Test 2 Flashcards by Courtney W

Malignant proliferation of plasma cells that results in an overproduction of the specific immunoglobulin, monoclonal (M) proteins
Generally detected in blood and protein by detecting M protein (1-2% don’t have M protein)
Accounts for 14% of all malignancies
Slow-growing neoplasm typified by long, asymptomatic period
Poor prognosis, increases for younger patients; survival range from few months to 10 years

Multiple myeloma (MM)

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No known cause of MM but 6 factors that correlate with it

Increases with age (predominant factor)
More common in men and African Americans because they have higher immunoglobulin than caucasians
Exposure to low level radiation
Occupational exposure: agricultural pesticides/chemicals, rubber plants, and leather tanner chemicals
Chemical exposure to benzene for cleaning
Genetics and obesity

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4 signs and symptoms of MM

Systemic bone disease
Renal disease: hydration very important
Increased calcium, anemia, and/or infections
Sometimes abnormal protein in blood or urine: M protein

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Plasma cells develop and take/”punch” out density of bones and develop lytic lesions (black spots on radiographs); if continuous patient may end up with osteoporosis
70%; leads to bone pain, weak bones can lead to fractures, and spinal compression

Systemic bone disease

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2 renal diseases caused by MM

Hypercalcemia

Hyperuricemia

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Calcium enters blood through lytic lesions; lytic bone disease and immobility
Treated with vigorous hydration, dialysis, and using corticosteroids to block osteoclast activity

Hypercalcemia

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High uric acid in blood

Hyperuricemia

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5 MM diagnostic studies

Urinary analysis: M protein
Immunoglobulin test
Skeletal survey: degree of bone marrow involvement, plasmacytoma, and lytic lesions (metastatic, treated with RT or surgery)
CBC
Chemical studies: renal function and hypercalcemia

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Discrete, solitary mass of neoplastic monoclonal plasma cells in bone or soft tissue can develop into MM; treated with RT or surgery

Plasmacytoma

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How does MM metastasize?

Hematogenous spread by blood

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2 treatments of MM

Radiation

Chemo

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Treatment for local controld of MM

Radiation

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Can see long term remission of MM over over ___ years with radiation treatment

5 years

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MM response to RT

75% reduction in rate of MM protein production

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Patients over 70 years old with MM treated symptomatically (slow growing, indolent tumor); traditional chemo, etc. to prolong life by about ___ years

3 years

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Reduces temporary remission of MM, incurable but patients may go into remission
Alkylating agents and prednisone (steroid)
High dose with stem cell transplant

Chemo

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Specific biological agents for immune system

Thalidomide

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3 side effects of MM treatment

Drug resistance
Infection
Leukemia (alkylating agents)

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Bone marrow transplants for MM patients over ____ years old

60 years old

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5 year survival of MM; ___-___% achieve disease free survival over 5 years

45-50%

25-30%

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9 disease related complications of MM

Thrombocytopenia
Severe anemia
Leukopenia and renal failure
Spinal cord compression
Hypercalcemia
Dehydration
Lytic bone lesions
Pathologic fractures because of deterioration of bone
Repeated infections

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5 treatment related complications of MM

Myelosuppression
Renal insufficiency
Mental status changes
Neuropathy: biological agents
Cardiopulmonary toxicities

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Measures tumor burden by the number of myeloma-related bone lesions seen on a radiograph and the concentrations of serum calcium, serum M protein, ect.

Durie-Salmon system

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4 oncologic emergencies of MM

Spinal cord compression can become permanent damage if not handled fast
Hypercalcemia
Sepsis causes death in 20-50% of patients
Hyperviscosity

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Thickening of blood because of too many red blood cells (RBCs) caused by large amounts of M protein Neurological and cardiac complications, visual disturbances, headaches, confusion, and drowsiness

Hyperviscosity

Median survival of MM

3 years

Stage 1 MM 5 year survival and median survival

5 year survival = 50% | Median survival = 60 months

Stage 2 MM 5 year survival and median survival

5 year survival = 40% | Median survival = 41 months

Stage 3 MM 5 year survival and median survival

5 year survival = 10-25% | Median survival = 23 months

Arises from lymphoid tissues, may develop anywhere Caused by a malignant clonal expansion of one of the elements of a lymph node (LN) Elderly white males May begin in a LN, spleen, liver, and marrow and can be in skin, GI tract, pharynx, and CNS Painless enlarging LN unless infected, feel rubbery Heterogenous and sporadic spread; no Reed-Sternburg cells, non-biomodal age distribution Advanced not considered curable

Non Hodgkin's lymphoma (NHL)

Median age of diagnosis of NHL; NHL incidence increases ____% over 75 years old

67; 400%

LN suspicious for NHL

Supraclavicular LN

4 sites for NHL lymphadenopathy

Neck Armpit Groin Abdomen

________ LN involvement common in adults; kids present with ________ or ________ involvement and high grade disease (usually have B-symptoms)

Peripheral | GI or mediastinal

4 clinical features of NHL

Generalized painless lymphadenopathy Vague abdominal discomfort Back pain Gastrointestinal complaints

6 risk factors for NHL

Inherited immunodeficiency disease Acquired immunodeficiency disease Viral exposure Occupational exposure Environmental factors: cotton, hair dye, etc. Therapy factors: chemo, organ transplant, RT

3 viruses associated with NHL

HIV EBV associated with Burkitt lymphoma cases Human T-cell lymphoma

RT latent period of NHL

5-6 years

6 diagnostic workups for NHL

``` H&P CBC Sedimentation rate CT: thorax and abdominal area MRI Biopsy involved LNs ```

Cells can have different appearance (small, large, cleaved or noncleaved, vehicular, etc.)

Heterogenous

4 chemo drugs for NHL

Cyclophosphamide Doxorubicin Vincristine Prednisone (CHOP)

5 adverse prognostic factors of NHL

``` Age over 60 Stage III or IV Two or more extranodal sites Intermediate or high grade histology Masses greater than or equal to 10 cm ```

5 year and median survival of NHL

5 year = 60% | Median survival = up to 10 years if indolent tumor type

3 emergency procedures of NHL

Tumor lysis syndrome SVC syndrome Spinal cord compression by enlarged LN

When patients develop multiple electrolyte abnormalities due to the release of chemicals in the blood from the dying blast cells causes cardiac problems

Tymor lysis syndrome

LN pressing against SVC and compromising venous drainage of head, neck, and upper extremities can cause swelling, headaches, SOB, CP, and septic shock

SVC syndrome

Evolution of low grade lymphoma to high grade/diffuse large cell lymphoma

Richter's transformation

Most common NHL in kids | Treatment with high dose chemo, intrathecal chemo for CNS, radiation for bulky tumors, and bone marrow transplant

Lymphoblastic lymphoma

Rare, chronic, and progressive form of NHL arising in skin | Treatment: TSEI, topical chemo, UV light, and extracorporeal photopheresis for advanced disease

Mycosis fungoides

Form of apheresis and photodynamic therapy in which blood is treated with a photosensitizing agent and subsequently irradiated with specified wavelengths of light to achieve an effect

Extracorporeal photopheresis

Radioactive iodines (conjugant) target B-cells

Rituxan/zevalin

3 disease related complications of NHL

SVC syndrome CNS involvement Spinal cord involvement

Unhealthy pale appearance; change in color

Pallor

Anemia with a mean corpuscular volume (MCV) of 80–100 which is the normal range; however, the hematocrit and hemoglobin is decreased

Normocytic anemia

Form of anemia in which the concentration of hemoglobin in the red blood cells is within the standard range; however, there are insufficient numbers of red blood cells

Normochromic anemia

Displacement of hematologic bone marrow in blood

Myelophthisis

Minute red spots caused by the escape of small amounts of blood

Petechiae

Escape of blood into the tissues, causing large, blotchy areas of discoloration

Ecchymosis

Way cell looks

Grade

5 year survival rate of low grade NHL (more favorable; long term natural course without treatment, not curable

50-70%

Treatment of stage 1 & 2 and 3 & 4 low grade NHL

Stage 1 & 2 = RT and chemo | Stage 3 & 4 = watching and waiting, chemo when symptoms start

5 year survival rate of intermediate NHL

33-45%

Treatment of stage 1 & 2 and 3 & 4 intermediate NHL

Stage 1 & 2 = RT and chemo | Stage 3 & 4 = chemo with local radiation for local control

5 year survival rate of high grade NHL; best treatment is same as stage 3 & 4 intermediate CHOP or CVP chemo

23-32%

3 chemo drugs of CVP

Cyclophosphamide Vincristine Prednisone (no doxorubicin)

NHL has a ___-___% remission rate but high recurrance

60-80%

Disease of spinal cord

Myelodysplasia

7 aids related malignancies

``` Kaposi's sarcoma NHL Invasive cervical cancer: HIV and human papilloma virus (HPV) increases risk Anal cancer increases in men 80 times Hodgkin's Lung cancer Melanoma ```

More common in men with HIV, bi- or homosexual men 1872, older men of eastern European or Mediterranean descent Purple, red, brown, or black blotches on lower legs Younger men and women aggressive in involved lymph nodes Compromised immune system: HIV and organ transplant Caused by infectious agent, herpes: cytomegalovirus, EBV, HPV Multifocal, widespread lesions involving skill, oral mucosa, lymph nodes, or visceral organs including lungs, liver, spleen and GI tract Skin lesions that appear as flat or raised plaques ranging in size (mm to cm); have colors from blue-purple to red-brown Lower extremities Treat when symptoms arise and start causing problems; not considered curative, palliation

Kaposi's sarcoma

3 reasons immunosuppression predisposes malignancy

Absence of protective immune surveillance to eliminate abnormal clones Dysregulation of cell proliferation and differentiation; immunocompromised leads to cell dysregulation Chronic antigenic bombardment of the immune system by various infections

Usually high grade B-cell More aggressive, extranodal sites involved: CNS, bone marrow, and GI tract Can be immunoblastic (B-cells affected); noncleaved small lymphoma, usually intermediate grade large cell lymphoma

NHL with AIDS

4 symptoms/clinical features of NHL with AIDS

Painless lymphadenopathy that may involve the abdominal nodes (most common) Low CD4 lymphocyte counts (less than 50, typical = 500-1000) Persistent generalized lymphadenopathy B-symptoms: fevers, chills, and weight loss

Glycoprotein that helps identify immune system in HIV patients

Cluster of differentiation (CD4)

5 types of Kaposi's based on where they arise

Classic-non-African Endemic-African: all ages, more common in men than women Transplant: all ages and types of people HIV: AIDS related Nonepidemic gay-related: homosexuals with no evidence of HIV

Indolent-type tumor shows up as nodule on skin, primarily men 88% appear distal to knee

Classic-non-African Kaposi's

Belong/native to

Endemic

More than one spot

Multifocal

3 diagnostic tests for Kaposi's, helps determine treatment

Biopsy of skin lesion Lab work: HIV, immunocompromised (CD4), etc. Physical examination: history of lesions, skin, mouth, lymphadenopathy, etc.

Mouth involved in ____% of Kaposi's cases

30%

Kaposi's tumor confined to skin and/or lymph node CD4 over 200 No opportunistic infections, thrush, or B-symptoms Karnofsky status of 70 or greater

Good risk

Infection someone gets because they're immunosuppressed; normal, healthy person wouldn't get

Opportunistic infections

Extensive oral, GI, or other visceral Kaposi's disease Tumor associated with edema or possible ulcerations (lesions, stones, etc.) CD4 less than 200 History of opportunistic infection and B-symptoms Performance status less than 70

Poor risk

Limited cutaneous Kaposi's lesion, less than 10 in one anatomic area

Stage I

Disseminated cutaneous Kaposi's lesion, greater than 10 or in more than one anatomic area

Stage II

Visceral Kaposi's lesions only, GI lymph node

Stage III

Cutaneous and visceral Kaposi's lesions

Stage IV

2 subtypes of Kaposi's staging

A | B

Asymptomatic, no systemic signs or symptoms of Kaposi's

B-symptoms of Kaposi's; night sweats, chills, and fever over 37.8 F

7 indications of treatment for Kaposi's

Cosmetic control Painful, bulky lesion Oral lesions interfering with eating or swallowing Lymphedema from lymph node or vessel infiltration; ex: node pressing on spinal cord Pulmonary involvement Extensive GI involvement causing obstruction Rapidly progressive disease

2 types of treatment for Kaposi's

Local | Systemic

3 local treatments of Kaposi's

Radiation therapy Intralesional therapy (topical cream: vincristine injected into lesion) Cryotherapy

Treatment with liquid nitrogen

Cryotherapy

4 systemic treatments of Kaposi's

Single agent chemo Multi agent chemo Alpha-interferon: protein enhances immune system, best response rate RT and chemo for advanced disease where surgery can't be done

Chemo for Kaposi's in immunocompetent patient response rate

About 80%

Kaposi's long-term survival

40%

Kaposi's AIDS patient response and survival

``` Response = 50% Survival = 5-6 months ```

New cases and deaths from bladder cancer in 2017

New: 79,033 Deaths: 16,870

Bladder cancer affects men ___ times more than women; white men affected ___ times more than African Americans

4 times | 2 times

Bladder cancer affects older people with the average age of diagnosis at ___ years

65 years

5 risk factors for bladder cancer (environmental)

Exposure to aromatic amines and smoking cigarettes; smokers 4 times more likely to develop disease Schistosoma haematobium parasite infections Chronic irritation from bladder stone or chronic indwelling of foley catheter Family history Aniline dye (cleaning, printers, etc.) increases risk Chemo drugs cyclophosphamide and pelvic irradiation

2 signs and symptoms of bladder cancer

``` Painless hematuria (80%) Irritative symptoms (20%) ```

4 irritative symptoms

Urgency Frequency Dysuria Altered stream, change in stream/not constant

4 signs and symptoms of advanced bladder disease/cancer

Palpable mass Bone pain Pelvic or rectal pain Acute renal failure

5 workup tests for bladder cancer

H&P CBC and chemical profile IVP or IVU Cystoscopy and transurethral resection of bladder tumor (TURBT) CT/MRI looking at muscle invasion, high grade tumors, etc.

4 pathologies of bladder cancer

Transitional cell carcinoma Squamous cell carcinoma Adenocarcinoma Small cell disease

Most common histology of bladder cancer; 90% of bladder made of transitional epithelium cells Constantly being exposed to carcinogens because it's where toxins/waste in urine goes

Transitional cell carcinoma

Second most common histology of bladder cancer; 3% of bladder cancer in US

Squamous cell carcinoma

2 subgroups of bladder cancer

Superficial | Muscle invading

Lower grade noninvasive bladder cancer

Superficial

Cancer moves from bladder to muscle, more aggressive

Muscle invading

3 prognostic factors of bladder cancer

Tumor grade Muscle invasion Blood vessel or lymphatic invasion

3 stages of superficial bladder cancer

Ta Tis T1

3 stages of invasive bladder cancer

T2-T4

5 year survival for all stages of bladder cancer combined, localized, regional, and distant disease

``` All = 77% Localized = 69% Regional = 34% Distant = 6% ```

___% survival for stage T0 bladder cancer (no evidence of primary tumor)

90%

___% survival for stage T4 bladder cancer (tumor invades any of the following: prostate, uterus, vagina, pelvic wall, abdominal wall)

23%

3 treatments of superficial bladder tumors; intravesical agents

Bacillus Chalmette-Guerin (BCG) Chemo drugs placed within 24 hours of resection Photodynamic therapy

Instill drugs directly into bladder

Intravesical

Bacteria causes immune system to respond to and fight cancer cells Side effects: fever; lower side effects than chemo Can't be given to immunocompromised patients Given weekly for about 6 weeks

Bacillus Chalmette-Guerin (BCG)

3 chemo drugs for the treatment of superficial bladder tumors

Doxorubicin Mitomycin Thiotepa

3 treatments for muscle invading transitional cell bladder carcinoma

Radical cystectomy Chemo in high risk patients to decrease recurrence and increase cure rate Radiation

Treatment of choice for muscle invading transitional cell bladder carcinoma; remove all parts of bladder with local pelvic lymph nodes

Radical cystectomy

In men, remove all parts of bladder with local pelvic lymph nodes, prostate gland, and seminal vesicles

Cystoprostatectomy

In women, remove all parts of bladder with local pelvic lymph nodes, uterus, fallopian tubes, ovaries, urethra, and segment of interior vaginal wall

Anterior exenteration

5 common combo chemo drugs for the treatment of muscle-invading transitional cell carcinoma

``` DDMVAC CMV Gemcitabine and cisplatin 5FU (radiosensitizer) and cisplatin Mets: MVAC ```

DDMVAC

Dose-dense methotrexate Vinblastine Doxorubicin Cisplatin

CMV

Cisplatin Methotrexate Vinblastine

MVAC

Methotrexate Vinblastine Doxorubicin/adriamycin Cisplatin

Made from terminal ileum and proximal ascending colon; turned in on itself and sewn together Ureters removed from bladder and positioned to drain into new pouch Stoma made with small intestine Sterilely catheterized to empty every 4-6 hours Can create impedance in men and vaginal shrinkage in women

Indiana reservoir/Kock pouch

Common sites of mets from bladder cancer

``` Lungs Bones Liver Lymph nodes Brain most common in patients successfully treated with combination chemo/RT ```

5 common sites bladder cancer goes invasively (regional structures)

``` Sigmoid Rectum Prostate Uterus Vagina ```

Develops in connective tissue; most common soft tissue sarcoma (STS) in kids, over 85% occur in kids Common sites: arms, legs, H&N, and urinary and reproductive organs Dose levels lower because it usually occurs in kids; treat kids at lower doses because they're developing

Rhabdomyosarcoma

Fleshy growths that develop in connective tissue Can be in muscles, tendons, fibrous tissues, and bone and cartilage Less than 1% of all cancer and cancer deaths

Sarcomas

5 risk factors for sarcoma

Some genetically transmitted diseases increase risk Certain herbicides (kill plants) Radiation induces 10 years after in treated area Some chemotherapy alkylating agents and cumulative chemicals Lymphedema develops into angiosarcomas

Disorder of nervous system, benign fibrous growths on nervous tissue that can develop into STS

Recklinghausen disease

Sarcomas of inner lining of blood vessels

Angiosarcomas

2 classifications of sarcoma

Soft tissue sarcomas (STS): 50-70 types, very rare | Bone sarcomas

4 most common sarcomas in adults

Osteosarcoma most common Malignant fibrous histiosarcoma Liposarcoma Leiomyosarcoma

Sarcoma of fat

Liposarcoma

3 most common sarcomas in kids

Rhabdomyosarcoma Ewings Osteosarcoma most common in 2nd decade of life

Level of differentiation, very important in evaluating the aggressiveness of sarcomas and is included in the pathology report along with the exact histologic type High = bad, poor survival; low = good survival

Grade

Appearance of cell histology

Differentiation

Varying in size and shape of cell; cellular makeup, etc.

Pleomorphism

3 signs and symptoms of sarcomas

Mild pain Mild soft tissue swelling Palpable mass

Poorly differentiated

Anaplastic

STS staging uses the __________ staging system, while bone depends on _______ (surgical staging more often used)

Tumor, node, metastasis (TNM) | Grade

Low grade bone sarcoma

Stage I

High grade bone sarcoma

Stage II

Any grade bone sarcoma with regional and/or distant metastasis

Stage III

Well diffentiated STS, no nodes or metastasis

Stage I

Moderately differentiated STS, no nodes or metastasis

Stage II

Poorly differentiated/anaplastic STS, no nodes or metastases

Stage III

Any differentiation STS with nodes and/or metastases

Stage IV

2 subclassifications of stage I-III STS

A less than 5 cm | B greater than 5 cm

2 subclassifications of stage I & II bone sarcoma

A intracompartmental | B extracompartmental

Stage I-IV sarcoma 5 year survival rates

``` I = 90% II = 70-81% III = 20-56% IV = less than 20% ```

High grade sarcoma greater than 5 cm have over ___% chance of recurrence, less than 2 cm has cure rate of about ___% (excellent prognosis)

50% | 90%

When sarcomas originate somewhere other than arms or legs, ______ prognosis

Worse

5 areas where STS most commonly arise

``` Extremities 60%; lower (legs) more common than upper (arms) Trunk 19% Retroperitoneal area 15% Head and neck region 9% Viscera/GI tract very small percentage ```

Behind abdominal lining

Retroperitoneal area

3 most common mets sites of STS

``` Lung = 33% Bone = 23% Liver = 15% ```

STS spreads via ______, not common by lymph nodes (less than ___%, very rare)

Blood | 10%

Treatment for low grade STS

Complete surgical resection for local disease

Treatments for small and larger STS

Chemo (doxorubicin) and radiation Small: surgery Larger tumors over 5 cm: multimodality approach with chemo to shrink, surgery to remove, and RT to prevent spread/recurrence

Malignant tumor usually arising in the bone that are characterized by bone or osteoid production Most common form of bone cancer; 35% of bone cancers in US Knee/distal femur most frequently affected site Spindle cell type Most common in 2nd decade of life Bimodal age distribution: adolescents and 65 years or older; occurs in young patients 10-20 years old, peaks at adolescence Men and blacks more commonly affected Skip mets Treatment was amputation; now chemo, limb-sparing surgery (80-90%), and more chemo and radiation for high grade disease to prevent recurrence 75% cure rate, 5-10% recurrence with bad prognosis Mets survival rate = 20%

Osteosarcomas

Primary tumor in bone, another tumor appears in same bone but not connected to first tumor; high grade disease

Skip mets

4 indications for amputation for osteosarcoma; focus on mobility

Only way to remove all malignant disease Amputation would be more functional than limb sparing Couldn't undergo rehab for limb-sparing High morbidity rate with limb-sparing

Rare tumor of bone mainly in adolescents, usually in diaphysis Most common in 1st decade of life, 2nd to osteosarcoma in 2nd decade 3rd most common sarcoma, 16% Small, round, blue cells Treatment: preoperative chemo, limb-sparing surgery, and more chemo; disease-free survival = 10% and radiation for disease unresponsive to treatment, palliation, and local control; avoid because of retardation of growth and secondary malignancies

Ewing's sarcoma

Diaphysis, epiphysis, and metaphysis

Diaphysis: midshaft of bone Epiphysis: knoblike portions at either end of bone Metaphysis: growth plate, narrow portion of long bone between epiphysis and diaphysis

Second most common form of bone cancer; most common in adults, 40% 30% of primary bone cancer, 2nd most common 40-75 year olds Surgery is the preferred primary treatment, radiation for high grade disease or positive margins after limb-sparing surgery; chemo has limited to no benefit Grade 1 & 2 = 80-90% 5 year survival, grade 3 = 20% 5 year survival More common to have late recurrence (like breast cancer) 10-15 years (diseases usually occur within months)

Chondrosarcoma

Cam be benign (less aggressive) or malignant (more aggressive); difference is the aggressiveness of tumor histology Cause unknown but RT causes them Affects people of all ages (bimodal age distribution of 3-8 and 40-60 years old), men more commonly affected, and patients with Hippel-Lindau disease (vascular tumors in CNS, spinal cord, etc.) , neurofibromatosis/von Recklinghausen's, and hemangioblastomas (vascular tumors put patients at high risk) Usually can't drive, duty to report if they are

Brain tumors

5 types of brain tumors

``` Gliomas CNS lymphomas Medulloblastoma Ependymoma Oligodendroglioma ```

Most common brain tumors arise from glial cells in brain

Gliomas

Nourish and protect neurons, compose over half of CNS cells

Glial cells

Most common subtype of gliomas, primary CNS (brain and spinal cord) cancers

Astrocytomas

Brain tumors that commonly arise from B-cells in AIDS patients

CNS lymphomas

Most common brain tumors in kids, 20% of childhood CNS disease Median age of diagnosis = 5-6, 50% 5 year survival rate More common in boys

Medulloblastoma

Glial tumor; 2 peak ages = 3-8 and 4th and 5th decades of life

Ependymoma

Brain tumors that originate in oligodendrocytes; 6% of CNS gliomas Most common between 20-40 years old

Oligodendroglioma

Cells that support neurons

Oligodendrocytes

3 types of tumors caused by neurofibromatosis/von Recklinghausen's

Meningiomas Astrocytomas Schwannomas

Tumors that form on membranes that cover brain and spinal cord

Meningiomas

Brain tumors that originate from schwann cells that cover myelin sheath

Schwannomas

5 signs and symptoms of brain tumors; tumor infiltration causes pressure on brain

Headaches most common, bifrontal/bioccipital area when patient wakes up Seizures also most common (anticonvulsants) Motor or sensory loss Fatigue Nausea and vomiting

2 most common signs of glial tumors

Headaches | Seizures

4 cognitive signs and symptoms of brain tumors; usually hardest signs and symptoms for patient to control

Reasoning and judgement Lack of initiative and awareness Short term memory deficit Personality change

Small, discrete pigmented skin lesions that develop into multiple along the course of peripheral nerves and may undergo malignant transformation

Neurofibromatosis/von Recklinghausen's

Difficulty speaking

Aphasia

Sensorium

Perception

Most aggressive brain tumors | Prognosis without treatment = weeks, with treatment = 12-18 months whether adult or child

``` Astrocytoma, grade IV Glioblastoma multiforme (GBM) ```

3 brain tumor treatment methods

Surgery: remove as much of tumor as safely possible and consider location, aggressiveness, etc. for quality of life; total resection can be attempted depending on location, treat positive margins with radiation if partial resection Radiation usually after surgery, regular fractionation Chemo not commonly used, usually palliative; portacath because of blood-brain barrier (BBB)

5 forms of radiation therapy for brain tumors

``` IMRT/conformal therapy reduces dose to surrounding good brain tissue Hyperfractionated radiotherapy Stereotactic radiosurgery/gamma knife Brachytherapy Boron neutron capture ```

Higher fractions with less dose usually BID with 4-6 hours between, reduces side effects

Hyperfractionization

RT for small, well-defined tumors, small dose of 1-2 fractions Fewer fractions than SRT CT, MRI, and angiogram Narrow beams to treat small area and reduce dose to normal tissue

Stereotactic radiosurgery/gamma knife

3 long-term problems with treating brain tumors in kids with RT

Delay radiation after 2-years old reduces risk Cognitive deficits If pituitary treated, reduce production of growth hormone; can affect sexually as well

Drowsiness, lethargy, loss of appetite, etc. 4-6 weeks after radiation

Radiation somnolence syndrome

Chemo used at diagnosis of astrocytoma and for recurrence

Diagnosis: temozolomide Recurrence: nitrosourea

Most common: dexamethasone/decadron Reduces intracranial pressure to control symptoms Different anabolic steroids; cortisol hormone produced by renal cortex Side effects/problems: retention of fluid and weight gain, increased likelihood of infection, upset stomach, irritable mood changes, muscle weakness in proximal extremities, bone disease, and cataracts

Corticosteroids

Prognosis for astrocytoma grade II, anaplastic astrocytoma grade III, and glioblastoma (grade IV astrocytoma)

Astrocytoma grade II = 6-7 years Anaplastic astrocytoma grade III = 18-24 months Glioblastoma (grade IV astrocytoma) = 12-18 months

5 other treatment options for brain tumors

``` Localized brachytherapy (place source in balloon), hyperthermia, and hyperfractionization Localized and high-dose chemo Tumor vaccines (preventative) Gene therapy: use DNA to treat disease Interruption of BBB to allow chemo to pass ```

Test 2 Flashcards

(201 cards)