Neuro Oncology

Question 1

Arise from different cell types in CNS

*wide prognosis variety

Answer 1

Primary Brain Tumors

Question 2

• tumor from other part (breast, lung, skin)

* Tx = ex. BREAST cancer Tx, not brain cancer tx

Answer 2

Secondary / Metastatic Brain Tumor

• if Brain tumor, always look at rest of body first
• ALWAYS STAGE 4

Question 3

Primary Brain Tumors

Who?

Answer 3

*Caucasions >

• Men = MORE malignant , LESS menigiomas (SMOKING LINK)
• Women = MORE meningiomas, LESS malignant
• up w/ age
• HIV + = primary brain lymphoma

Question 4

Brain Tumors

Risk factors

Answer 4

• Ionizing radiation
• HIV + (primary brain lymphoma)

PROTECTIVE: asthma/allergies,
fruits/veg

NO PROOF: cell phones, pesticides, smoking/alcohol (but metastatic risk)

Question 5

ID tumor with scan 100%?

Answer 5

NO

Question 6

Primary Brain Tumor

Types

Answer 6

• Glial
• Meningiomas
• Pituitary Tumors
• Primary Brain Lymphoma
• Peds tumors

Question 7

• kids
• cerebellum (also brain stem/optic nerve)
• slow grow, curable if resectable

Answer 7

Astrocytomas/Gliomas
Pilocytic astrocytomas

Grade I LOW
*good prognosis

Question 8

• invasive
• difficult to resect
• slow grow

Answer 8

Astrocytomas/Gliomas

Grade II LOW
*tx - chemo, steroids, surgery, radiation

Question 9

• fast grow

* poor cell differentiation

Answer 9

Astrocytomas/Gliomas

Tx: debulking surgery (LIFE-EXTENSION), radiation, temozolomide chemo

Stage III HIGH
*poor prognosis

Question 10

*FINGER-LIKE PROJECTIONS

Unresectable

Answer 10

Astrocytomas/Gliomas

*Tx: Debulking surgery, radiation, temozolomide chemo

Grade IV HIGH (GLIOBLASTOMA)
*Median survival time: 2 years

Question 11

• ependymal lining of ventricles

* who: children/young adults

Answer 11

Ependymomas

*prognosis = variable (location, tissue invasion, biopsy : genotype tumor)
= recurrent tumors : poor

Question 12

• CALCIFICATION IN TUMOR
• well-differentiated (good), diffusely infiltrating (bad)
• ADULTS

Answer 12

Oligodendrogliomas

PROGRESS from low to high

• low grade= “classic”
• high grade = “anaplastic”

Question 13

• VERY slow-growing

* meninges= brain surface, spinal cord, maybe ventricles

Answer 13

Meningiomas
*BENIGN (but watch ICP)

*excellent prognosis

Question 14

Meningioma

Risk factors

Answer 14

• Neurofibromatosis Type 2
• Female + Estrogen exposure (obese)
• Ionizing radiation

Question 15

**Brain tumors worse during… (time of day)

Answer 15

Morning

*laying down raises ICP, rising lowers

Question 16

*WIDE DISSEMINATION (resection difficulty)

IMMUNODEFICIENCY -(HIV, EBV)

Answer 16

Primary Brain Lymphoma

IMMUNODEFICIENCY - Find cause!! (HIV, EBV)
*HIV defining

Question 17

Brain images = TUMOR:

Watch for

Answer 17

• Midline deviation

* Smaller ventricle (also watch turning of head during imaging)

Question 18

• Headache
• Seizure
• Elevated ICP (N/V, papilledema)
• Focal neuro deficits

S/S?

Answer 18

CNS Tumor

Question 19

Brain Tumor

Headache

Answer 19

• bifrontal

* RED ALERT = wakes from sleep, progressively worsening

Question 20

Brain Tumor

Seizure

Answer 20

Vary on location

*RULE-OUT = Syncope (some twitching) from UP ICP

Question 21

Seizure characteristics

Answer 21

• NOT crossing midline

* repeated firing of one muscle/group, going one way, NOT COORDINATED

Question 22

Brain Tumor

Elevated ICP from

Answer 22

• Mass Effect
• Obstructive Hydrocelphalus. = ventricle draining blocked (epyndoma?)
• TRIAD = HA, Nausea, Papilledema
• vomiting w/ position change
• syncope

Question 23

Brain Tumor

General Evaluation

Answer 23

• MRI (CT fast)
• Give radiologist Good Hx summary to localize s/s
• Evaluate for 2ndary metastasis from otherwhere
• Brain Biopsy
• LP = ONLY for primary brain lymphoma

Question 24

Tumor

Management

Answer 24

• Reduce Edema = Steroids
• Obstructive hydrocephalus = Urgent (next few hours) surgery
• anti-convulsants
• Urgent referral Neurosurgery/Brain Tumor team

Question 25

Tumor Tx

Answer 25

* Surgery , radiation, chemo (hard to cross BBB) * meningioma = surgery * glioblastoma = nothing * tumor DNA markers * BRAIN TUMOR TEAM

Question 26

Spinal tumors Tissue type

Answer 26

Bone OR Neural tissue

Question 27

Metastases to the Spine

Answer 27

LUNG, Breast, renal cell, melanoma, lymphoma

Question 28

Back pain, leg tingling + cancer risk factors Think...

Answer 28

Metastases to Spine!!

Question 29

Spinal Tumor History RED FLAG

Answer 29

*loss of bowel/bladder control (ER - need surgery now)

Question 30

Spinal Tumor PE

Answer 30

Complete Neuro (focal vs systemic?) Rectal exam Try to localize level of lesion

Question 31

Spinal Tumor Imaging

Answer 31

MRI w/ gadolinium contrast IF CAN'T = CT (id acute spinal cord compression)

Question 32

Spinal Cord Tx

Answer 32

* surgery * chemo * focused radiation

Question 33

Radiation evolution

Answer 33

Gamma knife --> Stereotactic --> Proton radiation

Question 34

*TRIAD = HA, Nausea, Papilledema S/S?

Answer 34

Elevated ICP