Brain Tumor Information Module

Brain Tumor Information Module

1 Basic Brain Information and Anatomy2The brain is the major control center of a persons body and mind. It is where ideas, senses, reflexes and movements originate. The human brain is extremely complex, but can be roughly organized into different structures that are responsible for different tasks.3Cerebral Cortex-The largest, most familiar part of the brain-Divided into left and right cerebral hemispheres that control the opposite sides of the body-responsible for reading, speech, thinking, learning, emotions, and reactions to senses.- Can be divided into more specific areas

4Divisions of the Cerebral Cortex

Frontal Lobe- gives you the ability to choose right from wrong, use correct social responses, and retain long term memoriesTemporal Lobe involved with speech, memory and hearingOccipital Lobe processes visual stimuliParietal Lobe processes information to help with spatial orientation, manipulation of objects and understanding numbers

5Inner BrainThe inner brain lies beneath the cerebral cortex and works as a connection between the cerebral cortex and the brainstem. Its structures determine our emotional state, consciousness, perceptions and reflexes.

6Inner Brain Structures

Thalamus processes information from the cortex and plays an important role in consciousnessHypothalamus Links the nervous system to the endocrine system, which makes it a major control center for emotionsHippocampus Responsible for memory formation and storagePituitary Gland Controls hormone secretion7Inner Brain StructuresBasal Ganglia A collection of nuclei that provide connections between the cortex, thalamus, and brainstem. These connections are involved with movement coordination, executing voluntary movements, perception, learning and memory. Olfactory Bulb Involved with smell. Amygdala Controls emotions, especially by forming emotional memories, and is also responsible for long-term memory.

Brain Stem

Responsible for essential life functions and relays information between the brain and the rest of the bodyMidbrain Controls reflexes and movement.Pons - Responsible for breathing and arousal, and also coordinates movement information between the cortex and cerebellum.Medulla Maintains autonomic functions like breathing, blood pressure, and heart rate.9Cerebellum

Detects surroundings and coordinates movements to respond to specific situations10Important LinksBrain Anatomy (for fun)

3-D Brain Anatomy

http://anatomyarcade.com/games/wordsearch/nervousWS/nervousWordsearch.html

Question

What are the 4 main lobes of the Cerebral Cortex?

What actions is the Cerebral Cortex responsible for?

Answer:

The Cerebral cortex is responsible for:Frontal lobeLong term memories, social interactionParietal lobeSpatial orientation, object manipulationOccipital lobeProcessing visual stimuliTemporal lobeInvolved in speech, memory, and hearing

Meninges

The brain is a floating network of cells suspended in Cerebrospinal fluid (CSF). The CSF is produced by ependymal cells and circulates through the ventricles and meninges. The meninges cover the brain and attach it to the skull. 14Meninges

We have 3 MeningesDura MaterThe tough layer next to the skullArachnoid MaterThe middle layer that is made up of web-like projections that connect the two other layers and allows CSF to flow throughPia MaterThe thinnest layer that lies closely against the brain15VentriclesThere are four ventriclesThe paired lateral ventriclesThird VentricleFourth VentricleThey are cavities in the brain that carry and promote the flow of cerebrospinal fluid

16Question:What are the three Meninges?

What flows through the Meninges

What are the big cavities in the brain that hold this fluid?AnswerDura Mater, Arachnoid Mater , Pia Mater

Cerebrospinal Fluid

VentriclesBrain MatterThe brain is made up of neurons and glial cells. The neurons carry signals throughout the brain, while the glial cells mainly provide support for the neurons.

19Neurons

100 billion neurons in the brainHave 3 basic partsDendritesDetect signals from the surrounding cells and transmits them to the cell bodyCell bodyContains the nucleus, which is the control center for the cell AxonCarries signals from the cell body to the end of the axonThe axon is covered with myelin, which is an insulating sheath that helps to speed up signal movement

20Glial CellsEstimated 10x more glial cells than neurons Do NOT chemo-electric carry signalsMain job is to hold neurons in placeCapable of secreting nutrients and other chemicals that can change signals sent throughout the brain

21Types of Glial Cells OligodendrocytesSchwann Cells

These cells produce myelin (insulating cover) for the nerves in the brain and spinal cordThese cells produce myelin for the nerves outside of the brain and spinal cord22 Astrocytes MicrogliaAnchor to neurons and provide supportAct as a buffer to absorb chemicals and promote homeostasis in the brainEat foreign entities in the brain part of the brains immune system

23Ependymal CellsLine the ventricles in the brain Make CSF and helps it flow throughout the ventricles

24Questions:Are there more neurons or glial cells in the brain?

What is the main role of glial cells?

Specifically, what do Oligodendrocytes do?

Specifically, what do Astrocytes do?Answers:Glial cells There is up to ten times more glial cells than neuronsGlial cells provide supportOligodendrocytes make the insulating cover for neurons (myelin)Astrocytes anchor neurons and absorb chemicals in the brainBrain Tumor InformationBrain Tumors arise when cell division occurs irregularly and uncontrolled. When more tissue is produced than needed, tumors are formed. They can grow in many different parts of the brain and involve different types of tissues and cells. If tumors are benign, they grow locally and do not spread. If a tumor is malignant, it is invasive and can spread throughout the body.27Malignant Brain Tumors-When determining how malignant a brain tumor is, the cells are examined by a pathologist and given a grade. Brain tumors can be graded using the WHO classification system. WHO Grade 1 Well differentiated (Low Grade)WHO Grade 2 Moderately differentiated (Intermediate Grade)WHO Grade 3 Poorly Differentiated (High Grade)WHO Grade 4 Undifferentiated (High Grade)28Cell Differentiation Examples

A Grade 2B Grade 3C Grade 429Symptoms of a Brain TumorBy Location:Frontal lobeWeakness, personality changes, speech disturbancesParietal lobeLoss or changes in sensation, changes in visionTemporal lobeSeizures, difficulty understanding, difficulties with languageOccipital lobeChanges in visionCerebellumAbnormal eye movements, loss of coordination, changes in gait, hearing loss, vertigo, headaches, nausea, vomiting DiagnosisThe process of detecting and treating a brain tumor can be extremely stressful and complicated. Once a patient goes to see the doctor, they do a basic neurological exam. This exam tests many functions, such as eye movements, pupil reactions, reflexes, hearing, mental abilities, facial movements, and balance and coordination.If these are abnormal, the doctor may schedule an MRI or a CT Scan31MRI Magnetic Resonance Imaging

The patient lies on a table that slides into a tunnel with a magnetic fieldDuring the scan, radio waves are sent to the head. The different cell types in the brain cause the waves to bend, which are recognized by a computer that forms a picture.32CT Scan Computed Tomography

For a CT Scan, a person is injected with a dye and then lies on a table. A big donut shaped machine circles the head and sends x-ray waves through the brain to measure the amount of rays that are emitted back in the machine vs. the amount that are absorbed. By putting together all of the signals, a computer forms a picture of the brain. 33BiopsyOnce it is determined that there is a growth in the brain, a biopsy is done in order to make an accurate diagnosis. If the tumor is in an accessible location, a patient may choose to have the whole tumor removed and then send a sample away for the biopsy. If the tumor is inaccessible, a tiny needle can be inserted into the brain to capture a small sample of tissue. Once the samples are attained, they are sent to a neuropatholigst.

34Pathology

The tissue samples are either frozen or dried, then sliced into very thin sections.The slices are mounted on to slides and examined with a microscopeFirst, the cell type that the tumor originated from is determinedNext, the growth rate of the tumor is assessedFinally, the type and grade of the tumor is diagnosed35Pathology ReportWhen a patient is diagnosed, the details are put into a document called a pathology report. Physicians write them with the intent that other physicians will read them, so they are often complex and difficult to decipher. Get picture36Pathology Report ContentsMain SectionsPersonal InformationName, date of birth, etc.Clinical HistoryA brief description of a persons medical situation Gross DescriptionDescribes how the tissue looks to the naked eyeMicroscopic DescriptionDescribes how the tissue looks under the microscopeDiagnosisStates the final DiagnosisThis is the biggest section of the report that specifically describes the type of tumor, what tissues are involved and patterns of growth. This section provides important information that is used to determine how to treat the patients specific tumor type. Comments37QuestionsWhat are some symptoms of brain tumors?

How is the level of malignancy graded?

What types of scans are done to see if a person has a brain tumor?

What document gives the results of a tumor analysis?Answers:Seizure, Nausea, Headaches, Weakness, Fatigue, Mood or Personality changes

WHO grade I-IV

MRI and CT Scan

Pathology reportTypes of Brain TumorsSome are from a single cell typeEx.- Astrocytoma, OligodendrogliomaSome are from a mixed cell typeEx. Oligoastrocytoma, mixed gliomaSome are mixed with neuronsEx. GangliomaSome are from neuronsGangliocytomaSome are from other tumors that have metastasized About 40% of brain tumors are metastaticThe most common cancers that spread to the brain are lung, breast, melanoma, renal and colon cancers

40Malignant Brain Tumors

AstrocytomasArise from Astrocyte cells - Astrocytoma Video4 typesPilocytic Astrocytoma (grade I)Occurs mostly in children, benignLow-Grade Astrocytoma (Grade II)Can be removed by surgery, but radiation is also recommendedAnaplastic Astrocytoma (Grade III)Radiation and Chemotherapy recommendedGlioblastoma Multiforme (Grade IV)Very aggressive and spreads throughout the CNSPatients usually have neurological symptomsRadiation and chemotherapy recommended Account for about 25% of all brain tumorsLife expectancy is about a yearGBM Video

42OligodendrogliomaArise from oligodendrocytesAverage age of diagnosis = 35 years9.4% of all primary brain and CNS tumorsOccur most frequently in the frontal lobePrimary symptom is usually a seizureUsually grade II or IIIMedian survival11.6 years for grade II 3.5 years for grade IIIUsually grows slower than an AstrocytomaMixed GliomaMost often a mix between an astrocytoma and an oligodendroglioma = oligoastrocytomaPrimarily occurs people aged 20 50Account for 1% of all brain tumorsSymptomsHeadacheNausea and vomitingBehavioral changesTreatment based on most malignant cell typehttp://www.braintumor.org/MixedGlioma/44Intraventricular Tumor

Make up about 10% of CNS tumorsMay be composed of surrounding cellsAstrocytoma, Meningioma etc.May arise from cells lining the ventricleEpendymoma5% of CNS tumorsSurvival rate of 5-10 years85% are benignTumor can block flow of Cerebrospinal fluid through the ventricles and cause obstructive hydrocephalusMay cause nausea, vomiting, deteriorating mental status, headache, neurological defectsStandard treatment includes surgery, and then radiation and/or chemotherapy if needed

http://nyp.org/health/neuro_intraventricular.htmlhttp://images.med.cornell.edu/news/wmc/09_28_05.jpg

45Primary CNS Lymphoma90% are diffuse large B-cell lymphomas Can also be poorly characterized low-grade lymphomas, Burkitt lymphomas, and T-cell lymphomasIncidence increasing especially among immunocompromised patientsMost commonly occurs around age 55Survival with radiation and chemotherapy is around 44 monthshttp://emedicine.medscape.com/article/1157638-overview46Metastatic Brain TumorsNot a primary brain tumor Composed of cancer cells that have spread from their original locationMost common:Breast, Melanoma, Lung, KidneyTreatment is composed of radiation and surgery if possibleChemotherapy has not been found to be helpfulSurgery is not done when there are multiple tumorshttps://health.google.com/health/ref/Metastatic+brain+tumor47QuestionWhat is the name of a Grade IV astrocytoma?

What is the average life expectancy for a Grade IV astrocytoma?

Oligodendrogliomas are usually what Grades?

What is a type of Intraventricular Tumor?Answer:Glioblastoma Multiforme

1 year

Grade II and III

EpendymomaBenign Brain TumorsBenign TumorsCaused by a group of cells that grow irregularlyNon-invasive and grow slowlyMay cause pressure on important brain structuresCan be removed by surgeryUsually dont grow back

http://www.medterms.com/script/main/art.asp?articlekey=434851MeningiomaArise from the meninges surrounding the brainAccounts for about 20% of brain tumors2nd most common brain tumorUsually occurs during 40s-60sMay cause weakness, seizuresSmall, slow growing tumors may not need to be treated be treated with surgery, radiosurgery or radiation therapy

Pituitary TumorAbnormal growth in the pituitary glandCauses irregular hormone levelsTreatmentSurgeryExpanded Endonasal approachRadiationDrugsTo shrink tumorTo treat irregular hormone levels

http://www.mayoclinic.com/health/meningioma/DS00901/DSECTION=treatments-and-drugs53Other Benign TumorsCentral NeurocytomaTypically in young adults in lateral ventriclesChondromaArises from cartilage, usually at the base of the skullGangliocytomaOccur in children/young adults and arises from ganglionSchwannomaArise in the nerve sheath and can compress nervesCause pain, weakness and numbness

http://wiki.cns.org/wiki/index.php/CENTRAL_NEUROCYTOMAhttp://wiki.cns.org/wiki/index.php/Gangliocytomahttp://wiki.cns.org/wiki/index.php/Schwannomahttp://brainsurgery.upmc.com/conditions-and-treatments/chondroma.aspx54QuestionsWhat brain structure do Meningiomas arise from?

What can a Pituitary Tumor Cause?

AnswersMeninges

Irregular Hormone LevelsTreatment

SurgeryStereotactic Biopsy3-D Mapping of the brain and removal of a small amount of specific tissueUsually done when the tumor can not be removedExplanationCraniotomyDone if the tumor is accessible and can be removed safelyA piece of skull is removed to reach the brainSurgeons carefully separate tumor from brain tissue and remove as much as possibleCraniotomy videoCraniotomy Video - Dr. Mintz

SurgeryExpanded Endonasal ApproachSurgeons reach structures in the brain by going through the nasal passages and sinus cavitiesAnimated Video

Chemotherapy

Given mainly to high-grade tumors, but may also be prescribed for low-grade or benign tumors Designed to prevent cells from dividing or promote cell deathCertain tumors may become resistant to chemotherapy or may simply not react at allMay also kill healthy cells, especially in the gastrointestinal tract http://www.abta.org/siteFiles/SitePages/76048D8B680BBF7FBD3EE59B11F061CD.pdf60Common Chemotherapy DrugsTemozolomide (Temodar)Most often prescribed for astrocytomas and other high-grade gliomasTaken in 28 day cyclesTake pill from days 1-5No pills from days 6-28Cycle may be different for some individualsMay cause nausea, fatigue and constipation

Other Chemotherapy DrugsThe PCV Regimen6 cycles, each lasting 42 DaysTake CCNU pill on day 1Taken at bedtime, may cause nauseaVincristine injection on day 8 and 29Usually given at hospital, may cause temporary nerve damageProcarbazine pills on days 8-21Taken at bedtime, may cause nausea, loss of appetite, fatigue, decrease in blood countsRadiation Therapy

Stereotactic RadiosurgeryNot surgeryPrecise radiation therapy given in concentrated beams Gamma-ray or x-ray beamsGamma Knife Surgery when gamma rays are usedBeams damage tumor cell DNA, causing it to shrinkReferred to as fractionated stereotactic radiosurgery when multiple treatments are donehttp://www.radiologyinfo.org/en/info.cfm?pg=stereotactic#part_onehttp://www.radiologyinfo.org/en/info.cfm?pg=gamma_knife63OtherAvastin (Bevacizumab)Vascular endothelial growth factor-specific angiogenesis inhibitor Stops the formation of blood vessels, which carry nutrients, into tumorsOften used in conjunction with chemotherapyFirst drug that inhibits angiogenisis (blood vessel formation)Approved in May 2009 for treatment of recurrent glioblastoma. In IIIrd phase clinical trial for treatment of initial tumor growthhttp://www.gene.com/gene/products/information/oncology/avastin/64Biotherapy (Investigational)Gene TherapyAdenoviruses are viruses that can change the DNA composition in the cells that they infectMade to target tumor cells in order to change their DNA composition to include the specific adenovirus DNA componentOnce the tumor cell DNA includes the adenovirus DNA, it can be targeted by a specific anti-viral agent

AdenovirusImmunotherapy (Investigational)Take tumor specific T-cells and helper t-cells (cells in the immune system that fight off disease) from the patientUse Interleukin-2 to help them grow and duplicateTransfer the T-cells back into the bodyTumors inhibit immune system activity, so this allows the immune system to gain strength and fight specific tumor cells

T-Cell killing a cancer cellQuattrochi et al:http://www.sciencemuseum.org.uk/exhibitions/lifecycle/images/1-2-5-3-5-2-2-0-0-0-0.jpg66Common MedicationsSteroids Decadron (Dexamethasone), PrednisoneUsed to control swelling in the brainAlso can be prescribed to increase appetiteSide EffectsInsomniaWeight gain with fat deposition in cheeksHigh blood pressureHigh blood sugarStomach ulcersCommon MedicationsAnti-Seizure Dilantin (Phenytion)May cause rashTegretol (Carbamazepine)May cause rashDepakote (Valproic acid)May cause tremor

Common MedicationsAnti-NauseaZofranUsually given along with chemotherapyAnti-ConstipationSenekotColace

QuestionsWhat chemotherapy drug is most commonly prescribed for Astrocytomas and Other High Grade Gliomas?

What do radiation beams do to cells?

What are common Anti-Seizure medications?

AnswersTemozolomide (Temodar)

It kills cell DNA, which causes the cells to shrink and die

Dilantin (Phenytion), Tegretol (Carbamazepine), Depakot (Valproic Acid)Games, Puzzles, Quizzes