Craniopharyngioma+(adult)

Grade II: The tumor still grows slowly, but it may spread into adjacent tissue and become a higher grade.
 * **Epidemiolgy:** || Craniopharyngioma is a benign brain tumor that arises from embryonic tissues located in Rathke’s pouch, a structure that forms the anterior portion of the pituitary gland. It can appear at any age for both men and women but is commonly seen in the adults in their early twenties and between the ages of fifty and sixty years old. [1] ||
 * **Etiology:** || ===== There is no specific cause of craniopharyngiomas. It is thought to develop from the epithelium of Rathke’s pouch due to metaplasia of residual cells. [1] ===== ||
 * =====**Signs & Symptoms: **===== || The most common symptom of carniopharyngioma is changes in vision. It may also cause blurriness or loss of peripheral vision in one eye. This is caused by the close proximity of the tumor to the optic nerves. Other common symptoms include headaches, nausea and vomiting, and excessive urination and thirst. [2] ||
 * **Diagnostic Procedures:** || * A complete history and general physical examination.
 * Biopsy.
 * Neurological examination.
 * Complete blood counts.
 * Diagnostic CT and MRI with intravenous contrast presents the tumor as a calcified, largely cystic, suprasellar mass. ||
 * **Histology:** || Histologically benign epithelial tumors of the sellar region. There are two varieties. Adamantinomatous is often nodular and multicystic. The squamous or papillary type found mostly in adults is encapsulated and composed of solid sheets of well differentiated epithelial cells.[3] ||
 * **Lymph node drainage:** || Craniopharyngioma is a benign tumor that is unlikely to spread. ||
 * **Metastatic spread:** || Craniopharyngiomas are benign neoplasms that originate from the suprasellar region. [2] ||
 * **Grading:** || 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.

Grade III: The tumor grows quickly and it is likely to spread into adjacent tissue. The tumor cells look very different from normal cells.

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.[2] || Headaches Cataracts Seizures Memory deficiency Thinking and speech problems Difficulty with learning, reading and writing Loss of balance and/or trouble walking DermatitisHormone dysfunction Vestibular damage Nausea and vomitingFatigue Secondary tumor Death[2] ||
 * **Staging:** || 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. [2] ||
 * **Radiation side effects:** || Alopecia
 * **Prognosis:** || Prognostic factors include age, tumor type, tumor grade, seizure symptoms, duration of symptoms, performance status, extent of resection, radiation doses. [2]

Treatment outcomes have shown a remission rate of 90% after four years and 10-year survival of 78%. [4] || Brain 45 Gy 50 Gy 60 Gy Brainstem 50 Gy 53 Gy 60 Gy  Cauda equina 60 Gy  Ear 55 Gy 55 Gy 55 Gy  Lens 10 Gy  Optic chiasm 50 Gy  Optic nerve 50 Gy  Retina 45 Gy  Spinal cord 47 Gy(20 cm) 50 Gy(10 cm) 50(5 cm) [2] || [2] Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Desicions//. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. [3] Barnes L. //Surgical Pathology of the Head and Neck//. 2nd ed. New York, NY: Informa Healthcare; 2001. [4] Lenhard RE, Osteen RT, Gansler T. //The American Cancer Society's Clinical Oncology//. Atlanta, GA: The American Cancer Society; 2001. [5] http://ars.sciencedirect.com/content/image/1-s2.0-S0360301602030298-gr1.jpg Accessed June 1, 2012.
 * **Treatments:** || Cure or long term survival may be accomplished with total surgical resection, although surgery is difficult due to the tendency to adhere to the optic chiasm and hypothalamus. Partial resection should be followed by irradiation to doses of 50-54 Gy (1.8 Gy daily). The radiation field should encompass the preoperative volume plus a 1.5 cm margin. Field arrangement is typically opposed laterals with a vertex or 3D conformal.[2] ||
 * **TD 5/5:** || __ ORGAN WHOLE ⅔ ⅓ __
 * **References:** || [1] Hansen KE, Roach M. //Handbook of Evidence-Based Radiation Oncology//. 2nd ed. New York, NY: Springer; 2010.



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