Mind map

Tumor

Moza Rashid English

Map content

Tumor

Signs and Symptoms
- Headaches
- Nausea
- Difficulty with balance
- Speech difficulties
  - Types
    - Apraxia of speech
    - Cluttering
    - Dysarthria
    - Dysprosody
    - Muteness
    - Speech Sound Disorders
    - Stuttering
    - Voice Disorders
- Confusion
- Seizures
- Hearing problems
- Behavior changes
- Limb Weakness
- Vomiting
  - Causes
    - Central nervous system
      - Closed head injury
      - Increased ICP
      - Migraine
      - Seizures
      - Vestibular
    - Gastrointestinal
      - Functional disorders
      - Obstruction
      - Organic disorders
    - Infectious
    - Medications and Toxins
    - Metabolic
    - Miscellaneous
      - Acute glaucoma
      - Psychiatric disorders
      - Acute MI
      - Nephrolithiasis
      - Pain
- Loss of consciousness
Eye
- Normal
  - Muscles
  - Visual Pathway
    - 1- Retina
      - 2- Optic nerve
        3- Optic chiasma
        4- Optic tract
        5- Lateral Geniculate Body (L.G.B.) - Diencephalon
        6- Optic radiation
        7- Primary visual cortex (visual cortex, area 17)
- Abnormal
  - Double Vision
    - Causes
      - Brain problems
        Migraine
        Increased ICP
      - Nerve problem
        Diabetes
        Myasthenia gravis
        MS
        Guillain Barre syndrome
      - Cornea Problems
        Astigmatism
        Dry eyes syndrome
        Infections
      - Lens Problems
        Cataract
      - Eye Muscle Problems
        Strabismus
        Graves disease
Risk factors
- Age
- Home & Work Exposures
- Gender
- Family History
- Exposure to infections, viruses and allergens
- Electromagnetic fields
- Race and ethnicity
- Ionizing Radiation
- Head Injury & Seizures
Metastatic (50%) / Primary (50%)
- Primary tumors
  - In adults are usually supra-tentorial
  - In children are usually infra-tentorial
  - Rarely metastasize outside the CNS
  - Classification
    - Tumors of neuroepithelial tissue
      - Gliomas
        Astrocytoma
        Infiltrating astrocytic tumors
        Diffuse astrocytoma, grade II
        Moderate cellularity / No anaplasia
        Mild to moderate increase in the number of glial cell nuclei / Variable nuclear pleomorphism / Branching fibrillary processes
        Anaplastic astrocytoma, grade III
        Cellularity, anaplasia, mitoses
        More cellular areas / Greater nuclear pleomorphism / Mitotically active cells are often
        Glioblastoma, grade IV
        Most common primary malignant tumor in adults usually arises in the cerebral hemisphere
        Malignant, high-grade tumor
        Characteristically crosses the corpus callosum (butterfly lesion)
        Tumor cells are GFAP positive
        Poor prognosis, death in less than one year
        Marked anaplasia and pleomorphism / Pronounced vascular changes with endothelial hyperplasia (glomeruloid appearance / Areas of necrosis surrounded by tumor cells (pseudopalisading)
        Localized astrocytic tumors
        Pilocytic astrocytoma, grade I
        Benign cytological features
        Associated with a variety of acquired mutations
        Mean survival 6-8 years
        Aggressive, affect older patients
        Oligodendroglioma
        Closely packed cells with large round nuclei surrounded by a clear halo of cytoplasm “Fried egg” appearance of cells"
        Long survival (5-10 yrs)
        Ependymoma
        Tubules, rosettes with cells encircling vessels or pointing towards a central lumen / Perivascular pseudo-rosettes are a characteristic finding on biopsy
        Recur after surgery, acquire more aggressiveness
      - Choroid plexus tumors
      - Neuronal tumors
      - Tumors of the pineal region
    - Embryonal tumors
      - Medulloblastoma, grade IV
        Histology reveals small round blue cells, homer- wright rosettes present
      - Craniopharyngioma
    - Tumors of cranial nerves
      - Schwannoma
        Two patterns (Antoni A interlacing bundles of elongated cells with palisading of nuclei / Antoni B looser, less cellular pattern than Antoni A)
      - Neurofibroma
      - MPNST
    - Tumors of the meninges
      - Meningioma
        Good prognosis
    - Tumors of the sellar region
      - Pituitary adenma
    - Metastatic
      - Mostly carcinomas
      - Common primary sites (Breast / Lung / Skin / Kidney / GIT)
      - Single or multiple lesions
      - May be the first presentation of the primary
Investigations
- Neurological examinations
- Blood tests
- X-ray (Skull and Chest)
- Brain scans
  - CT) / Contrast enhancement
  - MRI / Contrast enhancement
  - Positron emission tomography (PET)
- Single photon emission computed tomography (SPECT)
- Ultrasound imaging (Neurosonography)
- Angiography
- CSF analysis
- EEG
- Evoked potentials
- Biopsy
- Eye Examination
  - Cranial nerve
    - Optic II (vision)
      - Visual acuity - Eye chart / Visual field – confrontation / Visual reflexes (2-3) & accommodation reflex / Colour vision / Fundoscopy
    - III, IV and VI (Ocular gaze and posture)
      - Following finger / Smooth pursuit
Management
- Treat/Manage Symptoms
- Surgery
  - Risks of Surgery
    - Allergic reaction to anesthesia / Bleeding in the brain / Blood clot / Brain swelling / Coma / Impaired speech, vision, coordination, or balance / Infection / Memory problems / Seizures / Stroke
- Chemotherapy
- Radiation
- Targeted therapy
- Clinical trials
- Palliative treatment