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syposium control and movement > Intracranial tumor > Flashcards

Intracranial tumor Flashcards

1
Q

What are the two most common cancers in children?

A

1st is meningiomas

Then cancers of the nervous system

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2
Q

What is the most common 2 types of tumors of the nervous system?

A

Gliomas and meningiomas are the most common.

90% of all tumors

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3
Q

In children where in the brain do tumors most commonly grow and what type of tumor is that?

A

Most of tumours in the Cerebellum,

The tumor type is PNET (medulloblastoma)

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4
Q

In adult where in the brain do tumors most commonly grow and what type of tumor is that?

A

Most of the tumors from in the Cerebrum

They are either Glioma and Meningioma

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5
Q

What type of tumor of the nervous system is common in men and ladies.

A

Males: Gliomas
Females: Meningioma

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6
Q

What are the 3 structures that tumors can grow in in the CNS?

A

Arachnoid membrane and pia-matter
Blood vessels
Glia

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7
Q

What are all the different types of of glia cells? What is each of there functions

A

Astrocytes (support and protect)
Oligodendrocytes (myelin
Ependymal cells and choroid plexus cells (CSF)
Microglia (defense)

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8
Q

Where is microglia produced?

A

In the bone marrow and then migrate to the blood stream

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9
Q

What is Microglia ?

A

Microglia are a type of glial cell that are the resident macrophages of the brain and spinal cord, and thus act as the first and main form of active immune defense in the central nervous system (CNS)

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10
Q

What are the characteristics of a benign tumor?

A 
Slow growing
Respect surrounding tissue
No/slow progression
No recurrence
Surgery
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11
Q

What are the characteristics of a Malignant tumor?

A 
Rapid growing
Invade and destroy surrounding tissue
Progress 
Recurrent 
Surgery and adjuvant therapy
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12
Q

What is the Grading and biological behaviour in brain tumours?

A

I: benign, no recurrence, no/very slow progression
II: low grade, progression (Astrocytoma 6-7y)
III: high grade, rapid progression (Astrocytoma 2-3 y)
IV: aggressive –> die within one year

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13
Q

What is the histological criteria for malignancy in brain tumour?

A

Cellular density and atypia

Mitotic activity –> if you see this its grade 3

Necrosis

Vascular proliferation –> see this and or necrosis –> glyglastoma is stage 4

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14
Q

What is a glioma?

A

A malignant tumour of the glial tissue of the nervous system.

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15
Q

GIve 3 examples of gliomas

A

Astrocytic tumours
Oligodendroglioma
Ependymoma

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16
Q

What are the microscopical features of astrocytic Tumours?

A

Fine fibrillary and microcystic background

Increased cellular density

Pleomorphism ( variation in size, shape and chromasia)

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17
Q

What is the characteristics of Diffuse astrocytoma II?

A

Infiltrative, microcystic, fibrillary

Low cellular density

Mild atypia

No mitotic activity

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18
Q

what is the characterstics of Anaplastic astrocytoma III?

A

Moderate cellular density

Moderate Pleomorphism –> more than one form

Mitoses

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19
Q

What is the characterstics Glioblastoma IV?

A

High cellular density and mitoses

Necrosis

Vascular proliferation

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20
Q

What group of people is Pilocytic astrocytoma I common in? Where in the CNS does it effect?

A

Children and affects the cerebellum

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21
Q

What are the characteristics of Pilocytic astrocytoma I?

A 
Well-defined, cystic
Pilocytes -->  very thin like hair 
Rosenthal fibres 
Vascular proliferation 
Good prognosis
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22
Q

What are the characteristics of Oligodendroglioma II / III ?

A

Round uniform nuclei with clear cytoplasm (fried-egg appearance)

Arborising capillaries (chicken wire)

Calcifications

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23
Q

What are the characteristics of OEpendymoma II / III?

A

Well-defined tumour, ventricles

Pseudorosettes

Round small uniform cells

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24
Q

What are the characteristics of Meningioma I ?

A

Females, dura, adults

Well-defined extra-axial tumour

Whorls, psammoma bodies

Usually benign and arise from meningeal tissue of the brain

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25
Q

What is the prognossis of Meningioma I ?

A

Usually benign

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26
Q

What group of people is PNET (medulloblastoma) IV common in? Where does it effect?

A

Children, cerebellum

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27
Q

What is the characteristics of PNET (medulloblastoma) IV?

A

Very high cellular density
Anaplastic hyperchromatic cells
Frequent mitoses and apoptosis
Rosette formation

28
Q

GIve me three examples of nerve sheath tumours

A

Spindle-cell tumours
Schwannoma I
Neurofibroma I

29
Q

What are the characteristics of Schwannoma I?

A

8th cranial nerve
Biphasic pattern: loose and dense areas
Reticulin

30
Q

What are the characteristics of Neurofibroma I?

A

Spinal nerves

Rich in collagen

31
Q

What is the cause of meningioma ?

A

Radiotherapy

32
Q

What is the cause of lymphoma?

A

Immunosupression

33
Q

What self renewal of stem cells is the WNT signalling pathway invovled in? What tumorigenesis is formed if the pathway goes wrong?

A

Normally form: Haematopoietic, epidermal and gut

Tumorigenesis: Colon carcinoma and epidermal tumours

34
Q

What self renewal of stem cells is the Shh signalling pathway invovled in? What tumorigenesis is formed if the pathway goes wrong?

A

Normal: Haematopoietic, neural and germ line

Tumorigenesis: Medulloblastome
Basal cell carcinoma

35
Q

What self renewal of stem cells is the Notch signalling pathway invovled in? What tumorigenesis is formed if the pathway goes wrong?

A

Normal: Haematopoietic, neural and germ line

Tumorigenesis: Leukaemia and Mammary tumours

36
Q

What four markers present as the most relevant molecular diagnostics of gliomas?

A

MGMT promoter methylation

1p/19q deletion:

IDH1/IDH2 mutation:

BRAF duplication/fusion:

37
Q

What is IDH1/IDH2 mutation and BRAF duplication/fusion diagnostic markers for?

A

IDH1/IDH2 mutation: Diagnostic marker for diffuse WHO grade II and III gliomas as well as secondary glioblastomas and associated with a better prognosis in these tumors.

BRAF duplication/fusion: Diagnostic marker for pilocytic astrocytomas, helpful to distinguish these from diffuse astrocytomas.

38
Q

What does MGMT promoter methylation indicate for diagnostics of gliomas?

A

Predictive for response of glioblastomas to alkylating chemotherapy
Associated with longer survival of glioblastoma patients treated with radiotherapy combined with concurrent and adjuvant temozolomide
Prognostic in anaplastic glioma patients treated with radio- and/or alkylating chemotherapy

39
Q

What does I1p/19q deletion indicate for diagnostics of gliomas?

A

Associated with better prognosis in (oligodendro)glial tumor patients receiving adjuvant radio and/ or chemotherapy.
Not predictive for response to a particular type of therapy

40
Q

What is the most common presenation of intracranial tumors?

A

Pressure symptoms: headache (50%), N+V, confusion, reduced conscious level.

Seizures (50%)

Focal symptoms due to location (eg weakness, dysphasia) –> missed diagnosed as stroke

41
Q

What are the different treatments for intracranial pressure?

A

Steroids –> reducing the swelling around the tumor and help to relieve the symptoms caused by ICP

Anti-epileptics
Surgery
Radiotherapy
Chemotherapy

42
Q

What is the side effect of steroids?

A

But can get steroid side effects

Weight gain, hair loss , round face

43
Q

What is the side effect of Anti-epileptics?

A

Interact with other drugs –> the old ones

Sedation, personality changes

44
Q

What is radiotherapy?

A

Radiotherapy is the use of X-rays to treat tumours. Carefully controlled high energy X-ray beams are focused on the tumour.

These beams travel through the skin to the tumour. They are painless and invisible.

45
Q

What is the difference between proton and photon treatment?

A

Cure wise the protons are exactly the same as photons.

The difference is that Protons don’t give higher dose and effect on other parts of the brain that the area being targeted.

It is more accurate and therefore reduces side effects

46
Q

What group of people is proton treatment very effective?

A

For children as it prevents future problems from occuring

47
Q

What are the acute side effects of radiotherapy?

A

Cerebral oedema causing raised ICP & exacerbation of pre-RT neurological symptoms

  1. Hair loss
  2. Scalp / ear erythema
48
Q

What are the intermediate side effects of radiotherapy?

A

Somnolence syndrome (severe tiredness) & exacerbation of existing neurological symptoms

49
Q

What are the later side effects of radiotherapy?

A

Damage to sensitive structures

eg; lens (cataracts)

pituitary (hypopituitarism)

cerebral hemispheres (memory loss)

50
Q

When is radiotherapy not recommended for high grade gliomas (grade 3 and 4 gliomas?

A

If elderly or poor PS may die of brain tumour within 3/12s, before recovered from the side-effects of RT

51
Q

When is radiotherapy recommended for high grade gliomas (grade 3 and 4 gliomas?

A

If young & fit then could live for several years after RT

52
Q

What are the treatment outcomes for each grade of gliomas?

A

Grade 1 Many years (cured if complete resection)

Grade 2 5 - 12 years (depending on type)

Grade 3 2 - 4 years (depending on type)

Grade 4 6 - 18 months (depending on prognostic factors)

53
Q

What CNS tumors are curative by treatment?

A

Certain rare CNS tumours eg
germ cell tumours
medulloblastomas

54
Q

When is chemotherapy used?

A

Can be used palliatively

Can also be used to enhance the effectiveness of radiotherapy

55
Q

What are the presentations of tumour?

A

Raised intracranial pressure

Epilepsy

neurological deficit

endocrine dysfunction –> affect the hypothalamus and

endocrine galnds

incidental

56
Q

What symptoms do you get with raised ICP?

A

Headaches (early morning)
vomiting
blurred vision

57
Q

What can raised ICP be a indication of?

A

Tumor mass
surrounding edema
obstructive hydrocephalus

58
Q

what can seizures indicate?

A

Partial/complex partial/secondary generalized

supratentorial tumors

59
Q

What are the different Neurological deficits?

A 
cognitive
visual
cranial nerve
motor
sensory
60
Q

What are the investigations are done for intracranial tumors?

A 
Haematological
Tumor markers- aFP,Bhcg,PSA 
Hormonal assay
Visual fields
Chest X ray
61
Q

What does Ct scan show for the scan of the brain?

A

Bony structure mainly

62
Q

What does MRI scan mainly show for the scan of the brain?

A

soft tissue

63
Q

What does fMRI show?

A

Can use MRI scan to follow the function of the brain when doing a activity. See which part of the brain is defected

64
Q

What is the aims of surgery on intracranial tumour?

A

Diagnostic
Remove mass effect and alleviate symptoms
Treat complications

65
Q

What are the different surgery options?

A 
Biopsy
Stereotactic
Neuro-navigation
endoscopic
Free hand

excision
total
partial

66
Q

What does a Frozen section show when examaning the brain?

A

Confirm abnormal tissue

Normal/abnormal difficult to establish operatively for some intrinsic tumours
Oedema surrounding tumor can look abnormal
Subsequent tumour resection can proceed

67
Q

What does 5-ALA show?

A

Give this IV –> the tumor cells show up as pink –> different color –> easier to detect

syposium control and movement (11 decks)

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