Craniopharyngioma+(Adult)

Quadrantopsia, hemianopia are particular visual problems to craniopharyngioma [3] [6] || Surgery followed by radiation therapy: Subtotal tumor resection Radiation dose: 180cGy per fraction to a Total dose of 50-54Gy Radiation field: 1.5 cm margin around pre-op tumor volume Treatment field arrangement Note: Surgical decompression may be necessary before radiation treatment [11] || **Shun** Epidemiology and Etiology **Eric** Signs and Symptoms, Diagnostic procedures **Lisa** Histology and Metastatic spread **Curtis** Lymph node drainage, Prognosis and TD 5/5 **Kim** Grading and Staging **LaDonna** Side effects and Treatment
 * Epidemiology: || Craniopharyngioma is a very rare tumor that occurs approximately 2.4 to 4 percent of all intercranial tumors. Half of this tumor occurs in adults and a great percentage in children. “There appears to be a bimodal age distribution, with peaks occurring at ages 5-10 and 55-65 years.”[1] ||
 * Etiology: || The etiology of craniopharygioma is still unknown. However it is believed to have something to dealing with genetic mutations. “The tumor epithelium is thought to originate in either of 2 ways: from embryologic remnants or by metaplasia of mature tissues.”[2] ||
 * Signs & Symptoms: || [[image:Craniop[1].jpg width="572" height="397"]]
 * Diagnostic Procedures: || * Complete History and Work up [3,4]
 * General Physical exam [3,4]
 * <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Complete Blood work (CBC & chemistries)
 * <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Complete Neurologic examination- Assess mental status, coordination, reflexes, & motor and cranial nerves [3,4]
 * <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Opthalmoscopy – check for papilladema associated with ↑ cranial pressure [3]
 * <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%;">CT Scan of brain with and without contrast shows bony extension for disease if present [3,4]
 * <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%;">MRI – T1 weighted for anatomy delineation and T2 weighted for edema and tumor localization [3,4]
 * <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Biopsy – when and where possible depending on location and size. Either stereotactic with needle or open craniotomy.
 * <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Post Fossa Tumors – Indicate CSF spinal axis staging, (CSF cytology, preoperative Myelogram / MRI) [3,4] ||
 * Histology: || <span style="background-color: transparent; color: #ff0066; font-family: 'Times New Roman','serif'; font-size: 16px; line-height: 115%; text-decoration: none; vertical-align: auto;">Craniopharyngiomas are broken into three categories: adamantinomas, papillary, and mixed. Adamantinomas are made of reticular epithelial cells; these are normally seen in children. Squamous papillary craniopharyngiomas are normally seen in adults; these masses are made up of squamous metaplasia inside the connective tissue stroma. The mixed category consists of brain parenchyma that outlines both kinds of craniopharyngioma and is normally gliotic and has an increased number of eosinophilic Rosenthal fibers. [7] ||
 * Lymph Node Drainage: || ** <span style="color: #4f6228; font-family: 'Times New Roman',Times,serif; font-size: 120%;">There are no lymphatic channels in the brain and therefore do not metastasize through the lymphatic system [8] ||
 * Metastatic Spread: || <span style="background-color: transparent; color: #ff0066; font-family: 'Times New Roman','serif'; font-size: 16px; line-height: 115%; text-decoration: none; vertical-align: auto;">Craniopharyngiomas are benign neoplasms that originate from the suprasellar region. [3] ||
 * Grading: || * <span style="color: purple; font-family: 'Times New Roman',Times,serif; font-size: 120%; margin-bottom: 6pt; margin-top: 6pt;">Grade I: Tumor grows slowly. It contains cells that resemble normal cells. It rarely spreads into nearby tissues. It is possible for surgery to remove the entire tissue.
 * <span style="color: purple; font-family: 'Times New Roman',Times,serif; font-size: 120%; margin-bottom: 6pt; margin-top: 6pt;">Grade II: The tumor still grows slowly, but it may spread into adjacent tissue and become a higher grade.
 * <span style="color: purple; font-family: 'Times New Roman',Times,serif; font-size: 120%; margin-bottom: 6pt; margin-top: 6pt;">Grade III: The tumor grows quickly and it is likely to spread into adjacent tissue. The tumor cells look very different from normal cells.
 * <span style="color: purple; font-family: 'Times New Roman',Times,serif; font-size: 120%; margin-bottom: 6pt; margin-top: 6pt;">Grade IV: The tumor growth is very aggressive. The cells do not resemble normal cells at all. It is difficult to treat this tumor successfully.[9] ||
 * Staging: || <span style="color: purple; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: 150%; margin: 6pt 0in;">There is no formal staging system for adult brain tumors since CNS tumors cannot be staged the same way as other types of tumors. In the past the TMN system was used for staging brain tumors. Once a brain tumor has been diagnosed, the pathologist will perform testing on the sample and assign it a grade of I-IV. This grade describes the degree of abnormality of the cells contained in the sample. [10] ||
 * Radiation Side Effects: || * <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">Edema
 * <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">Visual impairment < 1.5%
 * <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">Optic neuropathy 30% >60Gy
 * <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">Brain neurosis 12% >60Gy ||
 * Prognosis: || ** <span style="color: #4f6228; font-family: 'Times New Roman',Times,serif; font-size: 120%;">The three most important prognostic factors are age, performance status, and tumor type. Tumor grade is a stronger factor than size. The average 5 year survival is about 90%. [8]. ||
 * Treatments: || <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">Surgery alone: Total surgical resection when possible
 * <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">3 field: Parallel opposed lateral plus AP field or vertex field
 * <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">3D conformal planning
 * <span style="color: #0070c0; font-family: 'Times New Roman','serif'; font-size: 16px;">IMRT planning [3,10]
 * TD5/5: || [[image:5_table[1]_(2).jpg width="572" height="221"]] [12] ||

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">**__References__** <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">[1] Moore A, Newell DW. //Neurosurgery: Principles and Practice//. Springer-Verlag London Limited. 2005:201 <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">[2] Craniopharyngioma. Web site. Available at: []. Accessed May 30th 2011. <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;"> [3] Chao C, Perez C, Brandy L. Radiation Oncology Management Decisions. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA. 2002 <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt;">[4] National Cancer Institute at the National Institutes of health. Available at: [] Accessed June 1, 2011 <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt;">[5] American Cancer Society. //Brain and spinal cord tumors in adults.// Available at: [] Accessed June 1, 2011 <span style="color: #cc0000; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: normal; margin: 0in 0in 0pt;">[6] Help for vision loss. Availabile at: [] Accessed June 1, 2011 <span style="background-color: transparent; color: #ff0066; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: 115%; text-decoration: none; vertical-align: auto;">[7] Medscape Reference//. Craniopharyngioma workup histologic findings//. Available at: [] Accessed June 3, 2011. <span style="background-color: transparent; color: #76923c; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: 115%; text-decoration: none; vertical-align: auto;">[8]Washington, Charles, and Dennis Leaver. Principles and Practices of Radiation Therapy. St. Louis, Missouri: Mosby Elsevier, 2010. Print <span style="color: #7030a0; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: 150%;">[9]Cancernet. Craniopharyngioma. Available at: [|www.cancer.net/craniopharyngioma]. Accessed 6/2/2011 <span style="color: purple; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: 150%;">[10] Halperin E, Perez CA, Brady LW. //Perez and Brady's Principles and Practice of Radiation Oncology//. 5th edition. Philadelphia:Lippincott, Williams & Wilkins. <span style="color: #0070c0; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: 115%;">[11] University of Wisconsin-LaCrosse, DOS 431;D2L, Brain powerpoint slide 21 <span style="background-color: transparent; color: #76923c; font-family: 'Times New Roman',Times,serif; font-size: 120%; line-height: 115%; text-decoration: none; vertical-align: auto;">[12] Khan FM. Treatment Planning in Radiation Oncology. 2nd ed. Philadelphia, PA; Lippincott Williams & Wilkins; 2007.