Tumors

Question 1

Glial cells of brain & spinal cord

• star shaped glial cells, give support to endothelial cells of BBB
• Help w/ maintenance, repair, transporting nutrients

Answer 1

Astrocyte

(Astrocytoma)

(astro = stars)

Question 2

• Support & insulation for neurons
• Help w/ homeostasis, myelin
• Include 4 cell types, what are they?

Answer 2

Glial Cells

• Oligodendrocytes
• Astrocytes
• Ependymal cells
• Microglial cells

Question 3

What is the most common primary intra-axial brain tumor?

Answer 3

Astrocytoma

Question 4

Which grade of astrocytoma?

• Special astrocytoma such as: pilocytic astrocytoma

Answer 4

Grade 1

Question 5

Which grade of astrocytoma?

• Low-grade astrocytoma

Answer 5

Grade 1 and 2

Question 6

Which grade of astrocytoma?

• Anaplastic astrocytoma (malignant)

Answer 6

Grade 3

Question 7

Which grade of astrocytoma?

• Glioblastoma / Glioblastoma Multiforme / GBM
• (malignant)

Answer 7

Grade 4

Question 8

• More common in children and young adults
• Low degree of cellularity w/ preservation of normal brain tissue within tumor
• They do not always behave benign, and can undergo malignant transformation over a period of years

Answer 8

Grade 2 & 3 Astrocytoma

Question 9

What is the most common presenting symptoms of Grade 1 & 2 Astrocytoma?

*** on exam ***

Answer 9

Seizures (50%)

Question 10

What tx for Low Grade 1 Astrocytoma can be currative?

Answer 10

Surgical resection

(Chemo and Radiation if non-operable)

Question 11

Tx for seizures from Low grade (1&2) Astrocytomas

Answer 11

AEDs (anti epileptic drugs)

Question 12

• Considered malignant gliomas (form of astrocytoma)
• Anaplastic astrocytoma
  
  • slower growing / slower onset of sxs
  • Prognosis ___ yrs, but varies depending on age at dx
  • mean age at dx is ___ y/o

Answer 12

Astrocytoma grade 3 & 4

• 3 - 5
• 30

Question 13

2 types of grade 3&4 astrocytomas

Answer 13

• Anaplastic astrocytoma
• Glioblastoma

Question 14

Astrocytoma Grade 4

Glioblastoma

• Prognosis is ____ months, but varies depending on age at dx
• Mean age at dx is ___ yrs
• “tentacles” out to brain tissue, so hard to resect al of tumor

Answer 14

• 11 - 15
• 64

Question 15

Most common primary brain tumor

Answer 15

Glioblastoma

(glioblastoma multiforme) / GBM

Question 16

Most deadly tumor

Answer 16

GBM

Question 17

Glioblastoma

• ___ and ___ often present
• Can spread throughout ____
• Rarely ever ___ spread***

Answer 17

• necrosis & edema
• CSF
• systemic

Question 18

3 Tx for Malignant Astrocytoma

Answer 18

Surgery: (resection / lobectomy) NOT currative

Radiation: (focal or stereotactic) / Whole brain

Chemotherapy: Temozolomide (currently the only chemo which can tx glial tumors

Question 19

Prognosis for Grade 1/2 Astrocytomas

Answer 19

7 - 10 years

Question 20

Prognosis for GBM

Answer 20

18 months survival

50% for pts under 40 y/o

10-20% for patients 40+ yrs

Question 21

• Slow growing, extra-axial, benign tumors arising from arachnoid matter (outside of brain)
• Resection is usually curative
• Usually non-infiltrating (no necrosis)
• Displaces brain tissue
• Considered non-malignant mostly, but malignant forms exist

Answer 21

Meningioma

Question 22

• Meningiomas occur between age __ to ___
• More common in which sex?

Answer 22

• 30 - 70
• Women,
• unless malignant = males

Question 23

Meningioma

• Sxs occur rapidly or slowly?
• What imaging?
• __ needed to confirm dx
• Location of tumor?

Answer 23

• Slowly, usually associated w/ normal signs of agin
• MRI
• Surgical biopsy
• Anywhere meningeal tissue is…. (arachnoid tissue = periphery)

Question 24

Which tx offers best chance for cure of Meningioma?

Answer 24

Complete surgical resection

(should be offered in all SYMPTOMATIC pts, if feasible)

Question 25

**What tx is best for pts w/:** * Few sxs / little to no swelling in adjacent brain tissue * Mild/minimal sxs w/ hx of tumors w/o negative effect on quality of life * Older pts w/ very slow progressing sxs * Those whom tx carries a significant risk * Those who choose to not have surgery

Answer 25

Observation

Question 26

Tx as adjunct therapy, esp for unresectable tumors

Answer 26

Radiation

Question 27

What tx has NO ROLE in management of Meningiomas

Answer 27

Chemotherapy