Duke PA CNS Neoplasm
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| CNS tumors rarely __ | metastasize to other organs
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| __ which arise from astrocytes are the most common CNS tumor | gliomas
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| in a patient with a known systemic malignant disease, __ are more likely than a primary CNS tumor | metasteses
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| symptoms caused by intracranial tumors result from either __ or __ | compression of the brain by tumor and the presence of associated edema, infiltration and destruction of brain parenchyma by tumor cells
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| even small CNS tumors may cause symptoms because of the __ | uncompromising rigidity of the cranial vault
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| __ is the most common generalized symptom and is the first symptom in over on third of adults with brain tumor | headache
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| headaches from intracranial tumors are often worse in the __ | morning
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| headaches from intracranial tumors are provoked worse by | maneuvers that increase intracranial pressure
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| generalized symptoms of intracranial tumor | headache, changes in mood or personality, decreased appetite, nausea, seizure (general)
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| generized symptom of intracranial tumor that is common in children but rare in adults | projectile vomiting
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| tumors of the __ lobe may grow to massive proportions before symptoms prompt the patient or the patient's family to seek medical help | frontal lobe
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| __ may occur with a frontal lobe tumor | progressive difficulty with concentration and memory, personality changes, and lack of spontaneity
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| __ most commonly seen with gliomas or lymphomas may cause spasticity of the extremities and the appearance of primitive reflexes | bifrontal disease
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| __ tumors produce subtle sensory signs or hemianesthesia | parietal lobe
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| tumors of the __ may produce spatial disorientation or left homonymous hemianopia | right parietal lobe
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| __ tumors cause receptive aphasia or right homonymous hemianopia | left parietal lobe
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| tumors of the __ can lead to behavioral changes, olfactory hallucinations, complex partial seizures, and quadrantanopia | temporal lobes
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| all patients with a suspected brain tumor should have either __ | an MRI or contrast-enhanced CT
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| __ are not adequate for evaluating either primary tumors or metastatic tumors | CT scans done without contrast enhancement
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| cerebral angiography is indicated only when __ | an understanding of tumor blood supply is deemed necessary before surgical resection
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| PET scanning reveals areas of __ and may indicate greater extent of tumor than suggested on CT or MRI | increased glucose metabolism
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| __ are particularly useful in assessing response to treatment or providing evidence of recurrent disease after primary therapy | PET scans
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| __ is helpful only if leptomeningeal involvement with tumor is suggested | lumbar puncture
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| __ is contraindicated when an intracranial mass lesion is present | lumbar puncture
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| even when surgical cure is unlikely, resection of a large portion of the tumor may | relieve symptoms for many months
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| Surgical resection is not recommended for patients with __ b/c these tumors are often multifocal and respond to a combination of chemotherapy and radiation therapy | CNS lymphomas
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| most patients with CNS tumors have __ | brain edema
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| some patient with CNS tumors and brain edema benefit from | glucocorticoids (dexamethasone)
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| in patients with life-threatening edema with signs of brain herniation, __ can be given IV to reduce intracranial pressure, along with dexamethasone | mannitol
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| whole brain radiation therapy is associated with __ | long-term toxicity exhibited as dementia and gait disturbance
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| the major obstacle to the effective use of chemotherapy in brain tumors is the __ | blood brain barrier
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| oligodendromas are unusually __ | sensitive to chemotherapy
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| of the anaplastic gliomas __ is associated with the worst prognosis, with median survival of less than 12 months | glioblastoma multiforme
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| __ arise outside the brain and generally grow slowly | meningiomas
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| __ is not used in the treatment of meningiomas | chemotherapy
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| most intracranial tumors are __ | metastatic from other sites
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| the tumors that commonly metastasize to the brain are __ | lung cancer, breast cancer, and melanoma
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| rapidly growing tumors cause __ | massive edema
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| spinal tumors are __ compared to brain tumors | less common
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| among the earliest symptoms of spinal cord tumors | back pain and distal paresthesias
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| __ is the most useful tool for evaluating the patient with suggested spinal cord tumor | MRI
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| treatment of primary spinal cord tumors is with | surgical resection
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| patients with epidural metastatic tumors of the spinal cord are treated with __ and surgery or radiation | corticosteroids
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| in children most primary brain tumors are located in the __ | posterior fossa
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| in adults most primary brain tumors are located in the __ | cerebral hemispheres
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| primary tumors develop from __ cells | non-neuronal
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| 25% of all gliomas, can occur anywhere in the brain or spinal cord, grow by slow infiltration, 1/2 patients present with a focal or generalized seizure, later symptoms: headache and increased ICP | astrocytoma
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| 50% of all gliomas, highly invasive, rapidly growing, bilateral in 50% of patients, frequently causes intracerebral hemorrhage. less than 20% of patients survive one year | glioblastoma multiforme (GBM)
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| CNS lymphoma treatment is with | radiation and steroids
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| most common hormone secreted from a pituitary adenoma | prolactin
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| increase levels of prolactin from a pituitary adenoma can result in | amenorrhea/galactorrhea syndrome
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| tumors that rarely metastasize to the brain include | prostate, oro-pharyngeal carcinoma, and skin cancers other than melanoma
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| brain tumor presentation | localizing neurologic signs (+/-), mental function (slow, dull), headaches (occur at night and first awakening), vomiting (especially in posterior fossa tumors, seizures 20-50% of patients
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| signs and symptoms of increased intracranial pressure | headache (periodic bifrontal and bioccipital), projectile vomiting, mental slowness, incontinence, mental slowness, papilledema
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| causes of increased intracranial pressure | tumor mass, obstruction of CSF outflow, tumor related edema
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| mainstay of treatment for increased intracranial pressure | steroids
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| temporary treatment for increased intracranial pressure | osmotic agents (mannitol), hyperventilation (lowers pCO2, causing vasoconstriction)
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| remote effects of cancer | paraneoplastic syndromes
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| clinical paraneoplastic syndromes | Eaton Lambert, subacute cerebellar degeneration, brainstem encephalitis, sensory peripheral neuropathy
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| most common causes of paraneoplastic syndromes | small cell lung cancer, ovarian cancer
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