Clinical Neuroscience - Brain tumors

Inhalte wichtiger Krankheitsbilder der Neurowissenschaften - Brain tumors

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Kartei Details

Karten	28
Sprache	Deutsch
Kategorie	Medizin
Stufe	Universität
Erstellt / Aktualisiert	10.05.2014 / 31.05.2015
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Which is the major distinction of brain tumors?

Primary brain tumors --> arise from the brain

Secondary brain tumors --> metastases

Primary brain tumors --> metastases

Secondary brain tumors --> arise from the brain

Which are the most common metastases in brain tumors?

lung (40-50%)

breast (15-25%)

unknown primary tumor (11%)

skin / melanoma (5-20%)

prostate

Which is the most common pathway/location for spreading brain tumors?

lymphatic

direct spread

hematogenous (blood flow and vessels)

hemisphere (80%)

brain stem (5%) and cerebellum (15%)

What is the prognosis of metastasising brain tumor?

poor prognosis

What is true about primary brain tumors?

brain tumors make 2-8% out of all tumors

20% of all tumors in children

often Medulloblastoma

brain tumors make 4-15% out of all tumors

34% of all tumors in children

What is true about the etiology of brain tumors?

etiology is mostly sporadic

radiation (meningiomas and gliomas)

immunosupression (CNS lymphoma)

genetic factors/inheritable syndromes (NF1/2 and VHL)

chemicals

What defines a meningioma?

extra-axial brain tumor (located in meninges only)

arise from non-glial cells

caused by post-radiation

caused by genetic factors (NF2)

located in brain tissue

What defines a glioblastoma?

intra-axial brain tumor

astrocytomas arise from astrocytes

oligodendrogliomas arise from oligodendrocytes

ependymomas

meningioma

WHO divides gliomas into different stages I-IV. What is true about the grading?

Primary gliomas: derive from glia cells

Secondary gliomas: derive from grade II and grade III

Grade I: circumscribed pattern allows removal

Grade II-IV: invasive growth pattern

Name the striking tumor pathology of grade II-IV gliomas?

Grade II: pleomorphism

Grade III: mitosis

Grade IV: vascular proliferation and necrosis

Grad I: lesions

What is true about medulloblastoma?

20% of all brain tumors in children

occur in cerebellum

malignant (WHO IV)

poor prognosis (Chang Citeria): <3 years (incomplete resection)

does not metastase towards spinal cord

What are the characteristics of primary CNS lymphoma?

3% of all CNS tumors

increased in immunocompromised patients

poor prognosis

10% of all CNS tumors

Non specific signs & symptoms of brain tumors?

headache & nausea

changes in state of consciousness

vertigo/dizziness

changes in mental status/personality

eleptic seizures

Focal signs & symptoms of brain tumors?

motor, sensory, language or visual impairment

double vision

hormone imbalance

Parinaud syndrome

What is the "red flag" symptom and what symptoms are related to it?

headache

changing pattern of headache

associated with other neurological symptoms

Karnofsky performance status scale (KPS)

nausea

DIAGNOSTICS: the (standard) clinical approach is taking patients history and physical examination. What are the techinical approaches for brain tumor diagnostics for living patients?

Imaging: CT (abundant) and MRI (higher resolution)

Supportive Imaging: Angiography and intraoperative Imaging (ultrasound, fluorescent dye)

Pathology

Nuclear medicine: PET or SPECT

CSF: Cerebrospinal Fluid

What is true about therapy of edema and brain swelling?

edema is more severe than mass effect of the tumor

increases the intercranial pressure

Boswellia is the most potent drug

Steroids (Dexamethasone) is a common drug

Benzodiazepins are used as a drug

What is true about the symptom of seizures in brain tumors?

reduce quality of life

increase of morbidity and mortility

enzyme-inducing drugs are a the newest way of treatment

non enzyme-inducing drugs are currently the best way of treatment

benzodiazepins can be used as treatment

What is true about the treatment of other symptoms with brain tumors?

nausea is tumor or therapy induced

nausea is treated with antiemetics

teratogenicity is radiotherapy induced

hematoxicity is therapy induced

fatigue and depression are not therapy induced

Name the 4 main classes of drugs in chemotherapy?

alkylators

monoclonal antibody

steroids

anti-metabolites like MTX (lymphomas)

experimental drugs

What is true about the treatment with alkylators?

bind to DNA and induce apoptosis

first line treatment in gliomas is TMZ (Temozolomide)

TMZ is not combined with radiotherapy

MGMT is DNA repair protein allowing tumor resistance (2/3 of all patients)

unmethylated MGMT promoter indicates resistance

What is true of the antibody treatment in brain tumors?

Target: VEGF

First choice antibody: Bevacizumab

Aim: to inhibit tumor blood supply / "starvation"

side effects: Blood pressure, tumor bleeding and thrombosis.

Target: CD34

Radiotherapy in generell: what is true about mode of action?

biological mode of action: indirect or direct DNA damage of cells

DNA lesions lead to controlled cell death

DNA lesions lead to necrosis

High energy radiation consists of photons (x-ray or gamma-ray)

High energy radiation consists of particles (protons)

What are the practical issues about radiotherapy?

doses are usually divided into smaller doses (fractions)

treatment sessions last for some weeks

standard radiation therapy (glioblastoma): 600Gy for 6 weeks

radiation energy: 1Gy = 1J/kg energy absoprtion

standard radiation therapy (glioblastoma): 60Gy for 6 weeks

What are the side effects of radiation therapy?

Acute: headache, vomitting/nausea

Acute: loss of hair, skin changes

Acute: wound healing disturbance

Acute: thrombosis

Long-term: neurocognitive changes and/or radiation necrosis

What techniques are available in radiotherapy?

LINAC (standard photon beam)

Proton beam (Bragg peak: proton loose energy rapidly inside target tissue)

photons do not loss energy with increasing depth

Gamma-knife (radiosurgery)

Cyber-knife (radiosurgery)

What are the goals of neurosurgery?

tissue sampling for histopathology

reduction/resection of tumor

cure independent of histology

improving outcome

alleviation of mass effect (growing mass exerts pressure or dislocates tissue)

The maxim of neurosurgery is avoidance of creation of new neurological damage or destruction of healthy tissue. Though neurosurgery brings always certain risks. Which risks are likely?

bleeding

infection

paralysis

CSF leakage

hydrocephalus

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Clinical Neuroscience - Brain tumors

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