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Management of Neuropsychiatric Disorders > Neuro/psycho-oncology > Flashcards

Neuro/psycho-oncology Flashcards

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1
Q

incidence of brain tumours?

A

15 cases /100,000 population/ year

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2
Q

prevalence of brain tumours

A

11,000 new cases per year

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3
Q

how many brain tumours per year are gliomas

A

5000

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4
Q

most common cancers

A

breast
lung
large bowel
prostate

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5
Q

primary brain tumours

A

meningioma
glioma
glioneuronal
neuroepithelial
pituitary
primary CNS

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6
Q

types of gliomas

A

glioblastoma multiforme
low grade gliomas
ependymoma (rare)

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7
Q

what are the two types of low grade gliomas

A

astrocyteoma
oligodendroglioma

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8
Q

WHO grading of extrinsic meningiomas

A

grade 1 (most common)
grade 2 (atypical and often post radiotherapy)
grade 3 (very rare and a poor prognosis)

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9
Q

what are two examples of intrinsic brain tomours

A

glioma
lymphoma

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10
Q

WHO grading of intrinsic gliomas

A

grade 1 (pilocytic astrocytoma)
grade 2 (oligodendroglioma or astrocytoma)
grade 3 (anaplastic astrocytoma or anaplastic oligodendroglioma
grade 4 (glioblastoma multiforme)

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11
Q

presentation and sx of diffuse astrocytoma

A

asymptomatic
seizures
raised ICP
focal neurological deficit
cognitive decline
personality change

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12
Q

likelihood of seizures in patients with brain tumours

A

40-60%

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13
Q

likelihood of seizures in patients with low grade gliomas

A

65-95%

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14
Q

likelihood of seizures in high grade gliomas

A

12-255

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15
Q

likelihood of seizures in patients with mets

A

25%

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16
Q

likelihood of seizures in pt with meningiomas

A

25%

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17
Q

sx of raised ICP

A

headache (worse in morning)
vomiting
diplopia
drowsiness
confusion
unsteady
hiccoughs
cushings triad - high bp, low pulse, respiration

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18
Q

focal neurological deficit

A

focal loss of function over days to weeks of limbs, eyes and face
cognitive decline/ personality change (esp. from tumours affecting the temporal and frontal lobes)

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19
Q

which factors increase survival

A

surgery (extent of resection, gliolan, dafer surgeries eg. intraoperative MRI)
oncology tx (temozolamide)
molecular pathology

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20
Q

Gliolan

A

Gliolan is a fluorescent dye, indicated in adults for visualisation of malignant tissue during surgery for malignant glioma (WHO grade III and IV)

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21
Q

temozolomide for (high grade) glioblastoma

A

follow up after 28 months
26.5% survival rate with radiotherapy plus temozolomide vs 10.4% survival rate with radiotherapy alone

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22
Q

DC vaccine

A

dendritic cell vaccine, is a type of cancer vaccine that utilizes the body’s own immune cells (dendritic cells) to recognize and attack cancer cells

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23
Q

molecular pathology

A

methylation status predicts response to chemo
methylated patients respond better to temozolomide

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24
Q

stupp protocol

A

It consists of radiation therapy and concomitant chemotherapy with temozolomide
This therapy resulted in a significant survival improvement at 2 years:
26.5% vs 10.4%

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25
tx of low grade gliomas
Radiotherapy PLUS PCV prolongs both progression-free and overall survival compared with RT alone. – Median survival is increased by 5.5 years. – Five-year and 10-year survival are increased by 9%and 20%, respectively
26
seizure management in tumour associated epilepsy
treat after first seizure avoid enzyme inducing AEDs prophylaxis is unevidenced tumour treatment prioritised use AEDs from different groups
27
commonest brain tumours in adults
meningioma and glioma
28
what are some predictors of mental health problems in cancer
young age lower socioeconomic poor functioning pain fatigue comorbidity severe illness poor prognosis
29
according to a KCH internal audit what are the main domains of concern in cancer patients
physical emotional practical family/ relationships (spiritual)
29
what are the top five concerns expressed by cancer patients
worry/ fear/ anxiety tiredness/ fatigue breathing thinking about the future cough
30
what are the psychiatric effects of cancer
mass effect from the primary or metastatic tumour itself systemic depletion of substances e.g. nutrition hormone secretion from active tumours paraneoplastic hormone secretion onconeural antibodies cytokine release and proinflammatory action
30
what are the psychiatric effects of treatment
Surgery to CNS Surgery to distant sites (e.g. GI > B12 deficiency) Radiotherapy to CNS or distant sites (e.g. hypothyroidism) Chemotherapy – indirect pathways or direct neurotoxicity Steroids Small molecular targets (e.g. tyrosine kinase inhibitors in CML) Monoclonal antibodies CAR-T immunotherapy
31
what is the route of negative feedback
hypothalamus anterior pituitary glands (e.g. adrenal, ovaries/ testes, thyroid, other organs)
32
what is Cushing's syndrome
A syndrome of chronic, low level, hypercortisolaemia
33
what are some of the physical features of Cushing's syndrome
upper body obesity with thin arms and legs buffalo hump red, round face high blood sugar high bp water retention
34
what are neuropsychiatric features of Cushing's syndrome
severe depression cognitive difficulties emotional instability sleep disorders fatigue
35
causes of Cushing's syndrome (hypercortisolaemia)
active pituitary tumour secreting ACTH Paraneoplastic ACTH secretion small cell lung cancer Thyroid medullary tumour secreting ACTH Adrenocortical tumour secreting glucocorticoids (rare)
36
what is the most common tx for cushing's syndrome
corticosteroids
37
problems with steroids
lower doses can cause depressed mood, anxiety, insomnia, agitation or euphoria can exacerbate underlying mental health problems higher doses can cause severe psychosis or mania
38
physical sx of hypothyroidism
hair loss feeling cold slow heart rate constipation weight gain
39
psychiatric sx of hypothyroidism
fatigue mood and memory changes
40
what can cause hypothyroidism
Destruction of the hypothalamus or pituitary Thyroid damage from surgery Thyroid damage from radiation for head and neck tumours (40% post-treatment) Some molecular treatments (VEGFi) and monoclonal antibodies > autoimmune thyroiditis
41
VEGFi
Vascular endothelial growth factor (VEGF) inhibitors
42
testicular cancers
some testicular cancers secrete beta-human chorionic gonadotropin which mimics TSH causing hyperthyroidism
43
oestrogen
Neuroprotective, increases serotonin synthesis, promotes neuroplasticity
44
oestrogen deficiency
increases risk of depression and dementia
45
what can cause oestrogen deficiency
Oophorectomy pelvic irradiation oestrogen-receptor blockers hypothalamus pituitary surgery irradiation
46
psychiatric effects of growth hormone deficiency
depression anxiety attention memory deficits
47
causes of growth hormone deficiency
pituitary surgery/ irradiation hypothalamic surgery or irradiation
48
what are onconeural antibodies
antibodies produced by tumour cells that bind to targets in the CNS anti-hu anti-yo nmda antibodies
49
what % of pt have cognitive deficits after brain irradiation
50-90%
50
effects of radiotherapy
cognitive deficits 10 point drop in IQ (memory and attention)
51
which factors worsen effects of radiotherapy
intrathecal chemotherapy (into the subarachnoid spine space) e.g. methotrexate hormonal effects of pituitary irradiation
52
what is chemo brain
brain fog and subjective cognitive difficulties (controversial)
53
which factors complicate 'chemo brain'
effects of cancer other treatments psychological stress insomnia
54
which genotype may be associated with 'chemo brain'
APOe4
55
causes of chemotherapy induced cognitive impairment (CICI)
direct neurotoxicity impaired neurogenesis white matter abnormalities oxidative stress response immune dysregulation cerebral vascular alteration alteration of long term potentiation hormonal driven changes cancer induced cognitive impairment
56
what causes progressive multifocal leukoencephalopathy (pml)
reactivation of the JC virus in individuals with a weakened immune response
57
what is the effect of reactivation of the JC virus
irreversible oligodendrocyte invasion and demyelination
58
what is the tx for pml
monoclonal antibodies e.g rituximab anti-CD20 chemotherapy
59
PML frequently occurs as an effect of which condition
HIV/AIDS
60
sx of PML
progressive weakness speech problems cognitive deficits personality change seizures death
61
what is CAR T cell therapy
blood is taken from the pt to get their T cells CAR T cells are made in the lab millions of CAR T cells are made in the lab CAR T cells are infused into the pt CAR T cells bind to cancer cells and kills them
62
what does CAR T stand for
Chimeric Antigen Receptor T cell
63
what are protein targets and common tx uses of CAR T cells
CD19 for B cell lymphomas CD30 for Hodgkin's BCMA for myeloma CD33, CD123 and FTL3 for acute myeloid leukaemia solid tumours
64
what is cytokine release syndrome
CAR-T prompts massive inflammatory response Systemic cytokine release causes sepsis-like symptoms CAR-related encephalopathy syndrome (CRES)
65
what are the sx of CAR related encephalopathy syndrome (CRES)
headache cognitive impairment confusion agitation hallucinations aphasia motor weakness and tremor seizures impaired conciousness
66
what is the duration CAR related encephalopathy syndrome
temporary and reversible

Management of Neuropsychiatric Disorders (25 decks)

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