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X - Cancer Care COPY > Cancers of the Central Nervous System > Flashcards

Cancers of the Central Nervous System Flashcards

1
Q

What % of all cancers are brain tumours?

A

2-5%

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2
Q

What % of cancer deaths are caused by brain tumours?

A

2%

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3
Q

What is more common, primary brain tumours or mets to brain?

A

Mets

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4
Q

Where do mets to the brain commonly arise from?

A
  • Lung
  • Breast
  • Skin (melanoma)
  • Kidney
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5
Q

How can nasopharyngeal cancers spread to the brain?

A

They can extend directly through the foramina of the skull and involve the brain

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6
Q

What might meningeal metastases occur from?

A
  • Leukaemia
  • Lymphoma
  • Breast cancer
  • Small-cell lung cancer
  • Local extension of medulloblastoma and ependymal gliomas
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7
Q

What % of CNS tumours occur in the spinal cord?

A

Less than 20%

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8
Q

Is the cause of most adult brain tumours known?

A

No

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9
Q

What can be associated with brain tumours that tend to occur in children or young adults?

A

Inherited phakomatoses

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10
Q

What inherited phakomatoses are associated with brain tumours in children and young adults?

A
  • Tuberous sclerosis
  • Li-Fraumeni syndrome
  • Turcot syndrome
  • Neurofibromatosis type I
  • von Hippel-Lindau disease
  • Gorlin’s basal naves syndrome
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11
Q

What specific brain tumours are associat4ed with von Hippel-Lindau disease?

A

I’m only joking we obvs don’t need to know this lol got u

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12
Q

What can the symptoms of glial tumours be divided into?

A
  • General

- Focal

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13
Q

What causes the general symptoms of glial tumours?

A

Mass effects

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14
Q

What can mass effects cause in glial tumours?

A
  • Increased ICP
  • Oedema
  • Midline shift and herniation
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15
Q

What symptoms can be produced by midline shift in glial tumours?

A
  • Progressive altered mental state
  • Personality changes
  • Headaches
  • Seizures
  • Papilloedema
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16
Q

What do focal symptoms of glial tumours depend on?

A

The site of the tumour

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17
Q

What % of primary seizures are due to tumours?

A

Less than 10%

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18
Q

What % of supratentorial tumours present with seizures?

A

20%

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19
Q

How do meningiomas present?

A
  • Headache
  • Seizures
  • Motor and sensory disturbance
  • Cranial neuropathies (depending on site)
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20
Q

Where do meningiomas cause characteristic changes?

A

Plain skull radiographs

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21
Q

What are the characteristic changes on plain skull radiographs associated with meningiomas?

A
  • Bone erosion
  • Calcification
  • Hyperostosis
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22
Q

Are meningiomas more common in men or women?

A

Women

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23
Q

What is the frequency of tumour sites in the spinal cord?

A
  • 70% thoracic
  • 20% lumbosacral
  • 10% cervical
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24
Q

Where do spinal cord metastases most commonly occur from?

A
  • Breast
  • Lung
  • Prostate
  • Sarcoma
  • Lymphoma
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25
Q

How do spinal axis tumours present?

A
  • Sensorimotor dysfunction
  • Radicular symptoms
  • Syringomelia symptoms
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26
Q

What causes sensorimotor dysfunction in spinal axis tumours?

A

Cord compression

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27
Q

What causes radicular symptoms in spinal axis tumours?

A

Local extension of a tumour

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28
Q

What causes syringomyelia symptoms in spinal axis tumours?

A

Intra-medullary tumours causing central destruction

29
Q

How do olfactory groove tumours present?

A
  • Anosmia
  • Visual loss
  • Frontal lobe syndrome
  • Papilloedema
30
Q

How do sella turcica tumours present?

A

Visual field loss

31
Q

How do posterior fossa tumours present?

A
  • Ataxic gait
  • Cranial neuropathies
  • Cerebellopontine angle
  • Suboccipital pain
  • Hydrocephalus
  • Ipsilateral arm and leg weakness
32
Q

How do sphenoid wing tumours present?

A
  • Exophthalmos and visual loss
  • Temporal bone swelling
  • Skull deformity
  • Cavernous sinus syndrome
33
Q

What can the types of brain tumours be divided into?

A
  • Glial tumours

- Non-gliomas

34
Q

What are the types of glial tumours?

A
  • Gliomas
  • Ependymomas
  • Oligodendrogliomas
  • Medulloblastomas
35
Q

What % of brain tumours are gliomas?

A

50%

36
Q

What can gliomas be graded as?

A

I-IV

37
Q

What are ependyomas?

A

Cancers arising from ependymal cells lining the fourth ventricle

38
Q

What are oligodendrogliomas?

A

Cancers arising from oligodendroglia

39
Q

Who do medulloblastomas occur in?

A

Children

40
Q

Where do medulloblastomas arise from?

A

Cerebellum

41
Q

What might medulloblastomas be related to?

A

Neuroectodermal tumours elsewhere in CNS

42
Q

Give 4 non-glial brain tumours

A
  • Meningiomas
  • Primary cerebral non-Hodgkin’s lymphoma
  • Craniopharyngiomas
  • Choroid plexus tumours
43
Q

Give 4 types of primary spinal cord tumours

A
  • Schwannomas
  • Extradural meningiomas
  • Intramedullary ependymomas
  • Astrocytomas
44
Q

What is the imaging of choice in brain tumours?

A

MRI with gadolinium enhancement

45
Q

What might PET be useful for in brain tumours?

A

To help differentiate tumour recurrence from radiation necrosis

46
Q

What is required to confirm the diagnosis of brain tumour?

A

Biopsy

47
Q

When might a biopsy not be used to confirm the diagnosis of brain tumour?

A

Diagnosis is sometimes made on clinical evidence is made if biopsy is hazardous

48
Q

Why is staging not applicable to most primary brain tumours?

A

As they are locally invasive and do not spread to regional lymph nodes or distant organs

49
Q

What treatment is required for curing the majority of gliomas?

A

Surgery, radiotherapy, and chemotherapy

50
Q

How much of a glioma should be removed at surgery?

A

Removal should be complete as possible within the constraints of preserving neurological function

51
Q

What is the role of radiotherapy in glioma management?

A

Can increase cure rate or prolong disease-free survival in high-grade gliomas
May produce symptomatic improvement in patients with low-grade gliomas who relapse after initial therapy with surgery alone

52
Q

What is the role of chemotherapy in glioma management?

A

May prolong disease-free survival in some types

53
Q

What might limit the use of chemotherapy in gliomas?

A

Toxicity

54
Q

What management do meningiomas require?

A

Surgical resection

55
Q

What treatment is used for meningiomas that relapse after surgery?

A

Resect it again lol

56
Q

What is the role of radiotherapy in meningiomas?

A

Reduces relapse rate

57
Q

When should radiotherapy be considered in meningiomas?

A
  • High-grade

- Incompletely resected

58
Q

What are early complications of radiotherapy for brain tumours due to?

A

Reversible damage to myelin-producing oligodendrocytes

59
Q

How long do oligodendrocytes damaged by radiotherapy take to recover?

A

3-6 months

60
Q

What can radiotherapy induced damage to oligodendrocytes cause?

A
  • Somnolence
  • Exacerbation of existing symptoms in brain
  • Lhermitte’s sign
61
Q

What is Lhermitte’s sign?

A

Shooting numbness or parenthesis precipitated by neck flexion

62
Q

When can radiotherapy cause Lhermitte’s sign?

A

When you’ve zapped the spinal cord

63
Q

What are the late complications of radiotherapy for brain tumours?

A

Irreversible radiation necrosis

64
Q

What causes irreversible radiation necrosis?

A

Damage to blood vessels

65
Q

What might radiation necrosis mimic?

A

Disease recurrence

66
Q

What does radiation necrosis correlate with?

A

Radiation dose

67
Q

What % of patients receiving radiotherapy for brain tumours get radiation necrosis?

A

15%

68
Q

How many roentgens gives you radiation necrosis?

A
  1. 6… not great, not terrible

p. s. this isn’t a real card

69
Q

What do the prognostic factors for brain tumours depend on?

A
  • History
  • Grade and size of tumour
  • Age and performance status of patient
  • Duration of symptoms

X - Cancer Care COPY (36 decks)

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