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PT 680 Clinical Medicine > CNS Neoplasms/Tumors > Flashcards

CNS Neoplasms/Tumors Flashcards

(64 cards)

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1
Q

the tumor begins in normal CNS tissue

A

primary tumors

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2
Q

give examples of the cell types primary tumors develop on in CNS

A

neurons
glial cells - astrocytes, oligodendrocytes, microglia

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3
Q

tumor begins in other tissue and then spreads (metastisis) to the CNS

A

secondary tumors

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4
Q

what are some common areas in which secondary tumors develop and then travel to the brain

A

breast
lung
kidney
melanoma
gastrointestinal

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5
Q

usually slow growing, may compress other tissues but not typically invasive and list examples

A

benign tumors
meningioma, neurinoma, hemangioblastoma

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6
Q

usually more rapidly growing, may spread by invading other tissues or spreading to distant areas and list examples

A

malignant tumors
astrocytoma, glioblastoma, oligodendroglioma

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7
Q

do primary CNS tumors typically metastasize outside the CNS

A

no
due to lack of lymphatic system to the CNS to transport cancer cells

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8
Q

what is it called when a CNS tumor infrequently travels through CSF to the spinal cord and causes spinal cord complications

A

drop metastasis

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9
Q

how are brain tumors classified

A

via light microscopy
based on neuroembrologic cell type and aggressiveness of the tumor

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10
Q

what is the system called that is used to classify brain tumors and describe it

A

Ringertz system
1 = least aggressive
4 = most aggressive

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11
Q

what is the medial survival rate for glioblastoma

A

8 months

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12
Q

what is the most common primary malignant tumor of the brain

A

glioblastoma

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13
Q

what is the median age for the dx of primary brain tumors

A

61 y/o

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14
Q

most neoplasms in children are ______ (typically in cerebellum and brainstem)

A

intratentorial

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15
Q

another name for tumor

A

neoplasms

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16
Q

neoplasms in adults are _____ (typically in cerebral hemispheres)

A

supratentorial

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17
Q

how do brain tumors affect the CNS

A
  • effects vital functionals of brain and/or spinal cord
  • confined space becomes even more crowded by space occupying lesion (intracranial herniation)
  • may block CSF and reduce blood flow resulting in tissue ischemia
  • results in increased ICP
  • compression of neural tissues results in neurological deficits
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18
Q

lists some signs of CNS tumors

A

(depends on location of tumor and degree of compression on surrounding tissues)
headache, N/V, cognitive/behavior change, seizure activity, visual changes/papilledema, language and speech deficits, syncope, weakness, CN palsy

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19
Q

what is the most common clinical presentation of CNS tumor

A

headache that is generalized and retro-orbital and that is worse in the morning (ICP increases when laying flat)

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20
Q

optic disk inflammation

A

papilledema

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21
Q

list ways to diagnose brain tumor

A
  • MRI/CT
  • cerebral angiography
  • PET scan
  • needle biopsy
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22
Q

is the most informative way to dx brain tumors; can detect very small tumors when contrast is used; important in posterior fossa tumor detection

A

MRI

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23
Q

is effective to dx large tumors that are producing cerebral edema, midline shift, ventricular compression

A

CT scan

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24
Q

looks are metabolism and how the brain feeds (tumors require a lot of nutrients, so will see an increase in metabolic activity in pts with brain tumors)

A

PET scan

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25
list medical management techniques for brain tumors
- surgery: most important form of initial therapy to provide histologic confirmation of tumor and basis for determining tx and prognosis - radiation - chemotherapy - immunotherapy - palliative care
26
describe surgical tx for brain tumor
- histological dx may require stereotaxic biopsy - performed through craniotomy - goal is 100% removal with minimal surgical brain trauma - if not possible, removing as much tumor as possible will relieve pressure and minimize residual tumor size
27
lists complications following brain tumor surgery
increased ICP with bleeding and/or edema infection - meningitis CSF fluid leak or buildup endocrine abnormalities temperature fluctuation DVT occurs in 1/3 pts
28
what is normal ICP
0-15 mmHg
29
ICP above what level requires emergency tx
2- mmHg
30
how to help minimize increased ICP following brain surgery
HOB elevated 20-30 deg avoid coughing, sneezing or blowing nose
31
positioning precautions following brain surgery
- avoid extreme flexion of legs (can increase ICP) - check head positioning - varies with type of surgical procedure
32
often used following surgery; localized delivery of gamma rays; prove effective in malignant brain tumors; persons with deep inoperable tumors; 5x/week for 34-36 weeks; sterotaxic (gamma/cyber knife)
radiation
33
list some negative effects of radiation therapy
- acutely following radiation, increased neurologic deficit and increased ICP - post-irradiation syndrome - 1-3 months later, delayed inflammatory process - radiation necrosis - severe and irreversible - survival time increased but long term effects occur due to damage to cerebral vessels
34
what are the two types of chemotherapy infections
- intrathecal (into CSF) - intravenous
35
what is the chemotherapy drug of choice for gliomas
temozolomide (TMZ)
36
most frequently used and least-proven tx; infusion of interfersons or interleukin-2
immunotherapy
37
pt receive dopamine agonists to control prolactin (reduces signal for cell production); if successful, will be able to avoid surgery or radiation
hormone therapy
38
sx management for brain tumors
- anti-inflammatories to control brain edema - if increased intracranial pressure is sudden, may need quick acting agents - anticonvulsants to manage seizure activity (phenytoin) - pain management - psychosocial support - rehabilitation
39
what are some s/s of increased ICP
HA vision loss speech nausea changes in vitals seizures mood balance/coordination deficits
40
cancer specific quality of life outcome measures
- eastern cooperative oncology group performance status scale - cancer quality of life questionnaire 30 - functional living index - cancer - brief fatigue inventory to assess pt fatigue
41
account for 30-40% of all brain tumors - most common; list examples
gliomas astrocytomas, oligodendroglioma, ependymoma
42
often very large tumors and infiltrative
astrocytoma
43
what grades of astrocytomas are usually benign
1 and 2
44
what grades of astrocytomas are usually fast spreading and malignant
3 and 4
45
prognosis for astrocytomas
- good for low grade tumors with complete surgical excision and in pts younger than 40 - very poor for high grade tumors almost universally fatal and eventually recur if excised
46
slow growing, solid tumor, usually calcified; good long term survival rate with surgical resection and radiation however late recurrence is common
oligodendroglioma
47
where are oligodendroglimoas typically found
frontal lobe
48
initial sx of oligodendrogliomas
headache and seizures may bleed and present with stroke like presentation
49
very low incidence, usually only 2% of gliomas; more common in children; cause increased ICP or cerebellar dysfunction; 80% 5 year survival rate
ependymoma
50
common location of ependymoma
posterior fossa and around 4th ventricle
51
most common malignant brain tumor of children; rapidly growing; may metastasize to other brain areas via subarchnoid space; 5 year survival rate is over 50%
medulloblastoma
52
where does medulloblastoma arise from
cerebellar tissue
53
what is the most common benign neoplasm in CNS
meningioma
54
slow growing, s/s evolve over time; F > M; associated with history of breast cancer; genetic abnormality #22; close proximity to bone results in hyperostosis
meningioma
55
thickening of skull in region of tumor
hyperostosis
56
where does meningioma originate
arachnoid layer of meninges
57
benign tumor of pituitary gland results in excessive secretions of pituitary hormones or insufficiency (metabolic/endocrine activity; galactorrhea, amenhorrhea, gigantism. acromegaly; cushing's disease; hypopituitasm (fatgieu, weakness, hypogonadism); 3rd most common primary brain tumor in adults; 13% of intracranial tumors; F>M; usually middle aged or older
pituitary adenoma
58
visual abnormalities associated with pituitary adenoma
- local tumor pressure over optic chiasm - bilateral temporal field defects = loss of peripheral field of vision - diploplia
59
may develop in any peripheral N; common on 8th CN (acoustic neuroma); slow growing well encapsulated; commonly associated with neurofibromatosis
neuroma schwannoma
60
can present with involvement of any part of cord or nerve roots; primary tx is surgery; any known cancer pt with back pain should be a red flat for metastasis to SC until proven otherwise
primary and secondary spinal tumors
61
spinal tumors inside the spinal
intrathecal/intradural glioma
62
inside the meninges/outside the cord and example
extrathecal/intradural meningioma
63
outside the cord and meninges and example
extrathecal/extradural metastatic lung cancer to vertebral body
64
clinical presentation of spinal tumors
- poorly localized, deep, spontaneous pain - worse at night - pain aggravated by increased intrabdominal pressure - coughing, sneezing, bearing down - nerve root pain - LMN presentation - brown sequard presentation with sphincter deficits - sensory loss in dermatomal patterns - syringomelia - loss of pain/temp and paraparesis (a cyst formation within spinal cord)

PT 680 Clinical Medicine (18 decks)

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