Neoplasms Study Questions

What is Primary Tumor?

What is Primary Tumor?

• Benign or Malignant

• Originate from cells normally found in CNS

What is Secondary Tumors/Metastatic?

Tumors originate from structures outside the CNS such as lung, breast, GI, or melanoma

How are tumors classified (Based on Aggressiveness)?

>> Grade 1 - BENIGN, cells grow slowly and look nearly normal >> Grade 2 - BENIGN, cells look less like normal and grow slowly >> Grade 3 - MALIGNANT, cells look very different and actively growing (anaplastic) >> Grade 4 - MALIGNANT, cells look very abnormal and grow quickly (most aggressive)

What is a Malignant Tumor/Neoplasm? (4)

• Cancerous

• Often resistant to tx

• Spread to other parts of the body

• Can recur after tx/removal

What is a Benign Tumor/Neoplasm? (3)

• NON-Cancerous

• Localized

• Does NOT spread

Where are most brain tumors located in Adults and Children?

• Adults >> Cerebral Hemispheres (Supratentorial)

• Children >> Brainstem and Cerebellum (Posterior Fossa, Infratentorial)

What would be the most common FIRST clinical manifestations of a brain tumor?

Seizures and HA

What is the most common type of primary brain tumor?

Glioma

What is the most common subtype of Glioma Brain Tumor?

High grade astrocytoma (20-30% >> Grade 3-4)

What is a Glioma? What is it formed by? Who does it affect more?

• A (most common) primary brain tumor

• Tumors formed from the glial cells (support cells in the brain)

• Affects men 3:2 more than women

What is a Low Grade Glioma Tumor? What are the grades? When does it appear in? What’s the prognosis like?

>> Low-grade or BENIGN (astrocytoma) <<

• Grades I and II >> slower growing (10-20% of 1°)

• Appear in 3-4th decades of life

• Better prognosis

What is a High Grade Glioma Tumor? What are the grades? When does it appear in? Prognosis?

>> High-grade or MALIGNANT (astrocytoma) <<

• Grades III and IV >> faster growing (20-30% 1°)

• Appear in 6th decade of life

• Worse prognosis

Why are Astrocytomas so dangerous? (4)

• Very (always) infiltrative

• Aggressive

• Generally are progressive (low grade will usually become high grade)

• Faster growing (Grades III and IV)

What is the most common type of brain tumor in Children?

Medullablastoma (@ Brain Meninges)

What is the most common type of brain tumor that arises from supporting brain structures? Percentage?

Meningioma (27%)

What type of tumor is Meningioma?

Slow growing, usually benign (90%) lesions

Which 3 places do the Meningiomas most commonly occur? (3)

• Dural folds and cerebral convexities

• Between or over the cerebral hemispheres, base of skull, or posterior fossa

• Spinal cord

Where do Meningiomas originate?

Originate in the Arachnoid layer of the Meninges

Meningiomas represent how much % of all Intracranial Neoplasms?

27%

Meningiomas are most common for what age group? Who is it more prevalent in?

• Btw 40-70 years (Later in Life)

• 2-3x more prevalent in Female than Males

Why do Meningiomas generally NOT invade the Brain Parenchyma?

Because of slow growth AND abnormal signs/symptoms may evolve over a long period of time.

What are the 2 clinical presentations of Pituitary Adenomas?

• Excess Pituitary Hormone Release (Hyperpituitarism)

• Insufficient Pituitary Hormone Release (Hypopituitarism)

What are the s/s of Hyperpituitarism? (5)

• Galactorrhea

• Amenorrhea

• Gigantism

• Acromegaly

• Symptoms of Cushing's disease

What's Galactorrhea?

Lactation not associated with childbirth or nursing

What is Acromegaly?

Excess Growth Hormone

What are Symptoms of Cushing's Disease? (5)

• HTN

• Facial and truncal obesity

• Osteoporosis weakness

• Menstrual abnormalities,

• Female hirsutism (male hair growth patterns)

What are s/s of Hypopituitarism? (5)

• Fatigue

• Weakness

• Hypogonadism

• Secondary sexual characteristics and hypothyroidism

• Neurologic findings of HA, bitemporal visual loss, and ocular palsy (eye movement abnormality)

What is the most informative type of brain imaging used to diagnose a brain tumor?

MRI

What is the most important form of initial treatment for brain tumors?

Surgery

What are the other types of treatment for brain tumors? (5)

• Radiation

• Chemotherapy

• Hormone Therapy

• Immunotherapy (Biotherapy)

• Meds

What are the 3 Types of Intraspinal Tumors?

• Intradural-Intramedullary

• Intradural-Extramedullary

• Extradural-Extramedullary

Intradural-Intramedullary tumors arise where?

Spinal Cord Substance (Cellular Substance of the SC)

Intradural-Extramedullary tumors arise where?

Outside of the SC but within Dura

Intradural-Extramedullary tumors cause what?

Compression of SC RATHER than invasion of SC

Extradural-Extramedullary tumors arise from where?

Outside of SC and Dura

Extradural-Extramedullary tumors are prone to what?

Metastasize outside of SC

What type of pain is most common from Intraspinal Tumors and when is the pain worse?

• Spontaneous pain caused by nerve root irritation is common - Worse at night!

Intramedullary Tumors often present as what type of pain?

Poorly localized deep burning pain in Spinal Region

Extrameduallry Tumors often present as what type of pain?

Knifelike radicular pain along peripheral nerve pathways

Weakness and Muscle wasting are aggravated by what?

Coughing and Wheezing

What is the principal tx for all primary Intraspinal Tumors?

Surgery

Can Extramedullary Tumors be cured?

Most cases, YASS

Can Intraspinal Astrocytimas be cured?

Have lower rate of cure, although surgery and radiation can improve disease free survival

What is the most common Intracranial Brain Tumor in Adults?

Metastatic Tumors!

Prognosis of Metastatic Tumors depends on what?

Depends on the amount of tissue loss before radiation

Metastatic Tumor prognosis improvements? What improves in the majority of people? What are the 2 statistics regarding the patients ?

• Pain and neurologic function improve in the majority of people

• 80% pts who are walking at time of tx remain walking

• 30% pts who are not walking regain ability to walk

Radiation for Metastatic Tumors can cause what?

Myelopathy (Injury to SC)

What are the most common sites from which cancer metastasizes to the brain?

• Lung

• Breast

• Kidney

• GI Tract

What part of the spine is the most common site for metastasis?

• Thoracic (70%)

• Lumbar (20%)

• Cervical (10%)

What type of patient should always be evaluated for metastatic cancer?

Anyone with a hx of CA that presents with back pain!!! (95% of cases)

Most common primary sites that metastasize to the spine are?

• Lung

• Breast

• Prostate

• Kidney

• Lymphomas