Nervous system cancers

Primary tumor

Originates in the CNS (neurons nad glial cells)

Secondary tumor

Originates outside the CNS and them metastaizes to the CNS

Primary cancer sites that metastaize to the brain

Lungs, breast, kidney, melanoma and GI

Benign cancer

Slow growing and stas localized (doesnt really invade)

Malignant cancer

Rpaid growing and invades to other sites (metastasize)

DIrect effects of atumor on the CNS

Impacts vital functions of brain and SC, block CSF or blood flow (could cause ischemia), increased edema and ICP

Prevalence of primary to secondary tumors

Secondary much more common

What percentage of primary brain tumors are maliganat v non

Maliganat (25%), non malignant (75%)

Sx of CNS tumors

Increased ICP, mental, behavior, personality, seizure, language, sensory, motor, bowel and bladder, ataxia

What are sx of increase ICP from brain tumors

Headache (worse in morning), tnittus, visual changes, painful eye movement, N/V, drowsiness)

Dx of CNE tumors

Presentation of sx for location, imaging(MRI or CT), cerebral angiography, PET scan, needle biopsy (sterotactic procedure)

Grades of primary tumors

1-2: low grade, slow growing, normal cells

3-4: high grade, fast growing, abnormal growth of cells

Surgical interventions for CNS

100 percent removal, remove as much as possible with radiation or chemo\

fMRI or intreoperative cortical stimulation (preservable parts of the brain)

Complications and precautions post surgery

Monitor ICP between 0-15, need surgery for over 20mmhg, infection, CSF leak or DVT

Position HOB 20-30, avoid cough/sneezing/blowing nose, avoid extreme flexion of the legs

Radiation therapy for CNS tumor

Adjunct to surgery (when full tumor could not be removed or aggressive tumor cells)

Recurrent tumors 9surgery is not the best option)

Side effects of radiation therapy

Edema early (1-3days), late (months), damage to brain tissue and hypotpituitarism (endocrine problems)

Sterotactic radiosurgery

Fine beams of radiation for a precise dose (decrease exposure of the rest of brain and avoid surgical complications)

Chemotherapy in CNS tumors

Smaller application due to BBB, given intrathecally to CSF or catheter to ventricles, used for fast growing

Immunotherapy in CNS tumors

Stimulates the immune system

Interleukin-2: helps grow and divide immune cells

Interfeuron: directly attacks and slows growth of cancer cells

Medications for CNS tumors

Corticosteroids: antiinflammatory

Anticonvulsants: control seizures

Diuretic: decrease edema and ICP

Types of nervous system tumors (which is PNS)

Schwannoma

What tumors are more common in children

CGEM (craniopharngioms, gangliogliomas, ependymomas, medulloblastoma)

What are the 4 types of gliomas

Astrocytoma, oligodendrogliomas, ependymomas, glioblastomas

Gliomas

Starts in the glial cells (supporting tissue), most common, M>W, unknown etiology

Locations of gliomas in adults v children

Adults: frontal and temoral lobes

Children: cerebellum and Brainstem

Astrocytoma

Large and infiltrative

Low grade: benign and slow growing (I: pilocytic, II: Diffuse)

High grade: malignant and fast growing (III: Anaplastic, IV: glioblastoma)

Prognosis for astrocytomas

Low grade: good after complete excision and age under 40

High grade: poor, fatal or high recurrance rate

Olgioddendroglioma (and prognosis)

Slow growing, adult 20-50 y/o

Good long term survival with surgical resection and radiation, late recurrence of tumors

Initial sx of oligodendrogliomas

Headaches, seizures, personality changes (frontal lobe), bleed/stoke sx

Ependyoma

rare, children in cerebellum (posterior fossa and 4th ventricle), increase ICP and cerebellar dysfunction

90% 5 year survival

Presentation of ependymomas in adults

SCI and back pain

Meningioma

Benign, most common, females, genetic abnormality of chromosome #22

Where does meningiomas originate

Meninges

What resutls from meningioma

Hyperostosis (thickening of the skill in the region of the tumor)

Medulloblastoma

Children (3-8 years old), malignant, boys, in cerebellum (metastaize to subarachnoid space)

What is the most common malignant brain tumor in children

Medullobalstoma

What is the most common benign brain neoplasm

Meningioma

Prognosis of medulloblastoma

5 year survival is 70-80 percent

Gangliogliomas

Children, in neurons and glial cells, benign, in temporal lobe (seizures)

Treatment of gangliogliomas

Cured with surgery and or radiation with 90 percent survival

Craniopharyngiomas

Benign, congentical, near optic chiasm and pituitary gland

Prog: surgery and rad, recurrance

Sx of craniopharyngiomas

Visual disturbances, headache, piituitary hypofunction, neuroendocrine disorder, hypothalaus dysfucntion, CN palsies

Schwanoma

in peripheral nerve, CN 8 (acoutstic neuoma) or fascial/trigeminal, benign

Sx of schwanoma

Hearing loss, ringing, dizziness, facial paralysis

Pituitary adenoma

Benign, adults 30-40, in pituitary gland, causes excessive sedcretion of hormones or insuficiency

Sx of pituitary adenoma

Weight gain, galactorrhea, amenhrrea, gigantism, acromegaly, cushing, hypopituitarism, vitual abnormalities, mood swings (erectile dysfuction)

What are the sx of hypopituitarism

Fatigue, weakenss, hypogonadism

Why are there visual abnormalities in pituitary adenoma

Local pressure over the optic chiasm (biltateral temporal field defects, diplopia)

Galactorrhea

Milkd from breasts without childbrith

Amenhorrhea

absense of menstural period

Treatment of pituitary adenoma

Hormonal therapy, sterotaxis radiotherapy

Primary treatment of spinal tumors

Surgery

What are classifications of spinal tumors based on (and what are they)

Location in the spine

Extradural (vertebral), intradural (extremedullary), intramedullary

Extradural (vertebral) spinal tumor

In vertebral bodies (cervical or sacral), typically metastatic

Intradural/extremedullary spinal tumor

in arachnoid membran (meningiomas) and nerve roots (scheanomas and neurofibromas)

Intramedullary spinal tumor

in supportingccells within SC, astrcytoma or ependyomas

What cancers have a 90 percent 5 year survival rate

Meningiomas, ependymomas, pilocytic astrocytoma

Prognosis of last 3 astrocyotomas

DIffuse and anaplastic (20%), glioblastoma (7%)

What is prognosis of tumors based on

Age, surgical resection ability, grade