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Clinical and Neuropsychology - 1 > NP ch.15: Cancer > Flashcards

NP ch.15: Cancer Flashcards

1
Q

General Notes

A
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2
Q

What is Cancer?

A

Cancer is a group of diseases involving abnormal cell growth with the potential to spread or invade other parts of the body

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3
Q

What is the cause of Cancer?

A

DNA Errors that accumulate in our cells throughout life

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4
Q

What are some general numbers/statistics on cancer?

A
  • 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
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5
Q

What are the 3 types of cancers?

A
  • 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
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6
Q

What is the mean survival rate for each type?

A

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%

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7
Q

What is glioblastoma?

A

Most aggressive and most common type of brain cancer.
- 15% of all brain cancers
- Arises from mutation in the glial cells

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8
Q

What is the cognitive impairment arising from each type of cancer?

A
  • In-CNS cancer: 75% of patients have cognitive impairment
  • Non-CNS cancer: 30% of patients have cognitive impairment
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9
Q

How does WHO classify brain tumors?

A
  • Grade:
    ~ 1: non-malignant, 2-4: ,malignant
    ~ Low-Grade (low danger): 1-2, High-Grade (High danger): 3-4
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10
Q

What are some factors that must be taken into account when diagnosing or treating brain tumors/cancer?

A
  • 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
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11
Q

Primary Brain Tumors

A
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12
Q

What are the two types of primary brain tumors and what is their prevalence?

A
  • 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)
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13
Q

What are the causes of cognitive impairments in primary brain tumor patients?

A
  • Tumor
  • Cancer treatments and other medication
  • Distress
  • Fatigue
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14
Q

What does the type of cognitive impairment depend on?

A

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

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15
Q

Tumor - How can it cause cognitive impairment in primary brain tumor patients?

A
  • Affects healthy brain tissue
  • Affects blood flow
  • Edema
  • (In Meningioma): pressure on brain and nearby nerves and vessels
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16
Q

In Glioma patients, what cognitive impairments are observed if the right or left temporal lobes are affected?

A
  • 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
17
Q

Cancer Treatments: Surgery - How can it cause cognitive impairment in primary brain tumor patients?

A
  • 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
18
Q

Cancer Treatments: Radiotherapy - What is the goal of radiotherapy?

A

Cause damage to the DNA of cancer cells to overwhelm their ability to repair themselves, leading to cell death (affects also healthy cells)

19
Q

According to the phase of radiotherapy, what might be the possible negative side effects?

A
  • 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)
20
Q

Cancer Treatments: Radiotherapy - How can it cause cognitive impairment in primary brain tumor patients?

A
  • Vascular damage
  • Inflammation and microglial dysregulation
  • Oligodendrocyte injury
  • Neuronal damage and altered neurogenesis
21
Q

Cancer Treatments: Chemotherapy - What is the goal of Chemotherapy?

A

Chemotherapy kills dividing cells (can also kill dividing cells)
affect healthy cells

22
Q

Cancer Treatments: Chemotherapy - How can it cause cognitive impairment in primary brain tumor patients?

A
  • Kills various cell types in an abundance
  • If Blood-Brain Barrier is not intact, Chemotherapy is even more neurotoxic
23
Q

Other treatments - How can medication cause cognitive impairments in primary brain tumor patients?

A
  • 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
24
Q

What are some interventions to improve cognitive impairment?

A
  • Pharmacological treatments
  • Technological treatments
  • Behavioral interventions:
    ~ Cognitive training
    ~ Cognitive strategy training
25
Q

What is the aim of cognitive training?

A
  • Regain cognitive functions
  • Often appealing to patients but not effective
26
Q

What is the aim of cognitive strategy training?

A

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

Clinical and Neuropsychology - 1 (21 decks)

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