Brain Tumors

Definition

A brain tumor is a noncancerous (benign) or cancerous (malignant) growth in the brain, whether it originates in the brain or
has spread (metastasized) to the brain from another part of the body.

Brain tumors are equally common among men and women, but some types are more common among men and others are
more common among women. Brain tumors are occurring with increasing frequency among older people.

Brain tumors may be primary or secondary. Primary brain tumors originate in the cells within or next to the brain. These
tumors may be cancerous or noncancerous. Secondary brain tumors are metastases originating in another part of the body and thus are
always cancerous.

Noncancerous tumors are named for the specific cells or tissues in which they originate. For example, hemangioblastomas
originate in blood vessels (“hema” refers to blood vessels, and hemangioblasts are the cells that develop into blood vessel tissue).
Some noncancerous tumors that originate in embryonic cells may be present at birth.

Most commonly, cancerous brain tumors are metastases from cancer that started in another part of the body. Metastases may
grow in a single part if the brain or in several different parts. Many types of cancer-including breast cancer, lung cancer, cancer in the
digestive tract, malignant melanoma, leukemia, and lymphoma- can spread to the brain. Lymphomas of the brain are common among
people who have AIDS and, for unknown reasons, are becoming people who have normal immune systems. The most common type of
primary cancerous brain tumor is glioma.

Signs and Symptoms

Generally early signs involved decreasing level of consciousness, pupillary abnormalities, impaired motor function, and
impaired brain stem reflexes. Symptoms occur whether a brain tumor is noncancerous or cancerous. A brain tumor can cause many
different symptoms, and symptoms may occur suddenly or develop gradually. Which symptoms develop first and how they develop
depends on the tumor size, growth rate, and location. In some parts of the brain, even a small tumor can have devastating effects. In
other parts of the brain, tumors can grow relatively large before any symptoms appear. At first, the tumor pushes and stretches nerve
tissue, which can compensate for these changes very well, so symptoms may not develop at first. Symptoms develop when brain tissue
is destroyed or pressure within the skull (intracranial pressure) increases, compressing the brain. Pressure may increase because the
tumor is enlarging. Eventually, any brain tumor can increase pressure within the skull.

When the brain tumor is a metastasis from cancer in another part of the body, a person may also have symptoms related to
that cancer. For example, a person with a metastasis from lung cancer may have a cough that brings up bloody mucus in addition to
symptoms of a brain tumor.

A headache is often the first symptom, although most headaches are not caused by brain tumors. A headache due to a brain
tumor usually recurs more and more often as time passes. It eventually becomes constant without relief. It is often worse when the
person lies down and may awaken the person from sleep. A gradually growing tumor causes a headache that typically is worse when
the person first awakens. If headaches with these characteristics start in a person who has not headaches before, a brain tumor may be
the cause.

Brain tumors may produce a change in personality. For example, a person may become withdrawn, moody, and, often,
inefficient at work. A person may feel drowsy, confused, and unable to think. Such symptoms are often more apparent to family
members and co-workers than to the person. Depression and anxiety, especially if either develops suddenly, may be an early symptom
of a brain tumor. Bizarre behavior is unusual. In older people, certain brain tumors cause symptoms that may be mistaken for those of
dementia.

Other common symptoms of a brain tumor include dizziness, loss of balance, and incoordination. Later, as the pressure
within the skull increases, nausea, vomiting, lethargy, drowsiness, intermittent fever, and even coma may occur. Some brain tumors
cause seizure depending on what area of the brain is affected.
Common Symptoms of Some Brain Tumors

Astrocytomas and Oligodenndrogliomas

Some astrocytomas and aligodendrogliomas grows slowly and may initially cause only seizures. Others grows fast and
cancerous; they can produce various symptoms of brain dysfunction. Glioblastoma multiforme, a type of astrocytomas, grows so fast
that it increases pressure in the brain, causing headaches and slowed thinking. If the pressure becomes high enough, drowsiness then
coma may result. Symptoms vary depending on the tumor’s location. Tumors in the frontal lobe can cause weakness and personality
changes. If they develop in the dominant frontal lobe, they can cause speech disturbances. Tumor in the parietal lobes can cause loss
of or changes in the sensation; sometimes vision is lost in the eye on the side opposite the tumor. Tumors in the temporal lobes can
cause seizures and if they develop in the dominant side, the inability to understand and use of language. Tumors in the occipital lobes
can cause partial loss of vision in both eyes. Tumors of or near the cerebellum especially medulloblastomas in children, can caue
alteration in eye movements, incoordination, unsteadiness in walking, and sometimes hearing loss and dizziness. They can block the
drainage of cerebrospinal fluid, causing the fluid to accumulate in the spaces within the brain. As a result, the ventricles enlarge and
pressure within the skull increases. Symptoms include headaches, nausea, vomiting, and difficulty turning the eyes upward, lethargy,
and coma with herniation of the brain. In infants the head enlarges.

Meningiomas

Meningiomas are usually noncancerous but may reoccur after they are removed. They occur more often in women and
usually appear in people aged 40 to 60, but they can begin growing in childhood or later life. They may cause weakness or numbness,
seizures, an impaired sense of smell, and changes in vision. If they become very large, they may cause mental deterioration, including
memory loss, much like dementia.

Pineal Tumors

Pineal tumors usually develop during childhood and usually cause early puberty. They can obstruct during the drainage of
cerebrospinal fluid around the brain, leading to hydrocephalus. The most common type of pineal tumor is germ cell tumor.

Pituitary Glands Tumors

The pituitary gland, located at the base of the skull, controls much of the body’s endocrine system. Tumors of the pituitary
gland are usually noncancerous. They secrete abnormal large amount of pituitary hormones. Effects may vary depending on which
hormone is secreted in large amounts.

i. For growth hormone, extreme height or disproportionate of the head, face, hands, feet, and chest.
ii. For corticotrophin, Cushing’s syndrome.
iii. For thyroid stimulating hormone, thyriodism
iv. For prolactin, the cessation of menstrual periods in women, production of breast milk in women who are not
breastfeeding, and in men, erectile dysfunction and enlargement of the breast.

Pituitary gland tumors can also destroy the tissue in the pituitary gland that secretes hormones, eventually resulting in
insufficient levels of these hormones in the body. Headaches commonly occur. If tumor enlarges, peripheral vision in both eyes is lost.
 Pathophysiology

Predisposing Precipitating
- Genes - ionizing radiation
- immunosuppression
- pathologic organisms
(virus, fungi, parasites)
- direct inplantation during CNS procedures
- extension from infected sinuses or the peripheral
nervous system

Abnormal cellular growth that is unresponsive to normal growth control mechanism

Alters normally stable volume of brain, blood & CSF

Compression, infiltration of neural tissue and decreased blood supply

Elevation of capillary pressure

Vasogenic cerebral edema

Damage in capillary

Escape of vascular fluid into the interstitial

Displacement of CSF from subarachnoid space and ventricles through the foramen
magnum to the spinal subarachnoid space & also through the optic foramen to the perioptic subarachnoid space

Impaired venous drainage from optic nerve head and retina

- headache
- nausea and vomiting
Rapid development of tumor - mental changes
- visual disturbances

Increased ICP

Treated Untreated

- Increased ICP treatment - Brain herniation

- Craniotomy
 Treatment and Laboratory Exams

Nonsurgical Management
The goal of treatment of brain tumors is to decrease tumor size, improve quality of life, and improve survival time. The type
of treatment depends on the tumor size and location, client symptoms and general condition, and whether the tumor is recurrent.
Radiation therapy
Radiation therapy may be used alone, after surgery, or in combination with chemotherapy and surgery. An anti-tenascin
radioactive monoclonal antibody treatment that is directly injected into the cavity where the tumor was removed is being investigated.
The antibodies deliver radiation directly into the brain but are less potent than traditional radiation.
Drug therapy
The health care provider may prescribe a variety of medications to treat the tumor as well as manage the symptoms and
prevent complication.
Chemotherapy
Chemotherapy may be given alone, in combination with radiation and surgery, and with tumor progression. Although these
drugs may control tumor growth or decrease tumor burden, the benefit is very short-lived. Chemotherapy usually involves more than
one agent. The most common used drugs are alkylating agents, especially nitrosoureas such as carmustine and lomustine.
Other drugs
Analgesics, such as codeine and acetamenophin are given for headache. Dexamethasone is usually is usually given to control
cerebral edema. Phenytoin may be used to prevent or treat seizure activity.

Radiosurgery
Radiosurgical procedures are an alternative to surgery. These techniques include the modified linear accelerator using
accelerated x-rays (LINAC), a particle accelerator using beams of protons and isotope seeds implanted in the tumor.
Gamma Knife
The gamma knife is a type of stereotactic radiosurgical procedure that uses a single high dose of ionized radiation to focus
201 beams of gamma radiation produced by the radioisotope cobalt 60 to destroy intracranial lesions selectively without damaging
surrounding healthy tissues.
Surgical management
The most important modality in the treatment of brain tumors is a biopsy to determine the specific pathology. A craniotomy
is the most common surgical treatment and may be done to improve symptoms related to the lesion or to decrease pressure effects.
The challenge for the surgeon is to remove the tumor as completely as possible without damaging the normal tissues.

Nursing Management
Postoperative care
The focus of postoperative care is to monitor the client to detect changes in status and to prevent or minimize complications,
especially increased intracranial pressure.
 Assess neurologic and vital signs every 30 minutes for the first 4 to 6 hours after surgery and then every hour. If the
client is stable for 24 hours, the frequency of these checks may be decreased to every 2 to 4 hours.
 Strict recording of the client’s intake and output and possibly fluid restriction to 1500 ml daily as clinically
indicated.
 Range of motion exercises to all extremities are performed at least every 2 to 3 hours. Assist the client to turn,
cough, and deep breath every 2 hours.
 To prevent the development of deep vein thrombosis, sequential compression stockings or pneumatic compression
boots are kept in place until the client is ambulating.
 Clients who have undergone supratentorial surgery should have the head of the bead elevated 30° or as tolerated to
promote venous drainage from the head.
 If a large tumor has been removed, it is recommended that the client be placed on the nonoperative side to prevent
displacement of the cranial contents by gravity.
 The client should receive nothing by mouth (NPO) for 24 hours because edema around the medulla and lower
cranial nerves may place the client at risk for vomiting and aspiration.
 For monitoring the head dressing, check every 1 to 2 hours for signs of drainage.
 Often the client is electively mechanically ventilated and hyperventilated for the first 24 to 48 hours after surgery to
prevent increased intracranial pressure.
 If the client is awake or attempting to breathe at a rate other than the set on the ventilator, medication such as
fentalyn citrate is given to treat pain and anxiety as well as to promote rest and comfort.
 Medications routinely given postoperatively include antiepileptic drugs, histamine blockers, proton pump inhibitors,
and corticosteroids. Analgesics such as codeine are given for pain, and acetaminophen is given for fever or mild
pain.
 Saint Gabriel College
Old Buswang, Kalibo, Aklan

A Case Study about Brain Tumor

In Partial Fulfillment of the Requirements in

Related Learning Experience

Submitted to:
Mrs. Ellen B. Arboleda, BSN, R.N
Clinical Instructor

Submitted by:
John Leo E. David
BSN IV-C

September 25, 2008