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Clin Med - NEURO > Neoplasms > Flashcards

Neoplasms Flashcards

1
Q

what is a tumor

A

abnormal mass of tissue resulting from a DNA mutation
OR
cells not dying when its the usual time (failure of apoptosis)

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2
Q

what are the types of cancers

A

Carcinoma
Sarcoma
Blastoma

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3
Q

what are carcinomas

A

arise from epithelial cells, most common type of cancer, 80-90% of cancers

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4
Q

what are examples of carcinomas

A

adenocarcinoma
squamous cell carcinoma
basal cell carcinoma

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5
Q

what is a sarcoma

A

arise from connective tissue cells, including bone cartilage, fat, tendon, muscle

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6
Q

what are examples of sarcomas

A

osteosarcoma
myosarcoma
chondrosarcoma
liposarcoma

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7
Q

what is a blastoma

A

arise from immature cells of the cell line, “-blast”

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8
Q

what are examples of blastoma

A

glioblastoma
hepatoblastoma
retinoblastoma

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9
Q

what are benign/noncancerous lesion

A

generally less harmful
do not locally invade other tissues or parts of the body
do not spread via blood or lymph
can grow very large
cells are well differentiated

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10
Q

what is malignant/cancerous lesions

A

capacity to spread and form new tumors in other tissues or organs
can locally invade surrounding tissue
can spread via blood or lymph
grow quickly
cells are poorly differentiated

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11
Q

what is angiogenesis

A

growth of new blood vessels to feed tumor

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12
Q

what are the primary brain tumors

A

glioblastoma
astrocytoma
oligodendroglioma
ependymoma
meningioma
schwannoma
pituitary tumor

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13
Q

what is the most common primary malignant brain tumor in adults

A

glioblastomas

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14
Q

what is the most common benign brain tumor in adults

A

meningioma

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15
Q

what is the most common neoplasm in kids

A

primary neoplasms which originate in the CNS

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16
Q

what is the most common neoplasm in adults

A

metastatic or secondary neoplasms

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17
Q

what is our brain primarily made up of

A

Glial cell and Neurons

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18
Q

what falls under WHO low grade

A

Grade 1 and 2

less aggressive

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19
Q

what falls under WHO high grade

A

Grade 3 and 4

more aggressive

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20
Q

what are WHO grade 1 tumors

A

low grade
non-infiltrative
least malignant (benign)
possibly curable via surgery alone
long-term survival
slow growing

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21
Q

what are WHO grade 2 tumors

A

low grade
relatively slow growing
somewhat infiltrative
may recur as higher grade

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22
Q

what are WHO grade 3 tumors

A

high grade
malignant
infiltrative
tend to recur as higher grade

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23
Q

what are WHO grade 4 tumors

A

most malignant
rapid growth, aggressive
widely infiltrative
rapid recurrence
Necrosis prone

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24
Q

what grade tumor is a meningioma

A

WHO grade 4

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25
Q

what is important about the signs and symptoms of neoplasms

A

duration and intensity and progression

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26
Q

what are important imaging for neoplasms

A

CT is quick and dirty
MRI is gold standard (shows edema)
if tumor enhances with contrast on CT, that means chemo can also get through BBB

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27
Q

what is the gold standard for diagnosing a neoplasm

A

MRI - shows edema and lesions

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28
Q

what are treatment options dependent on for CNS neuroplasms

A

dependent on patients wishes, age, and type of tumor

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29
Q

what are the common symptoms of neoplasms

A

headaches
N/V
seizures (focal or localized depending on location)
cranial nerve palsies
neurocognitive disturbances
psychiatric symptoms

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30
Q

what are the mechanisms that cause symptoms of neoplasms

A

compression and destruction of health brain tissue
production of hormones
tumor growth

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31
Q

if a patient presents with CN deficits, incorrdination/imbalance, ataxia, hydrocephalus and possible coma - what location is most likely for a tumor

A

Cerebellum

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32
Q

if a patient presents with sensory loss, motor incoordination, agniosia, visuospatial processing, apraxia, visual field cut - what location is most likely for a tumor

A

Parietal lobe

33
Q

what are the common symptoms for a frontal lobe tumor

A

hemiparesis
dysphasia
abulia
altered personality

34
Q

what are the common symptoms with an occipital lobe tumor

A

visual field cut

35
Q

if a patient presents with auditory/olfactory hallucinations, seizures, memory impairment, dysphasia and visual field cut - where is the most likely location for a tumor

A

temporal lobe

36
Q

how are CNS neoplasms managed

A

control cerebral edema with steroid (dexamethasone)
ASM (only if applicable)
CSF shunt for hydrocephalus
surgery, radiation, chemo, embolize and shrink tumor pre-operatively or if not surgical candidate

37
Q

what are the risk factors with treatment of CNS neoplasms

A

inoizing radiation exposure (radiation therapy for prior malignancy, diagnostic imaging, ? cellhpone)
immune compromise
genetic syndromes

38
Q

what population is more likely to develop a meningioma

A

women > men

39
Q

what genetic syndromes increase your risk of neoplasm

A

NF1 and 2, Tuberous sclerosis, Turcot syndrome, Van-Hippel-Lindau

40
Q

what is supratentorial

A

cerebral cortex

41
Q

what is infratentorial

A

cerebellum, brain stem, pituitary

42
Q

what are gliomas

A

glial cell tumors - 1/3 of all brain tumors

43
Q

what are the different types of gliomas

A

astrocytomas
brain stem gliomas
ependymomas
oligodendrogliomas

44
Q

what is an ependymomas

A

rare, more common in kids. from ependymal cells lining ventricles and spinal cord.
associated with hydrocephalus when they block the flow of CSF. associated with drop metastases

45
Q

what type of tumor is associated with drop metastases

A

ependymomas

46
Q

what is the presentation of oligodendrogliomas

A

better prognosis than other gliomas, commonly in men, commonly present with seizures (50-80%)

47
Q

what are the common symptoms of gliomas

A

mainly from mass effect and compression of brain tissue or spinal cord - Headaches, seizures, personality changes, weakness, numbness, problems with speech, N/V, vision loss, dizziness

48
Q

what is glioblastoma multiforme

A

supratentorial and is the most common form of glioma, can cross corpus collosum into other hemisphere (butterfly)
WHO IV diffusely infiltrating astrocytoma (can occur anywhere in CNS but mostly cerebral)
median age of diagnosis is 65 (age is biggest risk factor)

INCURABLE
median survival 15 months with maximal therapy

49
Q

what are the treatment options for glioblastomas

A

Incurable
surgery, chemotherapy, radiation therapies

greater the extent of resection, the greater the survival benefit
surgical techniques are progressing but still have very poor prognosis

50
Q

where are meningiomas located

A

supratentorial

51
Q

what are meningiomas

A

graded 1-3, usually slow growing and 85-90% are benign - often discovered incidentally

52
Q

what population are meningiomas associated with

A

F>M (3:1), most frequently occur in people in 70s-80s

53
Q

what are the risks of meningiomas

A

radiation therapy, prolonged use of certain hormones, neurofibromatosis type 2

54
Q

what do meningiomas arise from

A

arachnoid mater of meninges, often occur on surface of brain under dura mater, attachment to dura via a dural “base” or “tail”

right beneath skull, so irritated adjacent bone may proliferate - hyperostosis

55
Q

what is hyperostosis

A

irritated adjacent bone may proliferate

56
Q

how are meningiomas treated

A

for benign and slow growing - observation and regular imaging
surgery and radiation for more aggressive tumors or ones that are causing symptoms

57
Q

what is another name for schwannomas

A

acoustic neuroma

58
Q

what are schwann cells

A

types of glial cell (myelin insulates axon) - electrical impulse/action potential propagation

59
Q

where are schwannomas usually found

A

around peripheral nerves, usually benign and dont invade or metastasize
usually around CN8 - vestibulocochlear

60
Q

what is the growth pattern for Schwannomas

A

grow very slowly, but can compress nerves, obstruct arteries, veins or flow of CSF

61
Q

what are typical symptoms of Schwannomas

A

relate mainly to nerve compression and depend on location
acoustic neuroma -unilateral hearing loss, tinnitus, balance, facial weakness/paralysis if compressing facial nerve
pain can also be a symptom

62
Q

how are schwannomas diagnosed

A

CT or MRI - also checking auditory brainstem response test (measuring evoked action potential from sound)

63
Q

what is the treatment for Schwannomas

A

surgery

64
Q

what is a pituitary adenoma

A

formed by the hormone secreting cells of the anterior pituitary
typically benign, do not invade neighboring tissues but can compress.

65
Q

what are pituitary adenomas very close to

A

optic chiasm - can cause bitemporal hemianopsia (blindness in outer halves of both R&L visual fields)

66
Q

how are Pituitary adenomas differentiated

A

by size
Microadenoma < 1cm
Macroadenoma > 1cm

67
Q

what is the most common hormone associated with pituitary adenomas

A

Prolactinoma - functional adenoma

68
Q

what is associated with growth hormone secreting adenomas

A

gigantism (kids)
acromegaly (adults)

69
Q

what is associated with adrenocorticotropic hormone secreting tumor

A

excess cortisol - cushing disease

70
Q

what is seen with cushings syndrome caused by tumor

A

moon facies, buffalo hump, truncal obestiy

71
Q

what is a gonadotroph derived adenomas

A

most frequent non-functional tumors, clinically silent

72
Q

how are pituitary adenomas diagnosed

A

MRI

73
Q

how are pituitary adenomas treatede

A

depends on type and size
some managed medically others surgically
transsphenoidal resection
in nonfunctional, only treated if compressing

74
Q

what are the primary 3 brain metastases from

A

lung cancer
breast cancer
melanoma

75
Q

what are differential diagnosis of brain metastases

A

infection
abscess
demyelinating disease such as MS
Primary brain tumor

76
Q

what is the prognosis factors for brain metastases

A

patient age
number and size of metastases
site of primary tumor
any other sites of metastases
sensitivity of the tumor to radiation or chemotherapy
presence of mass effect

77
Q

what are potential complications of brain mets

A

mass effect
brain herniation
seizures
hydrocephalus
invasion of surrounding tissues
neurological deficit
death

78
Q

what are the treatments for brain metastases

A

surgical resection
radiation (whole brain vs stereotactic)
chemotherapy
immunotherapy

Clin Med - NEURO (13 decks)

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