Ch 25 Cancers Flashcards
(132 cards)
1
Q
Cancers in 2 major areas
A
primary neoplasm of the CNS
cancers of other organ systems that can affect CNS directly (e.g. brain metastases) or indirectly (e.g. radiation and chemo)
2
Q
how do Brain Tumors develop
A
consequence of abnormal replication of cells inside the skull cavity due to genetic alterations that allows cells to circumvent normal cell regulatory functions and avoid immune system targeting
3
Q
Two types of brain tumors
A
Primary brain tumors
Metastatic brain tumors
4
Q
Primary brain tumors originate where
A
CNS
5
Q
Do primary tumors occur more frequently in children or adults?
A
more common in children than adults
6
Q
Metastatic brain tumor
A
Primary cancer is outside the nervous system and spreads to the brain
Most common intracranial tumor in adults
7
Q
% of people who have cancer resulting in metastatic brain tumor
A
20 to 40% of adults with cancer
8
Q
Name malignancies that commonly spread to the brain
A
melanoma
breast CA
lung CA
colon CA
9
Q
% of metastatic tumor in CNS that seed in the cerebral hemisphere?
A
80%
10
Q
most common location of metastatic brain tumor
A
gray and white matter junction
11
Q
how are brain tumors classified?
A
cell of origin
proliferation potential
molecular genetic features
12
Q
how many tumor grading
A
I to IV
13
Q
how is tumor graded
A
based on the degree of histological malignancy and molecular genetic characteristics
14
Q
definition of benign or malignant is useful or not useful in the context of brain tumors?
A
not useful because benign tumors can have high morbidity due to critical structures in the brain and confined space
15
Q
Tumor grade I characteristics
A
Well differentiated non-infiltrative low proliferative potential slow growing good possibility of cure with surgery
16
Q
Tumor grade I histologic types and example
A
Pilocytic astrocytoma ganglioglioma craniopharyngioma meningioma pituicytoma
17
Q
Tumor grade II characteristics
A
Moderately differentiated
somewhat infiltrative
Low proliferative activity
can progress to higher grades
18
Q
Tumor grade II histologic types and example
A
Diffuse astrocytoma
ependymoma
ogliodendroglioma
19
Q
Tumor grade III characteristics
A
Poorly differentiated brisk mitotic activity infiltrative typically require adjunctive chemo or radiation tend to progress to a higher grade
20
Q
Tumor grade III histologic types and example
A
Anaplastic astrocytoma
anaplastic ependymoma
choroid plexus carcinoma
21
Q
Tumor grade IV characteristics
A
Undifferentiated widespread infiltration high degree of anaplasia high degree of necrosis requiring multi modality treatment rapid recurrence
22
Q
Tumor grade IV histologic types and example
A
glioblastoma
medulloblastoma
pineoblastoma
atypical teratoid rhabdoid tumor
23
Q
How are brain tumors categorized by cell origin
A
glial
neuronal
embryonal
mixed or other
24
Q
diffuse astrocytic and ogliodendroglial tumors
A
glioblastoma
diffuse astrocytoma
anapestic oligodendroglioma
25
incidence rate of primary brain and CNS tumor
23.03/100,000
26
highest incidence rate of brain tumor in which age group
older adults 85+
27
most common tumor site for primary brain tumors in the CNS is
```
meninges 36%
lobes of the brain 18.7%
- frontal 8.2%
- temporal 6%
- parietal 3.5%
- occipital 1%
```
28
most common types of tumor from ages 0-4
1 - embryonal tumor
| 2- pilocytic astrocytoma
29
most common types of tumor from 5-14
1 - pilocytic astrocytoma
| 2 - malignant glioma
30
most common types of tumor from 15-19
1 - pituitary
| 2- pilocytic astrocytoma
31
most common types of tumor from 20-44
1- pituitary
| 2- meningioma
32
most common types of tumor from 45-54
1-meningioma
| 2-pituitary
33
most common types of tumor from 55+
1-meningioma
| 2-glioblastoma
34
gender differences in brain tumors overall
females > males
35
types of brain tumor that are higher in female than male
meningioma (2x more in F)
| pituitary tumor
36
types of tumor that are higher in male than female
```
neuroepithelial tumor (1.4x more in M)
glioma and germ cell tumor
```
37
which racial group has highest incidence rate of brain tumor
whites
38
which racial group has highest incidence rate for non malignant tumor?
blacks
39
how common are childhood brain tumors?
second most common
40
childhood brain tumors account for ? % of all CNS tumors
6%
41
mortality in brain and CNS tumor
5 year survival rate - 62% in adults 20-44
| 5 year survival rate - 6% age 75 or above
42
brain tumor type that has the poorest survival rate?
glioblastoma for all age groups
43
survival rate for patients with multiple brain metastases?
odds of 6+months of survival are low
44
age group that has the lowest survival rate with primary brain tumor?
under 1 years
45
risk factors for brain tumor
exposure to ionizing radiation
genetic cancer disposition (e.g. TSC, NF1,2, Li Fraumeni, nevoid basal cell carcinoma, Von hippo Lindau)
HIV (higher rate of CNS lymphoma)
46
which determines brain tumor severity?
location
| mass effect
47
presentation of brain tumors
headache (most common sx in all groups)
- new onset HA with nausea and vomiting esp in the morning
- persistent HA
signs of Increased ICP
progressive neurologic deficits
- sensory motor deficits, ataxia, cranial nerve palsy posterior fossa tumor, pineal tumor, diplopia
endocrinopathy
- hormonal disruption (usually with pituitary tumor)
seizure
- 15-20% of children have seizures
- 25-30% present with seizures
- 40-60% adults have seizures some time
cog and behavioral changes
48
endocrinopathy
- hormonal disruption (usually with pituitary tumor)
| - tumor in the cellar region are related with neuroendocrine dysfunction such as Diabetes, hypogonadism, growth delay
49
Diagnosis of brain tumor
CT
- show most tumors, calcifications and hemorrhage
- may not show posterior fossa tumors or low grade glioma
MRI - BEST CHOICE
- dx and monitoring tumor
- can tell location and characteristics
- contrast can indicate breakdown of blood brain barrier, information about type and degree of malignancy
50
Treatment of brain tumor
*surgery
radiation
chemo
51
Surgery
first line of treatment!
some areas not good for surgery (e.g. brainstem)
good for low grade tumor and extra axial tumor (eg meningioma, pituitary tumor)
management of hydrocephalus and edema
52
tumor types that are good candidate for surgery
meningioma
pituitary tumor
posterior fossa tumor (obstructs 4th ventricle)
53
surgical complications of brain tumor
perioperative stroke
motor sensory deficit
damage to pituitary structure
posterior fossa or cerebellar mutism syndrome
- can cause mutism, emotional lability, cranial nerve deficits, ataxia
- mutism and motor deficits resolve over weeks or months
54
radiation therapy for brain tumor, used for?
whole brain or craniospinal radiation is used to treat tumors with potential for spreading (e.g. medulloblastoma)
55
how does radiation therapy help?
target dividing tumor cells by depositing high frequency energy in tissue
creating ionization and free radicals
damaging tumor DNA
56
why are cancer cells are more vulnerable to effects of radiation
because they are more involved in replication rather than maintenance and repair
57
why is radiation therapy contraindicated in age 3 or under or in older adults
young - can impair growth of normal tissue and subsequent brain development
old - toxicity is very high because of less robust cellular repair mechanism associated with aging
58
complications of radiation therapy
acute radiation encephalopathy (early on)
- headaches, somnolence, worsening of neurologic deficits
- responds to corticosteroids
early radiation encephalopathy (1-6 months post radiotherapy treatment)
- associated with reversible demyelination related to disruption of blood brain barrier and neuroinflammation
- 12 months back to baseline
late complications (>12 months after) in adults
- not reversible
- can consist of local radionecrosis or diffuse leukoencephalopathy
- cog deficits can be mild to very severe
- attention and short term memory
- incontinence
- gait disturbance
- MRI shows ventricular enlargement, atrophy, white matter changes
late complications (>12 months after) in kids
- neuropsych deficits
- neuroendocrine dysfx, infertility
- vascular complications
- hearing loss
- cataracts
- impaired growth and development
59
Why is there cog dysfunction in children who are treated with radiation
because it damages developing white matter
younger children are more at risk for neurocognitive toxicity
radiation injuries ogliodendrocyte precursor cells and brain microvasculature
reduced diffusivity in corpus callous, internal capsule, frontal white matter
damag to hippocampal progenitor cells
60
Chemotherapy - how does it work to treat
targets rapidly dividing cells by disrupting DNA and interfering with transcription and replication
61
treatment of medulloblastoma in kids
surgery
radiation
maintenance chemo
use intrathecal chemo and bone marrow transplant to avoid radiation therapy
62
combined chemo and radiation can have positive or negative impact on cognition?
negative impact on late effects
| higher risk of cognitive impairment
63
late complication and effects of chemo in adult
```
cerebral white matter damage (leukoencephalopathy)
hearing loss
peripheral neuropathy
secondary cancer
fatigue
neuropsych deficits
```
64
late complication and effects of chemo in children
```
cerebral white matter damage
endocrine dysfunction (infertility)
cardiovascular problems
seizures
hearing loss
neuropathy
cerebellar symptom
organ dysfunction
secondary cancer
neuropsych deficits
```
65
inpatient hospitalization for brain tumor
children can recover quickly from surgery if complications are few
66
how is radiation therapy administered?
in fractions over 6 weeks
67
how is post radiation chemo administered?
delivered in cycles
| overall course of treatment can be a year or longer
68
NP assessment during treatment
NP testing post surgery and before additional therapy can be helpful to understand functional status
defer testing until after radiation therapy or tx is completed
69
outpatient rehab in brain tumor treatment
recovery from tx is variable
70
adult survivors of childhood brain tumors are at more risk for more problems such as
```
late occurring seizure
neuroendocrine dysfunction
sensory motor deficits
late occurring stroke
increased risk of death (13x)
psychosocial factors
```
71
if treated with cranial radiation of strong dose, what may be a consequence
stroke
72
how often should NP assessment be done for children with treated brain tumors?
periodically every 3 years or more frequently
| late effects can emerge over time
73
Non CNS cancers and paraneoplastic syndrome
-
74
5 year survival rate for all non CNS cancer
70%
75
cancer death rates are increasing or decreasing
decreasing
76
most common CA type in adults?
```
breast CA in female
lung CA
prostate CA in males
colorectal
melanoma of skin
```
77
cancer disparities in race
blacks have higher mortality in breast CA, advanced state ovarian CA, advanced stage prostate CA, colorectal CA
black males higher rate than whites to die from lung CA
78
paraneoplastic syndromes
rare neurological complication of cancer
remote effects of cancer on nervous system
can cause severe neurological disability
79
incidence of paraneoplastic syndrome
less than 5%
80
what is paraneoplastic syndromes caused by
indirect immune system reaction to cancer
81
3 types of paraneoplastic syndromes
progressive encephalomyelitis
cerebellar degeneration
opsoclonus myoclonus
82
associated cancer of progressive encephalomyelitis
lung, hodgkin's
83
sx of progressive encephalomyelitis
seizure
amnesia
mental status change
affective change
84
associated cancer of cerebellar degeneration
lung, gynecologic cancer, hodgkins
85
sx of cerebellar degeneration
```
motor incordination leading to progressive gait ataxia
dysarthria
nystagmus
vertigo
diplopia
cognitive changes
```
86
associated cancer of opscolonus myoclonus
neuroblastoma in children
chest/lung cancer in children
lung cancer in adults
87
sx of opscolonus myoclonus
```
arrhythmic saccades (eye movement)
myoclonus of trunk limb head diaphragm palate larynx pharynx
```
88
paraneoplastic syndromes that affect CNS and neurological fx
Lambert eaton myasthenia syndrome
3% of patients with small lung cancer
progressive encephalomyelitis
cerebellar degeneration
89
common childhood non CNS Cancer in children
```
leukemia
lymphoma
soft tissue sacroma
neuroblastoma
kidney tumor
```
90
5 year survival rate for all childhood cancer
83%
91
most common malignancy of childhood is?
acute lymphoblastoma leukemia (ALL)
92
acute lymphoblastoma leukemia (ALL) 5 year survival rate?
90% with treatment
93
what is acute lymphoblastoma leukemia (ALL)
cancer of blood and bone marrow
lymphocytes proliferate and crowd out healthy and functional cells
diagnosed mostly in preschool years
94
when is acute lymphoblastoma leukemia mostly diagnosed
diagnosed mostly in preschool years
95
% of people who have cognitive dysfc during chemo
13-70% during chemo
| 17-75% have cognitive dysfx prior to tx
96
NP complaints during and after chemo of non CNS cancer?
processing speed
attention
working memory
EF
97
chemobrain after breast CA
persistent changes in 30% of people (1 yr post)
| decreased gray matter densities and white matter changes
98
risk factors for cog impairment with breast CA
old age
low cog reserve
genetic contribution
99
cog changes post cancer tx?
accelerated aging
100
age of bone marrow transplant and effect on NP functions?
younger age at dx and treatment has more problems
101
NP effects after bone marrow transplant
EF
| memory
102
endocrine therapy for tx of what cancers?
breast, prostate, thyroid
103
how does endocrine therapy work?
block, add, remove hormones that can slow or stop the growth of cancer
surgical excision of the gland responsible for producing the hormone
take meds to prevent cancer from using the hormones to grow
104
endocrine therapy can be used with other tx
surgery
radiation
chemo
immunetherapy
105
side effects of endocrine therapy
hot flashes, low libido, fatigue, nausea, mood changes
106
use of tamoxifen and NP results
word list generation
| verbal memory
107
% of childhood cancer survivors that experienced at least one late effect of tx?
60%
108
% of childhood cancer survivors developed a chronic disease
40%
109
increased risk in childhood cancer survivors in the following conditions
```
reduced life expectancy
endocrine dysfunction
fertility problems
NP impairment (esp intrthecal chemo or radiation)
cardiopulmonary dysfx
hearing loss, cataracts
gastrointestinal disorder
secondary malignancy
```
110
risk factors for cog impairment after treatment for non CNS cancer
young age
high dose of radiation
female
girls under 6
111
NP characteristics for brain tumors in adults
cog deficits usually present before tx
deficits related to tumor, tumor progression, neurocomplications, seizures
cog problems more diffuse in brain tumors than strokes
ICP can lead to structural shifts and produce features suggest involvement of sites distant from the tumor
112
neurocognitive late effects of radiation and chemo implication dysfunction in which part of the brain
frontal subcortical brain systems
113
NP should focus on assessing
attention, EF, language, memory and learning, VS, psych
114
NP characteristics for brain tumor in peds
deficits can be delayed and progressive
mild to severe cog deficits
low average IQ in medulloblastoma with radiation
surgery only - average IQ (but below average people more than normal)
affects attention, working memory, processing speed
fluid cog skills MORe vulnerable to disruption
115
Non CNS Cancers NP characteristics in adults
attention, concentration, learning memory, EF, speed of processing, mood, adaptive functions
116
chemo NP results for childhood leukemia
average IQ
deficits in attention, memory, EF, processing speed
VS, working memory
117
NP findings for non CNS cancer - IQ
adults
IQ generally preserved for chemo
IQ significant decline for brain tumor
kids
radiation and chemo early age = high risk for decline in IQ (2-4 points per year from diagnosis)
craniospinal radiation therapy - learn new skills at a slower rate
118
NP findings for non CNS cancer - attention
attention problems common in all ages
chemo and radiation compromise attention and affect memory
sustained attention difficulty
working memory difficulty
119
NP findings for non CNS cancer - processing speed
most common deficit in all ages
in kids - cranial radiation therapy most affected
in adults.- radiation for brain cancer
120
NP findings for non CNS cancer - language
children treated at a very young age show problems
foundational language preserved
later dx and tx better outcome
mild to mod problems with retrieval
adults with cortical brain tumor - language deficit/aphasia
121
NP findings for non CNS cancer - VS
often compromised in childhood cancer
NP type 1
decline VS in men with prostate cancer tx
122
NP findings for non CNS cancer - memory
```
more problems when tx in
third ventricle region
childhood leukemia
cranial radiation
earlier tx and dx
```
problems with learning and memory
123
NP findings for non CNS cancer - EF
peds - problems with initiation, self regulatory capacity, organizational skills
EF very vulnerable in adults and children treated for tumor and CA
124
NP findings for non CNS cancer - Sensorimotor
chemo have peripheral neuropathy as a side effect
lymphedema can impact motor speed
reduced fine motor speed and output
motor coordination, motor planning, speed of output, balance (posterior fossa tumor)
handedness change
125
NP findings for non CNS cancer - mood
depression
anxiety
suicidality in brain tumor in adolescents and young adults
regulation problems exist with steroid
social skills problems more frequent in children and adolescents
126
NP findings for non CNS cancer - PVT SVT
fatigue
energy level
misattribution bias
127
NP findings for non CNS cancer - achievement/adaptive
math problems:
brain tumor or childhood leukemia, NF type 1
language and reading difficulties
adaptive skills can be compromised a lot even if IQ is ok
128
intrathecal chemo
delivers therapeutic agents directly into CSF
to circumvent the blood brain barrier
administered via lumbar puncture
129
leukoencephalopathy
cerebral white matter injury that can be caused by radiation or chemo
130
methotrexate
antineoplastic agent classified as an antimetabolite
| folic acid antagonist and causes folic acid deficiency in cancer cells so THEY CAN DIE!
131
NF1
autosomal dominant genetic disorder
| higher risk of developing brain tumors, OPTIC GLIOMA
132
vasculopathy
any disease affecting blood vessels and includes vascular abnormalities caused by a number of conditions and disorders
