Podcast
Questions and Answers
Why is timely diagnosis and treatment of brain tumors considered essential?
Why is timely diagnosis and treatment of brain tumors considered essential?
- To ensure that patients are eligible for experimental treatments.
- To minimize potential complications and maximize functional quality of life. (correct)
- To reduce the financial burden on healthcare systems alone.
- To முற்றிலும் eliminate the chance of recurrence.
What role do primary care providers play in the context of patients with brain tumors?
What role do primary care providers play in the context of patients with brain tumors?
- Solely performing surgical resections of tumors.
- Conducting initial diagnosis and providing ongoing supportive care in collaboration with specialists. (correct)
- Focusing exclusively on managing the financial aspects of patient care.
- Prescribing experimental medications without specialist consultation.
How are brain metastases typically formed?
How are brain metastases typically formed?
- From abnormal neural stem cell differentiation within the brain.
- Through hematogenous spread of cancer from outside the nervous system. (correct)
- Through direct trauma to structures within the cranium.
- By malignant transformation of glial cells.
Which factor most significantly influences the potential severity of a brain tumor?
Which factor most significantly influences the potential severity of a brain tumor?
Why can even nonmalignant brain tumors pose a significant health risk?
Why can even nonmalignant brain tumors pose a significant health risk?
What characterizes primary central nervous system (CNS) lymphoma?
What characterizes primary central nervous system (CNS) lymphoma?
In the context of brain tumors, what is the key distinction between primary and metastatic lesions?
In the context of brain tumors, what is the key distinction between primary and metastatic lesions?
Among all diagnosed primary brain tumors, what is a notable characteristic of meningiomas?
Among all diagnosed primary brain tumors, what is a notable characteristic of meningiomas?
A patient with a known brain tumor presents with a fever while receiving chemotherapy. Which of the following is the MOST appropriate initial action?
A patient with a known brain tumor presents with a fever while receiving chemotherapy. Which of the following is the MOST appropriate initial action?
Why is warfarin typically avoided in brain tumor patients undergoing chemotherapy?
Why is warfarin typically avoided in brain tumor patients undergoing chemotherapy?
A patient with a brain tumor experiences a seizure at home. What instructions should be given to the family to ensure the patient's safety during the seizure?
A patient with a brain tumor experiences a seizure at home. What instructions should be given to the family to ensure the patient's safety during the seizure?
Which of the following scenarios would be an indication to call the provider?
Which of the following scenarios would be an indication to call the provider?
What is the primary purpose of a survivorship care plan for cancer patients?
What is the primary purpose of a survivorship care plan for cancer patients?
A patient who is about to start chemotherapy for a brain tumor asks about fertility preservation. What is the MOST appropriate response?
A patient who is about to start chemotherapy for a brain tumor asks about fertility preservation. What is the MOST appropriate response?
A patient with a low-grade brain tumor asks about long-term health maintenance. Which of the following is the MOST appropriate recommendation?
A patient with a low-grade brain tumor asks about long-term health maintenance. Which of the following is the MOST appropriate recommendation?
A brain tumor patient has been experiencing increased falls at home. What immediate safety advice is MOST critical to provide?
A brain tumor patient has been experiencing increased falls at home. What immediate safety advice is MOST critical to provide?
While providing education to a brain tumor patient and their family, what instructions should be given regarding medication adherence?
While providing education to a brain tumor patient and their family, what instructions should be given regarding medication adherence?
What is a key consideration regarding driving for a patient diagnosed with a brain tumor, especially one who has experienced seizures?
What is a key consideration regarding driving for a patient diagnosed with a brain tumor, especially one who has experienced seizures?
Which of the following factors is least likely to contribute to the classification of a meningioma as a higher grade (more aggressive)?
Which of the following factors is least likely to contribute to the classification of a meningioma as a higher grade (more aggressive)?
A patient presents with a brain tumor that appears histologically similar to a known lung adenocarcinoma. This is most likely a:
A patient presents with a brain tumor that appears histologically similar to a known lung adenocarcinoma. This is most likely a:
A patient is diagnosed with Primary CNS Lymphoma (PCNSL). Histological analysis of the tumor tissue will most likely reveal:
A patient is diagnosed with Primary CNS Lymphoma (PCNSL). Histological analysis of the tumor tissue will most likely reveal:
Which of the following mechanisms directly contributes to the symptoms experienced by patients with brain tumors?
Which of the following mechanisms directly contributes to the symptoms experienced by patients with brain tumors?
How does peritumoral edema contribute to the clinical presentation of brain tumors?
How does peritumoral edema contribute to the clinical presentation of brain tumors?
A patient presents with progressive lower extremity weakness and urinary incontinence. Imaging reveals a mass obstructing the flow of cerebrospinal fluid. Which of the following complications is most likely?
A patient presents with progressive lower extremity weakness and urinary incontinence. Imaging reveals a mass obstructing the flow of cerebrospinal fluid. Which of the following complications is most likely?
Which type of brain tumor is most likely to present with a long history of slowly progressing, non-specific symptoms?
Which type of brain tumor is most likely to present with a long history of slowly progressing, non-specific symptoms?
A patient with a known history of lung cancer presents to the emergency department with a new onset seizure and rapidly progressing neurological deficits. Which of the following is the most likely underlying cause of this presentation?
A patient with a known history of lung cancer presents to the emergency department with a new onset seizure and rapidly progressing neurological deficits. Which of the following is the most likely underlying cause of this presentation?
A patient is being evaluated for a suspected brain tumor. They report experiencing progressive weakness in their right arm and difficulty finding words. Where is the tumor most likely located?
A patient is being evaluated for a suspected brain tumor. They report experiencing progressive weakness in their right arm and difficulty finding words. Where is the tumor most likely located?
Which of the following is the MOST accurate statement regarding brain metastases compared to primary brain tumors?
Which of the following is the MOST accurate statement regarding brain metastases compared to primary brain tumors?
A patient presents with recent onset headaches, blurred vision, and an altered mental status. On fundoscopic examination, papilledema is noted. Which of the following conditions is most likely?
A patient presents with recent onset headaches, blurred vision, and an altered mental status. On fundoscopic examination, papilledema is noted. Which of the following conditions is most likely?
Which factor is LEAST likely to influence the prognosis of a patient with brain metastases?
Which factor is LEAST likely to influence the prognosis of a patient with brain metastases?
What is the only currently established environmental risk factor for glioma and meningioma?
What is the only currently established environmental risk factor for glioma and meningioma?
Which of the following diagnostic imaging modalities is considered the gold standard for evaluating a suspected intracranial mass?
Which of the following diagnostic imaging modalities is considered the gold standard for evaluating a suspected intracranial mass?
In the acute setting, a head CT scan is often preferred as the initial imaging modality for suspected intracranial mass lesions due to its:
In the acute setting, a head CT scan is often preferred as the initial imaging modality for suspected intracranial mass lesions due to its:
A patient with HIV/AIDS is at an increased risk for which type of primary CNS tumor?
A patient with HIV/AIDS is at an increased risk for which type of primary CNS tumor?
A patient with a known history of melanoma presents with new neurological symptoms. After initial imaging reveals a mass lesion, what additional diagnostic step is typically avoided if suspicion for metastatic disease is high?
A patient with a known history of melanoma presents with new neurological symptoms. After initial imaging reveals a mass lesion, what additional diagnostic step is typically avoided if suspicion for metastatic disease is high?
Why does cerebral edema often accompany high-grade brain tumors?
Why does cerebral edema often accompany high-grade brain tumors?
What is the PRIMARY basis for grading primary brain tumors, according to the World Health Organization (WHO) grading system?
What is the PRIMARY basis for grading primary brain tumors, according to the World Health Organization (WHO) grading system?
Which of the following seizure types is characterized by abnormal electrical activity that spreads across the entire cortical surface of the brain?
Which of the following seizure types is characterized by abnormal electrical activity that spreads across the entire cortical surface of the brain?
A patient is suspected of having a brain tumor. Which nonfocal symptom is least likely to be associated with an intracranial neoplasm?
A patient is suspected of having a brain tumor. Which nonfocal symptom is least likely to be associated with an intracranial neoplasm?
How does the 2021 update to the WHO Classification of Tumors of the Central Nervous System MOST significantly refine tumor classification?
How does the 2021 update to the WHO Classification of Tumors of the Central Nervous System MOST significantly refine tumor classification?
What is the implication of identifying IDH-mutated versus IDH wild-type molecular markers in glioblastoma (GBM) tumors?
What is the implication of identifying IDH-mutated versus IDH wild-type molecular markers in glioblastoma (GBM) tumors?
According to the information provided, which type of primary malignant brain tumor is the MOST frequent?
According to the information provided, which type of primary malignant brain tumor is the MOST frequent?
What characteristic differentiates high-grade gliomas from lower-grade gliomas?
What characteristic differentiates high-grade gliomas from lower-grade gliomas?
Even though meningiomas are often slow growing, why are they often discovered in patients of advanced age?
Even though meningiomas are often slow growing, why are they often discovered in patients of advanced age?
A researcher is studying the genetic mutations that lead to the development of primary brain tumors. Based on the passage, what is currently understood about the etiology of these tumors?
A researcher is studying the genetic mutations that lead to the development of primary brain tumors. Based on the passage, what is currently understood about the etiology of these tumors?
A patient is diagnosed with a brain tumor, and the neuro-oncology team is using the fifth edition of the WHO Classification of Tumors of the Central Nervous System. How might this new classification system impact the patient's treatment plan?
A patient is diagnosed with a brain tumor, and the neuro-oncology team is using the fifth edition of the WHO Classification of Tumors of the Central Nervous System. How might this new classification system impact the patient's treatment plan?
A physician is explaining to a patient that their low-grade glioma has transformed into a higher-grade tumor. What are some of the characteristics the physician might use to describe this transformation?
A physician is explaining to a patient that their low-grade glioma has transformed into a higher-grade tumor. What are some of the characteristics the physician might use to describe this transformation?
Which of the following is LEAST likely to contribute to the increased detection of brain metastasis over the years?
Which of the following is LEAST likely to contribute to the increased detection of brain metastasis over the years?
Why is dexamethasone the preferred corticosteroid for treating vasogenic edema in brain tumor patients?
Why is dexamethasone the preferred corticosteroid for treating vasogenic edema in brain tumor patients?
What is the rationale for avoiding steroid use before biopsy in patients suspected of having primary CNS lymphoma?
What is the rationale for avoiding steroid use before biopsy in patients suspected of having primary CNS lymphoma?
Why are non-enzyme-inducing antiseizure medications preferred for seizure management in brain tumor patients?
Why are non-enzyme-inducing antiseizure medications preferred for seizure management in brain tumor patients?
Why is bupropion generally avoided in brain tumor patients experiencing depression?
Why is bupropion generally avoided in brain tumor patients experiencing depression?
What is the recommended first-line treatment for fatigue in brain tumor patients?
What is the recommended first-line treatment for fatigue in brain tumor patients?
What is the primary goal of rehabilitation for patients with cognitive and functional impairments due to brain tumors?
What is the primary goal of rehabilitation for patients with cognitive and functional impairments due to brain tumors?
Which of the following statements regarding the incidence of primary brain tumors across the lifespan is most accurate?
Which of the following statements regarding the incidence of primary brain tumors across the lifespan is most accurate?
When considering treatment options for older patients with brain tumors, what factors should be considered in addition to age?
When considering treatment options for older patients with brain tumors, what factors should be considered in addition to age?
What circumstance warrants immediate evaluation in the emergency department for a patient suspected of having a brain tumor?
What circumstance warrants immediate evaluation in the emergency department for a patient suspected of having a brain tumor?
Which of the following is NOT a potential contributor to elevated intracranial pressure (ICP) in brain tumor patients?
Which of the following is NOT a potential contributor to elevated intracranial pressure (ICP) in brain tumor patients?
Which of the following is the MOST appropriate initial step when a brain tumor is suspected in a primary care setting?
Which of the following is the MOST appropriate initial step when a brain tumor is suspected in a primary care setting?
A 72-year-old patient with a brain tumor has a Karnofsky Performance Score of 50. What treatment approach is MOST appropriate?
A 72-year-old patient with a brain tumor has a Karnofsky Performance Score of 50. What treatment approach is MOST appropriate?
What is the 5-year relative survival rate following diagnosis of a primary nonmalignant brain and other CNS tumors?
What is the 5-year relative survival rate following diagnosis of a primary nonmalignant brain and other CNS tumors?
An 8-year-old patient has recently been diagnosed with a brain tumor. What is the reported incidence rate of childhood brain and other CNS tumors in the United States from 2012 to 2016?
An 8-year-old patient has recently been diagnosed with a brain tumor. What is the reported incidence rate of childhood brain and other CNS tumors in the United States from 2012 to 2016?
In the context of brain tumors, when is a lumbar puncture most warranted?
In the context of brain tumors, when is a lumbar puncture most warranted?
Why is early detection not as impactful for brain tumors compared to other cancers?
Why is early detection not as impactful for brain tumors compared to other cancers?
What is the primary goal of brain tumor treatment, considering that it's often not curative?
What is the primary goal of brain tumor treatment, considering that it's often not curative?
What is a common radiation dosage range when fractionated schedule is used?
What is a common radiation dosage range when fractionated schedule is used?
When might a hypofractionated course of radiation be considered?
When might a hypofractionated course of radiation be considered?
How do tumor-treating fields (TTF) work to disrupt cancer cell growth?
How do tumor-treating fields (TTF) work to disrupt cancer cell growth?
What is the typical administration schedule for temozolomide after radiotherapy?
What is the typical administration schedule for temozolomide after radiotherapy?
What role does Bevacizumab play in treating brain tumors?
What role does Bevacizumab play in treating brain tumors?
Which diagnostic imaging is MOST appropriate when metastatic disease within the body is suspected?
Which diagnostic imaging is MOST appropriate when metastatic disease within the body is suspected?
A patient presents with new-onset seizures, severe headaches, and altered mental status. What is the MOST likely concern based on these symptoms?
A patient presents with new-onset seizures, severe headaches, and altered mental status. What is the MOST likely concern based on these symptoms?
A patient with glioblastoma is undergoing radiation therapy with concurrent temozolomide. After completing radiotherapy, what is the typical dosage and schedule for Temozolomide?
A patient with glioblastoma is undergoing radiation therapy with concurrent temozolomide. After completing radiotherapy, what is the typical dosage and schedule for Temozolomide?
Which of the following is the MOST likely therapeutic application of Bevacizumab in the treatment of brain tumors?
Which of the following is the MOST likely therapeutic application of Bevacizumab in the treatment of brain tumors?
Which statement accurately reflects the approach to managing primary CNS lymphoma?
Which statement accurately reflects the approach to managing primary CNS lymphoma?
A patient with recurrent glioblastoma is being considered for tumor-treating fields (TTF) therapy. What key instruction should the patient receive regarding the use of the TTF device?
A patient with recurrent glioblastoma is being considered for tumor-treating fields (TTF) therapy. What key instruction should the patient receive regarding the use of the TTF device?
Which condition would raise suspicion of metastatic disease, prompting further imaging such as CT of the chest, abdomen, and pelvis?
Which condition would raise suspicion of metastatic disease, prompting further imaging such as CT of the chest, abdomen, and pelvis?
Flashcards
Brain Tumor
Brain Tumor
Abnormal cell mass in the brain or surrounding tissues, also known as intracranial neoplasm.
Primary Brain Tumor
Primary Brain Tumor
Tumors originating from cells within the brain/cranium.
Brain Metastases
Brain Metastases
Tumors caused by cancer spreading to the brain from elsewhere in the body.
Primary CNS Lymphoma
Primary CNS Lymphoma
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Meningioma
Meningioma
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Brain Tumor Urgency
Brain Tumor Urgency
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PCP's Role
PCP's Role
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Nonmalignant Tumor Impact
Nonmalignant Tumor Impact
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Brain tumor presentation
Brain tumor presentation
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VTE Monitoring
VTE Monitoring
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VTE Treatment (Cancer)
VTE Treatment (Cancer)
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Fever During Chemo
Fever During Chemo
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Call Provider For...
Call Provider For...
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Seizure Safety
Seizure Safety
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Driving Restrictions
Driving Restrictions
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Chemo and Fertility
Chemo and Fertility
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Health Maintenance
Health Maintenance
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Long-Term Sequelae
Long-Term Sequelae
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Body Imaging First
Body Imaging First
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Initial Brain Tumor Imaging
Initial Brain Tumor Imaging
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When to use CT chest/abd/pelvis or PET/CT
When to use CT chest/abd/pelvis or PET/CT
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Differential Diagnoses for Brain Tumor
Differential Diagnoses for Brain Tumor
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Brain Tumor Symptoms
Brain Tumor Symptoms
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Brain Tumor Treatment Goal
Brain Tumor Treatment Goal
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Radiation Therapy for Brain Tumors
Radiation Therapy for Brain Tumors
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Tumor Treating Fields (TTF)
Tumor Treating Fields (TTF)
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How TTF works
How TTF works
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TTF application
TTF application
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First-line Chemotherapy for High-Grade Glioma
First-line Chemotherapy for High-Grade Glioma
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Temozolomide Dosing Schedule
Temozolomide Dosing Schedule
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Chemotherapy for Primary CNS Lymphoma
Chemotherapy for Primary CNS Lymphoma
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Bevacizumab Mechanism
Bevacizumab Mechanism
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Bevacizumab Uses
Bevacizumab Uses
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Gliomas
Gliomas
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Cancers with highest brain metastasis
Cancers with highest brain metastasis
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Most prevalent origins of brain metastases
Most prevalent origins of brain metastases
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Low-grade meningioma (WHO grade 1)
Low-grade meningioma (WHO grade 1)
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Brain tumors' environmental risk factor
Brain tumors' environmental risk factor
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Origin of most primary brain tumors
Origin of most primary brain tumors
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Factors escalating meningioma grade
Factors escalating meningioma grade
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Primary brain tumors are...
Primary brain tumors are...
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Brain metastases pathology
Brain metastases pathology
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WHO grading system
WHO grading system
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Primary CNS Lymphoma (PCNSL)
Primary CNS Lymphoma (PCNSL)
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PCNSL Histology
PCNSL Histology
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Types of Gliomas
Types of Gliomas
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How brain tumors cause symptoms
How brain tumors cause symptoms
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Characteristics of High-Grade Gliomas
Characteristics of High-Grade Gliomas
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High-Grade Gliomas behavior
High-Grade Gliomas behavior
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Peritumoral edema
Peritumoral edema
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Brain tumors and hydrocephalus
Brain tumors and hydrocephalus
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Brain tumors and seizures
Brain tumors and seizures
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Location of Meningiomas
Location of Meningiomas
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Cerebral edema of high-grade brain tumors forms because leaky vessels lack a competent...
Cerebral edema of high-grade brain tumors forms because leaky vessels lack a competent...
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Glioblastoma symptom onset
Glioblastoma symptom onset
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Leaky vessels impact
Leaky vessels impact
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Meningioma symptom onset
Meningioma symptom onset
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Brain metastases presentation
Brain metastases presentation
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Preferred brain tumor imaging
Preferred brain tumor imaging
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Emergent complications detected by Head CT
Emergent complications detected by Head CT
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Why tissue acquisition is required
Why tissue acquisition is required
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Immunotherapy Agents
Immunotherapy Agents
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Steroids for Brain Tumors
Steroids for Brain Tumors
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Dexamethasone
Dexamethasone
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Anticonvulsant Therapy
Anticonvulsant Therapy
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Non-enzyme-inducing antiseizure medications
Non-enzyme-inducing antiseizure medications
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Depression in Brain Tumor Patients
Depression in Brain Tumor Patients
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First-line treatments for fatigue
First-line treatments for fatigue
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Rehabilitation in Brain Tumors
Rehabilitation in Brain Tumors
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Neuropsychological Testing
Neuropsychological Testing
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Brain Tumor Incidence and Age
Brain Tumor Incidence and Age
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Factors to consider for elderly with brain tumors
Factors to consider for elderly with brain tumors
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Increased Intracranial Pressure (ICP)
Increased Intracranial Pressure (ICP)
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Causes of Increased ICP
Causes of Increased ICP
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Karnofsky Performance Score
Karnofsky Performance Score
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Anticonvulsants
Anticonvulsants
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Study Notes
- Brain tumors have significant physical, psychological, and financial impacts.
- Early diagnosis and treatment of brain tumors are crucial for minimizing complications and maximizing quality of life.
- Primary care providers play a key role in detecting subtle changes and providing ongoing supportive care.
Definition and Epidemiology
- A brain tumor, or intracranial neoplasm, is an abnormal cell mass in the brain or surrounding tissues.
- There are over 120 types of brain tumors, varying in severity from benign to malignant.
- Brain tumors are classified as primary (originating in the brain) or metastatic (spreading from elsewhere).
- Primary CNS lymphoma involves neoplastic lymphocytes infiltrating the CNS.
- In 2021, an estimated 83,570 new cases of primary brain and CNS tumors were expected in the US, with about one-third being malignant.
- Meningiomas account for 53.9% of all cases, mostly nonmalignant.
- Gliomas are the second most common primary brain tumor, accounting for 78.3% of malignant intracranial tumors.
- Brain metastases are more common than primary brain tumors.
- Melanoma and small cell lung cancer (SCLC) have a high propensity for brain metastasis.
- Brain metastases are more prevalent in non-SCLC and breast cancer due to their higher incidence.
- Improved imaging and novel therapies have increased the detection and survival rates.
- Prognosis is influenced by the primary malignancy, age, performance status, and extent of brain metastases.
- The cause of primary intracranial neoplasms is largely unknown, with the only established risk factor being prior ionizing radiation exposure.
- Hereditary syndromes like neurofibromatosis and Li-Fraumeni syndrome can contribute to primary brain tumors.
- Primary CNS lymphoma is more common in immunosuppressed individuals.
Pathophysiology
- Most primary brain tumors arise from random genetic mutations, but the exact mechanism is unclear.
- Primary brain tumors rarely metastasize outside the CNS.
- Cerebral edema, common in high-grade tumors, results from neovascular proliferation and leaky blood vessels.
- Brain tumors are graded (not staged), with higher grades indicating more aggressive behavior.
- The World Health Organization (WHO) grading system is used to predict tumor behavior.
- The 2021 fifth edition of the WHO Classification of Tumors of the Central Nervous System includes molecular markers and Arabic numerals for grading.
- The most malignant astrocytoma, previously grade IV glioblastoma (GBM), is now classified by IDH-mutated and IDH wild-type markers. Only tumors with GBM characteristics and IDH wild-type are considered grade 4.
- Gliomas, arising from glial cells, are classified into astrocytomas, oligodendrogliomas, and ependymomas based on cell origin and molecular genotyping.
- High-grade gliomas (WHO grade 3 or 4) are heterogeneous, with neovascularization, high mitotic rate, and necrosis.
- Meningiomas, originating in the meninges, are the most common intracranial tumor, often slow-growing and discovered in older patients.
- Low-grade (WHO grade 1) meningiomas have a low risk of recurrence.
- Higher-grade meningiomas have increased mitotic activity, brain invasion, and necrosis and are slightly more common in males.
- Brain metastases typically mimic the histology of the primary tumors.
- Primary CNS lymphoma (PCNSL) is a non-Hodgkin lymphoma confined to the CNS, usually presenting as a diffuse, large B-cell lymphoma.
Clinical Presentation and Physical Examination
- Brain tumors cause symptoms by infiltrating, expanding, and displacing healthy brain tissue.
- Peritumoral edema can increase mass effect, leading to cerebral herniation.
- Tumors can obstruct the ventricular system, causing hydrocephalus, or increase neuronal excitability, leading to seizures.
- Tumors in the hypothalamic-pituitary axis can cause endocrinologic syndromes.
- Fast-growing tumors produce subacute symptoms, while slow-growing tumors can be asymptomatic for years.
- Brain metastases often present abruptly due to rapid growth and edema.
- Patients may present with focal or nonfocal neurologic symptoms, often subacute and progressive.
- Focal changes include deficits in vision, speech, strength, sensation, or gait.
- Nonfocal symptoms include headache, memory loss, behavior change, cognitive deficits, and fatigue.
- Seizures are a common presenting symptom, more prevalent in low-grade glioma, meningioma, and metastatic brain tumors.
- Focal seizures are more common than generalized seizures in patients with brain tumors.
- Patients may exhibit signs of increased intracranial pressure (ICP).
- A thorough neurologic exam, including mental status and optic fundi examination, is crucial.
- Visual field testing, assessment of ocular movement, and motor and sensory function are important.
- Aphasia can be misinterpreted as confusion.
- Posterior fossa tumors may result in gait dysfunction or disorders of coordination.
Diagnostics
- Brain MRI with and without contrast is the preferred study.
- Head CT scan is used in acute settings to identify complications like mass effect or hemorrhage.
- MRI with gadolinium is the gold standard following CT identification of a mass.
- Additional imaging may be needed to define the primary cancer location and extent of disease if metastatic disease is suspected.
- Tissue acquisition is required for diagnosis and treatment recommendations, except for suspected metastatic cancer.
- MRI diffusion, perfusion, or spectroscopy may be useful.
- CSF analysis is warranted only if imaging suggests leptomeningeal involvement, primary CNS lymphoma, or encephalitis.
- Serology is typically unrevealing.
- Differential diagnoses include stroke, hemorrhage, and infection.
- Red flag signs of increased ICP include severe headache, nausea, altered mental status, and papilledema.
Interprofessional Collaborative Management
- Oncologic management requires a multidisciplinary approach.
- Treatment goals are typically to prolong progression-free survival rather than to cure, except in certain cases.
- Supportive care is integral, addressing symptoms and treatment side effects.
Treatment Modalities
- Surgery may be followed by radiation, which can be localized or whole-brain, typically in 30 to 60 Gy fractions.
- Hypofractionated radiation is used for older patients or those with poor performance status.
- Radiation is recommended for incompletely resected intermediate-grade meningioma, high-grade meningioma, low-grade glioma with high-risk features, or high-grade glioma.
- Radiation options for brain metastases depend on the number and size of metastases.
- Whole-brain radiation is used for primary CNS lymphoma but is reserved for relapse or incomplete response due to neurotoxicity risks.
- Tumor-treating fields (TTF) use alternating electrical fields to disrupt cell division, approved for recurrent and newly diagnosed glioblastoma after radiation and temozolomide.
- Chemotherapy is recommended for high-grade glioma and low-grade glioma with high-risk features.
- Temozolomide is the preferred first-line agent for chemotherapy because it can cross the blood brain barrier.
- Chemotherapy is typically recommended for treatment of high-grade glioma and for low-grade glioma with high-risk features.
- During radiation therapy, temozolomide is administered daily at a low dose.
- For patients with brain metastasis, the role of chemotherapy is less clear and depends largely on tumor sensitivity to the agent and degree of CNS penetration.
- Primary CNS lymphoma is treated upfront with a high-dose methotrexate-based chemotherapy regimen.
- Bevacizumab, a monoclonal antibody that inhibits blood vessel formation, is used in recurrent glioma and radiation necrosis.
- Immunotherapy agents, like checkpoint inhibitors, are emerging for brain metastasis from non-SCLC and melanoma.
- Clinical trial participation should be considered whenever possible.
Supportive Care
- Steroids, like dexamethasone, are used for vasogenic edema but should be used at the lowest effective dose.
- Anticonvulsant therapy is often lifelong for patients with seizures, with preference given to non-enzyme-inducing medications.
- Depression is frequently seen and treated with SSRIs; bupropion should be avoided.
- Nonpharmacologic therapies, including counseling, massage, and exercise, should be used in conjunction with pharmacologic therapy.
- Fatigue is common and managed with energy conservation, nutrition, and activity; stimulants like methylphenidate may be considered.
- Dietary recommendations are essential, with early referral to a dietitian.
- Cognitive and functional impairments require rehabilitation, including physical, occupational, speech, and cognitive therapy.
Life Span Considerations
- Brain tumor occurrence increases with age, peaking in older adults.
- Grade 4 tumors are more frequent in patients over 65, while low-grade tumors are more common in younger adults.
- Survival rates vary based on age, tumor location, and grade.
- Age is a critical factor in treatment decisions, considered in the context of performance status and comorbidities.
- Older patients can receive similar treatment options if healthy.
- Palliative care is appropriate for older patients or those with poor baseline performance status, facilitating level-of-care discussions.
Complications
- Increased ICP is a neurologic emergency requiring prompt intervention.
- Venous thromboembolism (VTE) is common, especially postoperatively, treated with low-molecular-weight heparin.
- Uncontrolled seizures or status epilepticus warrants prompt evaluation.
- Fever in chemotherapy patients requires urgent evaluation.
- Neurologic decline necessitates reimaging.
- Falls resulting in head trauma may require urgent evaluation.
Patient and Family Education and Health Promotion
- Call the provider for unrelieved headache, breakthrough seizure, new neurologic findings, fever, or treatment-related side effects.
- Never stop medications without consulting the provider, especially steroids.
- During a seizure, ensure safety by removing sharp objects, protecting the head, and rolling the person to the side.
- Driving ability may be compromised depending on tumor type and location.
- Discuss fertility preservation options before starting chemotherapy.
- Encourage health promotion activities, including health maintenance screenings.
- Encourage patients living with brain tumors to follow established guidelines for health promotion, such as not smoking, limiting alcohol, eating well, and managing stress.
- Regular physical activity is encouraged to help rebuild strength and edurance levels.
- Monitor for long-term sequelae related to radiation, chemotherapy, and corticosteroids.
- A survivorship care plan documents diagnosis, treatment, follow-up, and late effects.
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Description
Explore the critical aspects of brain tumors, including timely diagnosis, treatment methods, and the roles of primary care providers. Delve into the formation of brain metastases, factors influencing tumor severity, and the characteristics of meningiomas and primary CNS lymphoma. Understand the distinction between primary and metastatic lesions.
