DPTD 863 - CNS oncology

most common malignant primary brain tumor in adults

glioblastoma

most common overall primary brain tumors

meningiomas (often benign)

generalized symptoms

headaches, seizures, N/V, personality changes

localized symptoms

focal changes, sensory symptoms, gait ataxia, hemiparetic/hemiplegic presentation, visual changes, language dysfunction

gold standard diagnostic imaging for suspected CNS tumor

MRI w/ contrast

IDH status and disease progression

tumors w IDH mutations are less aggressive and may have better survival compared to IDH-wild type gliomas

chromosome 1/19 codeletion and prognosis

pt with codeleted tumors have the best prognosis - predicts better response to chemo and radiation

MGMY methylation and prognosis

• if methylated - better response to Temodar and better survival

• if unmethylated - poor response to Temodar and shorter survival

*Temodar (temozolomide) is an oral chemotherapy drug => methylates DNA, inhibits replication, and triggers apoptosis

normal ICP in adults

5-15 mmHg

malignant progression is characterized by…

angiogenesis, necrosis, infiltrative growth, resistance to apoptosis

grades/types of astrocytoma

• grade I - pilocytic astrocytoma: considered benign but has potential to develop into higher grade

• grade II - diffuse astrocytoma: tumor extends beyond what can be seen on imaging

• grade III - anaplastic astrocytoma: same as grade II, more severe

• grade IV - glioblastoma: often has butterfly shape on imaging, attempts to cross corpus callosum into other hemisphere (impossible to fully resect)

olligodendroglioma

usually arise in frontal lobes, but tend to infiltrate nearby tissue

ependymoma

ependymal cells line the ventricles and central canal of spinal cord

medulloblastoma

• most common embryonal CNS tumor, arises in 4th ventricle

• clinical symptoms result from hydrocephalus and cerebellar signs

• infants may have nonspecific signs - lethargy, delay in milestones, feeding difficulties

meningioma

typically benign, slow-growing tumors that compress underlying brain structures, but rarely invade

other primary cancers with metastases to the brain

lung, breast, melanoma, renal cell carcinoma

corticosteroids (dexamethasone) and tx…

do not shrink tumor - used to reduce cerebral edema and relive mass effect symptoms = headache, N/V, weakness/sensory loss, vision, balance

focus of PT management for hemiparesis

spasticity management, orthoses, functional retraining, caregiver training, strengthening

focus of PT management for ataxia

high repetitions of functional, multi-joint movements

focus of PT management for apraxia

motor planning retraining, compensatory strategies, goal-directed and functional tasks, repetitive to tap into procedural memory

focus of PT management for cognitive deficits

dual-tasking, simple instructions, multimodal cuing, part vs whole practice, blocked vs variable practice

focus of PT management for palliative care

maximizing QoL, family training, use of medical equipment, limit time in inpatient settings, transfer training