Medulloblastoma+(Adult)

tumor can spread to other parts of the CNS, but they almost never spread to other organs. The most dangerous aspect of these tumors is that they can interfere with essential functions of the brain. Very rarely, medulloblastomas may spread to other parts of the body. If they do spread to other parts of the brain, or to the spinal cord, this is usually through the cerebrospinal fluid (CSF)//. // CSF is the fluid that surrounds and protects the brain and the spinal cord.¹³  || Medulloblastomas are brain tumors that begin in the lower back of the brain. They are formed from abnormal brain cells at a very early stage in development. Medulloblastomas are usually found in children or young adults between the ages of 21 and 40 years. This type of cancer may spread from the brain to the spine through the cerebrospinal fluid. ¹³ || Tumors in the brain or spinal cord almost never spread to other parts of the body, there is no formal staging system. Staging is the process of gathering information from exams and imaging tests to find out how far a cancer has spread. A staging system is a standardized way for the cancer care team to describe the extent of the cancer spread. For most cancers, the stage (extent) of the cancer is one of the most important factors in selecting treatment options and in determining the outlook (prognosis).¹³ ||
 * ​ Epidemiology: || Medulloblastoma is the most common posterior fossa tumor.⁵ ||
 * Etiology: || Nevoid basal cell carcinoma syndrome.⁵ ||
 * Signs & Symptoms: || Morning headache, nausea, vomiting, increased intracranial pressure, abducens and oculomotor nerve defects.⁶ ||
 * Diagnostic Procedures: || Workup as detailed by Chao, et. al. includes: complete history and physical, complete neurologic evaluation, CT or MRI head scan (or both) with contrast, positron emission tomography (PET) scan, complete blood count, cerebral spinal fluid chemistry tests, cytology and microbiology studies. Neurologic exam includes mental condition, coordination, sensation, reflexes and motor + cranial nerves. Ophthalmoscopy to check for papilledema which indicates intracranial pressure. MRI contrast scan of the complete neuraxis for staging. Biopsy of any suspicious tissues. Cerebral spinal fluid (CSF) cytology should be performed for any tumor that typically spreads through the CSF.This is particularly true of germ call tumor, primary neuroectodermal tumors (PNET), medulloblastoma and central nervous system (CNS) lymphoma.¹ ||
 * Histology: || Central nervous system lesions are normally grouped by the World Health Organization into12 classifications: neuroepithelial tumors, choroid plexus tumors, neurologic tumors, pineal parenchymal tumors, embryonal tumors, cranial/spinal nerve tumors, meningeal tumors, mesenchymal tumors, uncertain histogenesis, cysts and tumor like lesions and sellar tumors.² Medulloblastomas are in the embryonal classification and are closely variant to PNET and the cell from which the tumor arises is unknown.³ ||
 * Lymph Node Drainage: || There is no lymphatic vasculature in the CNS and tumors of the CNS do not metastsize through lymphatics.⁴ ||
 * Metastatic Spread: || 
 * Grading: || **Medulloblastoma (grade IV) **
 * Staging: || 
 * Radiation Side Effects: || General side effects include nausea and vomiting, radiation dermatitis, alopecia, mucositis, esophagitis, fatigue, and decreased blood counts. If the ear is included, otitis externis, and high tone hearing loss can result. If the eye is treated then cataract formation can result as well as changes in visual acuity, visual field, or blindness in doses above 54 Gy.

Doses as low as 20Gy can produce hormone insufficiency. Cranial treatment can result in decreased learning ability, deficits in short term memory, and difficulties with problem solving

6-12 weeks after radiation, neurologic deterioration may occur and usually responds to steroid treatment.

Late reactions occur after 6 months, and peak at 3 years. The most serious is radiation necrosis which can mimic tumor recurrence. It can be controlled with surgery and steroids.¹¹  || Following total or near total resection, radiation to the craniospinal axis with a boost to the primary volume is recommended. Dose is 30 to 40 Gy, given in 1.6-1.8Gy fractions, to the whole subarachnoid space. Boost to posterior fossa to total dose of 50 to 55 Gy It is important to include the cribiform plate in the irradaition volume. Recurrence is common here due to blocking the ocular lens. The most common site of failure is in the posterior fossa at the tumor site.¹¹ || Table 1. TD5/5, TD50/5 10 || References__** 1. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:132-133. 2. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:134. 3. Nelson DF, Jenkins RB, Scheithauer BW, et. al. Central nervous system tumors. In: Rubin P, ed. //Clinical Oncology: A Multidisciplinary Approach// //for Physicians and Students//. 8th ed.Philadelphia, PA: W.B. Saunders Company; 2001:792-797. 4. Adams RD, Langlin L, Leaver D. Central nervous system. In: Washington CM, Leaver D, eds. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, MO: Mosby; 2004:726-727.
 * Prognosis: || 60% five year survival with surgery and radiation. No other prognostic factors seem to apply.¹² ||
 * Treatments: || Surgery and post-operative radiation for almost all patients.
 * TD5/5: || [[image:Cranio_and_Meningio.jpg width="620" height="356"]]
 * __[[image:Copy_of_CranioSpinal.JPG width="443" height="677" caption="Figure 1. CranioSpinal"]]

5. Philip Rubin, //Clinical Oncology - A Multidisciplinary Approach for Physicians and Students//. 7th edition. Philadelphia, PA: W.B. Saunders Company. 1993. 6. Washington CM, Leaver D, eds. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, MO: Mosby; 2004. 7. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002: Figure 1 8. American Journal of Neuroradiology [|www.ajnr.org] Accessed January 13, 2010: Figure 2 9. Massachusetts General Hospital www2.massgeneral.org Accessed January 13, 2010: Figure 3, 4 and 5 10. Wikibooks en.wikibooks.org TD5/5 adapted from Emami 1991 11. Chao KS, Perez CA. Brady LW. // Radiation Oncology - Management Decisions //. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins. 2002 12. Washington CM, Leaver D. //Principles and Practice of Radiation Therapy//. 2nd ed. St. Louis, MO: Mosby. 2004

13. [|www.cancer.net/medulloblastoma.com] acessed January 12, 2010. none //Optional:// comment for page history

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