Brain Cancer

Anatomy and Physiology

Brain Cancer
is a disease of the brain in which cancer cells (malignant) arise in the brain
tissue. Cancer cells grow to form a mass of cancer tissue (tumor) that
interferes with brain functions such as muscle control, sensation, memory,
and other normal body functions
Also called: Glioma, Meningioma
Primary brain tumors (gliomas) start in the brain and affect the central
nervous system (CNS). They can be noncancerous or cancerous. Secondary
brain tumors, which are 10 times more common, are cancers that
originated elsewhere in the body and have metastasized (spread) to the
brain. Secondary tumors are about 3 times more common than primary
tumors of the brain.


Types of Brain Cancer
Primary brain cancer - rarely spreads beyond the central nervous system,
and death results from uncontrolled tumor growth within the limited
space of the skull.
Primary brain tumors can be cancerous or non cancerous. Both types take
up space in the brain and may cause serious symptoms (e.g., vision or
hearing loss) and complications (e.g., stroke).

Metastatic (secondary) brain cancer indicates advanced disease and has
a poor prognosis. It tends to invade the brain tissue indiscriminately.

Types of Brain Cancer
Astrocytoma most common type of brain tumor in children; originates in the brainstem,
cerebellum, white matter of the cerebrum, or spinal cord
Brainstem glioma originates in the medulla, pons, or midbrain
Choroids plexus papilloma originates in the ventricles
Ependymoma originates in the membrane that lines the ventricles and central canal of the
spine
Glioblastoma multiforme most common types in adults; originates in glial cells in the
cerebrum
Medulloblastoma second most common type in children; originates in the fourth cerebral
ventricle and the cerebellum; often invades the meninges
Acoustic neuroma originates in the vestibulocochlear nerve
Lymphoma originates in lymphocytes; common in HIV/AIDS patients
Meningioma originates in the meninges
Pineal gland tumor rare; originates in the pineal gland
Pituitary adenoma originates in surface cells of the pituitary gland
Schwannoma originates in cells of the myelin sheath that covers neurons

Sign and Symptoms
Some brain tumors are cancerous. Any brain tumor can hinder the flow of
cerebrospinal fluid (CSF). This causes an accumulation of CSF
(hydrocephalus) and increased intracranial pressure (IICP). The common
symptoms are:vomiting
headache
nausea
The brain tumors damage vital neurological pathways and press the brain
tissue. Depending on the location and size of the tumor, the symptoms
vary.
Sign and Symptoms
If a tumor is present in the brainstem, then the symptoms are:drowsiness
behavioral and emotional changes (irritability)
hearing loss
difficulty in speaking and swallowing
headache, especially in the morning
muscle weakness on one side of the face
uncoordinated gait
vomiting
muscle weakness on one side of the body (hemiparesis)
vision loss, drooping eyelid (ptosis), crossed eyes (strabismus)

Sign and symptoms
Meningioma or a tumor of the meninges gives rise to the following
symptoms:
vision loss
seizures
prolonged drowsiness (somnolence)
mental and emotional change (apathy, disinhibition)
incontinence
impaired speech (dysphasia)
hearing loss
headache

Sign and Symptoms
If a brain tumor is present in the frontal lobe, then the symptoms
are:impaired sense of smell
paralysis on one side of the body (hemiplegia)
behavioral and emotional changes
memory loss
impaired judgement
vision loss and inflammation of the optic nerve (papilledema)
reduced mental capacity (cognitive function)

Signs and Symptoms
If a tumor is present in the parietal lobe, then the symptoms are:lack of
recognition
impaired speech
seizures
spatial disorders
inability to write

Signs and Symptoms
If the tumor is located in the right and left hemispheres of the frontal lobe,
then this causes:
behavioral changes
cognitive changes
uncoordinated gait

Risk Factors
People with the following conditions or characteristics may be at risk for
developing a brain tumor:
Radiation exposure
Increased age
Exposure to pesticides, herbicides, fertilizer
Certain occupations, such as lead, petroleum, plastic, rubber, and textile
workers, as well as aircraft and vehicle operators
Exposure to electromagnetic fields
Certain viruses, especially Epstein-Barr virus
Certain genetic disorders
People who have had transplants and individuals with AIDS
A small percentage of brain tumors may be hereditary (approximately 5%
of gliomas)

Brain Cancer Grading
Grade I: The tissue is benign. The cells look nearly like normal brain cells,
and cell growth is slow.
Grade II: The tissue is malignant. The cells look less like normal cells than
do the cells in a grade I tumor.
Grade III: The malignant tissue has cells that look very different from
normal cells. The abnormal cells are actively growing. These abnormal-
appearing cells are termed anaplastic.
Grade IV: The malignant tissue has cells that look most abnormal and tend
to grow very fast.
PATHOPHYSIOLOGY
Primary Tumor

Risk Factors
Race
Age
Exposure to Radiation
Chemical Exposure on job
Family History of Brain Tumors

Acquired Mutations

Proto oncogenes to Oncogenes

Uncontrolled Cell Differentation

Secondary tumor

Malignant tumors infiltrates other
tissues

Blood Stream

Lymphatic System
Normal Organization, growth inhibition, contact and cell cell communication
are lost

Cell membranes and surface antigens are altered

Blood vessels are compressed

Normal cells lead to progressive reduction of organ function

Focal Disturbances



Frontal Lobe
Hemiplegia
Excessive aphasia
Ataxia
Visual field defects
Focal Seizures











Parietal Lobe
Focal Sensory Seizures
Impaired position sense and
two point
discrimination
Hemianopia
Apraxia
Anosognosia
Speech Disturbances
Denial of Illness







Temporal Lobe
Convulsion
Aphasia/Dysphasia
Olfactory Aura preceding
seizure

Occipital Lobe
Hemianopia
Flashing Light Aura
Preceding Seizure

Brain Stem
Hemiplegia
Hemianesthesia

Treatment Modalities
Steroids
Anticonvulsants
Radiation therapy
Chemotherapy
Brachytherapy,
Bevacizumab (avastin)
Craniotomy
Streotatic Radiotherapy

Good Prognosis




If left untreated

Malignant cells infiltrates to other
tissues

Will spread into the blood stream

Lymphatic channels

Body Cavities

Death

Diagnostic Examinations
Imaging Tests
is the diagnostic test of choice
for brain cancer. Electromagnetic
energy produces detailed
computer images of the brain
from different angles. It can
detect edema (swelling of the
brain tissue) and hemorrhage
(bleeding). In some cases, a dye is
injected intravenously to improve
the contrast between an
abnormal mass and normal
tissue.
Diagnostic Examinations
Computed Axial
Tomography (CAT or CT
scan) involves the use of x-
rays and a computer to
obtain images of the brain.
A dye is often injected
intravenously to improve
the contrast between an
abnormal mass and normal
tissue. Not only can the
tumor be seen, but the type
of tumor sometimes can be
identified with a CT scan.

Diagnostic Examinations
PET scan can precisely
locate a tumor and
detect metastatic and
recurrent brain cancer
at earlier stages than
MRI or CT scan. This
technique also can be
used to evaluate the
tumors response to
chemotherapy and
radiation therapy.

Diagnostic Examinations
Biopsy
Examination of tumor tissue is
the only way to arrive at an exact
diagnosis of the tumor. In a
biopsy, a small part of tumor
tissue is removed surgically and
then sent to a lab, where a
pathologist examines it.
In stereotactic biopsy imaging
tests are used to locate the
tumor, a small hole is made in the
skull, and a hollow needle is
passed through to obtain a core
of tumor tissue. Examination of
the sample provides an accurate
diagnosis in over 90% of cases.

Drug Therapy
Drug Therapies
Steroids, to relieve swelling
Anticonvulsants, to prevent or control seizures
Radiation therapy, to destroy tumor tissue that cannot be removed with
surgery or to kill cancer cells that may remain after surgery, or when
surgery is not possible
Chemotherapy, to kill cancer cells
Brachytherapy, to destroy tumor cells from the inside (internal radiation
therapy)
Bevacizumab (avastin), a biologic drug that blocks the growth of blood
vessels that feed tumors

Other Treatment
Craniotomy is to remove as
much of the tumor as
possible. The procedure is
performed under general
anesthesia and involves
opening the skull (cranium).
Complications of
craniotomy include bleeding
(hemorrhage), swelling
(edema), increased
intracranial pressure (IICP),
infection, and brain tissue
damage.
Other Treatment
Stereotactic
radiosurgery
Other Treatment
New Cancer Breakthrough
Nursing Management
Instruct patient and family about the necessity and importance of
diagnostic tests to determine the exact location of the tumor.
Monitor and record vital signs and neurological status accurately q2-4h, or
as ordered. Report changes to professional nurse immediately.
Institute measures to prevent inadvertent increases in intracranial
pressure.
Elevate head of bed 30
Stool softeners to prevent straining at stool (which increases
intracranial pressure).
Nursing Management
Institute seizure precautions at patient's bedside. (Tongue blade airway.)
Supportive nursing care is given depending upon the patient's symptoms
and ability to perform activities of daily living.
Administer all doses of steroids and antiepileptic agents on time.
Withholding steroids can result in adrenal crisis.
Withholding of antiepileptic agents frequently precipitates seizure.
Surgery (craniotomy) is performed to remove neoplasm and alleviate
symptoms.

Nursing Management
Meticulous nursing management and care aimed at prevention of
postoperative complications are imperative for the patient's survival.
Accurately monitor and record all vital signs and neurological signs.
Postoperative cerebral edema peaks between 48 and 60 hours
following surgery.
Patient may be lucid during first 24 hours, then experience a decrease
in level of consciousness during this time.
Nursing Management
Administer artificial tears (eye drops) as ordered, to prevent corneal
ulceration in the comatose patient.
Maintain skin integrity.
Bone flap may not have been replaced over surgical site; turning patient to
the affected side, if the flap has been removed, can cause irreversible
damage in the first 72 hours.
Maintain head of bed at 30elevation.
Perform passive range of motion exercises to all extremities every 2-4
hours.
Maintain body temperature.
Nursing Management
Increases of body temperature in the neurosurgical patient may be
due to cerebral edema around the hypothalamus.
Monitor rectal temperature frequently.
Place patient on hypothermia blanket, as ordered.
Institute seizure precautions at patient's bedside. (Tongue blade, airway.)
Maintain accurate record of intake and output.
Prevent pulmonary complications associated with bedrest.
Cough and deep breath every 2 hours.
Perform gentle chest percussion, with the patient in the lateral
decubitus position, if tolerated.
Continuously talk to the patient while providing care, reorienting him to
person, place, and time.