About Neuroncology
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What is Neuroncology?
This is a subspecialty of medicine that studies the brain and spinal cord neoplasms. These neoplasms are typically dangerous and life threatening. Cancer spreads to the nervous system brain metastasis, compression or direct invasion. Compression from continuous tissues or direct invasion relates to the proximity of the nervous system to other structures such as the lumbosacral plexus, brachial plexus, cranium, base of the skull, vertebral neuroforamina, and pelvic bones.
Risk factors include: - Histology
- Tumor location
- Blood-brain barrier disruption
Symptoms of Neuroncological conditions include: - Visual impairment
- Tissue destruction
- Local brain infiltration
- Increased intracranial pressure
- Cerebral edema
Types of neuroncology tumors - Primary tumors
- Malignant astrocytomas
- Other astrocytomas
- Glioma
- Pituitary region tumors
- Brain stem gliomas
- Germ cell and pineal region tumors
- Meningiomas and other meningeal tumors
- Medulloblastoma and other primitive neuroectodermal tumors
- Oligodendrogliomas: these include anaplastic oligodendroglioma, low-grade oligodendroglioma, and oligoastrocytoma.
- Tumors of the optic nerve and chiasm
- Primary spinal cord tumors
- Primary central nervous system lymphoma
- Glioblastoma multiforme
- Ependymoma
- Pontine glioma
- Brain stem tumors
- Neuroepithelial tumors
- Nerve sheath tumors such as schwannoma, neurofibroma
Metastatic Tumors of the Central Nervous System - Intracranial Metastasi: There are three types of intracranial metastasis namely brain metastasis, leptomeningeal metastasis, and dural metastasis.
- Brain metastasis: It can be single or multiple and it involves any part of the brain
- Leptomeningeal metastasis: It is commonly a result of lung, breast or melanoma primary tumors
- Dural metastasis: It is due to direct invasion or hematogenous spread from a contagious bone
- Skull Metastasis: There are two types of skull metastases depending on the general site namely skull base and calvarium. Metastases to the calvarium are usually asymptomatic. Due to the close proximity to vascular structures and cranial nerves, metastases to the skull are symptomatic.
- Spinal Metastasis: The spine is usually affected by the metastatic disease which involves the epidural space. This generally occurs as an invasion of paravertebral masses through a neuroforaminal or direct invasion from a vertebral body. Management or treatment of spinal cord metastases is determined by the overall status of the patient’s cancer and if the metastasis is causing epidural spinal cord compression.
Diagnostic procedures - Diagnostic Imaging of the Brain and Spinal Cord: Common imaging studies used in neuroncology include magnetic resonance imaging (MRI) as well as computed tomography (CT). Other imaging techniques used are positron emission tomography (PET), myelography and diagnostic angiography.
- Lumbar Puncture (LP) and Cerebrospinal Fluid Analysis (CSF): These tests are used for the evaluation of some metastatic conditions, primary tumors and neurologic complications due to cancer.
- Pathologic Diagnosis: This uses biopsies which are surgically obtained to make a histologic diagnosis.
Commonly used treatments in neuroncology - Radiotherapy: This treatment uses ionizing radiation to control or kill malignant cancer cells.
- Chemotherapy: This is a type of cancer treatment that uses drugs to kill cancer cells.
- Corticosteroids
- Neurosurgical Interventions
Neurologic complications of cancer - Neuroncological conditions can cause the following complications.
- Complications of cancer therapy such as neuropathies related to chemotherapy
- Seizures related to cancer
- Paraneoplastic Syndromes such as myasthenia gravis, limbic encephalitis
- Opportunistic Infections
- Stroke in Cancer Patients
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