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65 Cards in this Set
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incidence of primary brain tumors
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14 per 100,000 persons (0.014%)
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Tumor Specific Statistics
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27% meningiomas
23% glioblastomas 12% asctrocytomaa 8% nerve sheath tumors (acoustic neuromas) 7% pituitary tumors 3% lymphomas 3% oligodendogliomas 2% medulloblastoma |
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Age specific Statisitics
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0-4 embryonal.primative neuroectodermal/medulloblastomas
5-19 pilocytic astrocytomas 20-34 pituitary tumors 35-54 meningiomas 55-74 glioblastomas 75+ meningioma |
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Most common tumors: 0-4 yo
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embryonal/primative neuroactodermal medulloblastomas
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Most common tumors: 5-19 yo
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pilocytic astrocytomas
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Most common tumors: 20-34
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pituitary tumors
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Most common tumors:35-54
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meningiomas
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Most common tumors: 55-74
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glioblastomas
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Most common tumors: 75+
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meningioma
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5 year survival rate for all pts dx with malignant brain tumors 1992-1998
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32%
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risk factors for brain tumors
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-no risk factors have been identified for the majority of brain tumors
-only proven risk factor (environmental) is exposure to ionizing radiation |
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genetic factors and brain tumors
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-only 5-10% of all cancers are herditary/familial
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brain tumors that are linked to genetic mutations include:
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-Li-fraumeni syndrome (TP53 gene)
-tuberous sclerosis (TSC 1 & 2) -Turcots (APC gene) -Gorlins (PTCH gene) -NF1 and NF 2 |
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Diagnoses for brain tumors
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-neurological exam
-scans (CT, MRI, angiography, MRS, PET) -xrays -laboratory test (for byproducts that tumors produce) -BIOPSY |
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Lab tests
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-LP
-endocrine evaluation |
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Lumbar Puncture tumor markers
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-germ cell tumors (AFP, HCG, PLAP)
-tumors of the arachnoid/pia mater (CEA) |
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Endocrine Evaulation
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-pituitary or hypothalamic tumors
-ACTH, GH, PRL, TSH |
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AFP
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alpha fetaprotein
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HCG
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human chorionic gonadotropin
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PLAP
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placental alkaline phosphatase
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CEA
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carcinoembryonic antigen
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ACTH
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adrenocorticotropic hormone
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GH
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growth hormone
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PRL
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prolactin
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TSH
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thyroid stimulating hormone
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Types of biopsy
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-diagnostic bx (sterotaxic) (remove 1-2 cells)
-intraoperative frozen section (remove part of lesion, slice into pieces, freeze it) -surgical pathology specimen (remove whole lesion) |
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Tumor
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-swelling, neoplasm
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neoplasm
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-new growth
-usually focal -autonomous and having no useful function |
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benign
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-noninvasive
-localized -slow growing |
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malignant
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-invasive
-distant spread (metastases) -lethal |
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Cancer
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-any malignant neoplasm
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Primary tumor
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-found where it began
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Secondary tumor
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-distant spread from primary site, (metastatic)
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Metastatic tumor
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-secondary tumor
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Infiltrative Tumor
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-direct extension or spread
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Staging
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-anatomic extent of a tumor
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Grading
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-degree of malignancy based on histologic pattern
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prognosis
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-forecast of the probable outcome of a disease (staging and grading are both designed to arrive at prognosis)
-includes demographics, race, socioeconomic class to some extent |
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Grade I tumor
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-slow growing
-least malignant -ususally associated with long-term survival |
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Grade II tumor
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-relatively slow growing
-can invade adjacent normal tissue -can recur as high grade tumor |
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Grade III tumor
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-actively producing abnormal cells
-infiltrate adjacent normal brain tissue -tumor tends to recur, often at higher grade |
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Grade IV tumor
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-abnormal cells which reproduce rapidly
-angiogenesis -area of necrosis |
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Common symptoms of increased intracranial prssure
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-headache
-nausea -vomiting -drowsiness |
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Pathological changes with intracranial expanding mass lesions
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-brain edema
-brain herniations -vascular changes -obstructive hydrocephalus -pituitary necrosis |
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Brain Edema
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-vasogenic
-results from breakdown of the BBB -increased permeability of capillaries and escape of fluids and plasma proteins into the extracellular space -cheifly in the white matter |
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Transtentorial Herniations
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-hemispheric lesions displace the hippocampus and uncus through the tentorial opening
-oculomotor nerveroot is pressed against the sharp edge of the tentorium causing ipsilateral oculomotor nerve palsy -dilated fixed pupil and ptosis |
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Cerebellar-tonsillar Herniations
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-mass lesion in posterior fossa displaces the cerebellar tonsils through the foramen magnum
-subsequently, the medulla is compressed -leads to resp impairment/ acute resp failure -usually fatal |
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Vascular Changes
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-caused by stretching or compression of blood vessels
-consequences may include occipital infarct and Pontine hemorrhage (Duret) |
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4 main types of brain tumors
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1. gliomas
2. neuronal tumors 3. poorly differentiated neoplasms 4. meningiomas |
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Gliomas
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-derived from glial cells
-include astrocytomas, glioblastomas,oligodendrogliomas, ependymomas |
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Neuronal Tumors
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-ganglion cell tumors
-include ganglioglioma, dysembryonoplastic neuroepithelial tumor |
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Poorly Differentiated Neoplasms
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-express few if any of the phenotypic markers of mature cells
-include medulloblastoma |
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Meningiomas
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-predominantly benign tumors of adults
-usually attach to the dura -arise from the meningothelial cells of the arachnoid |
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Astrocytoma
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-tumors that arise from astrocytes (supportive tissue of the brain)
-can be malignant or benign -look like normal brain tissue -graded 1-IV |
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Types of astrocytoma
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-cerebellar astrocytoma
-desmoplastic infantile astrocytoma -pilocytic astrocytoma -subependymal giant cell astrocytoma |
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Glioblastoma Multiforme (GBM)
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-20% of all primary brain tumors
-50% of glioma -rapid growing -5 year survival <1% |
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GBM are generally found in the...
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cerebral hemispheres
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GBM sx are usually due to...
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-increased intrcranial pressure
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On CT, GMC has a characteristic..
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characteristic enhancing ring
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Meningioma arises from...
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arachnoid mater
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Meningioma
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-27% of all primary brain tumors
-frequently in middle-aged women -most often a single tumor, but multiple meningiomas can occur -benign |
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Meningiomas risk factors
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-radiation exposure
-neurofibromatosis type 2 |
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Choroid plexus papilloma look like...
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-bunch of grapes
-can see tumor cells in CSF with lumbar puncture |
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Central neurocytoma is often associated with ...
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obstructive hydrocephalus
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Most common metastatic (secondary) brain tumors:
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-lung CA
-breast CA -melanoma -kidney CA -colon CA |