Brain Tumor Management

• When a physician suspects brain tumor, many

specialized tests may be used to gather clinical,
radiological pathological and laboratory information
to confirm the diagnosis.
CLINICAL DIAGNOSIS:
• A clinical diagnosis consist of information the
physician gathers during a comprehensive evaluation.
• First, medical history, including specific sign and
symptoms must be obtained.
• A neurological examination is then perform to test
reflexes and assess visual , cognitive, sensory and
motor functions.
• If the presence of brain tumor is suspected after the
neurological examination, the next diagnostic step is
tumor imagine.
 DIAGNOSIS

• CT provide anatomical analysis

• MRI evaluates edema, hydrocephalus or
hemorrhage
– MRI enhance identifies tumour & edema but
unable to predict tumour type or grade
• PET determines grade of primary brain
tumors & in differentiating tumor regrowth
from radiation necrosis
• Surgical biopsy is done to obtain tumour tissue as a
part of diagnosis or during surgical resection
• EEG: to monitor brain activity & detect seizures
• CSF analysis: diagnosis & detection of
dissemination of certain brain tumours
 MEDICAL & SURGICAL

• Treatment techniques are determined by

– Histological type, location, grade, size of tumor,
age at onset & medical history of patient
• Four types of treatment
– Traditional surgery
– Chemotherapy
– Radiation therapy
– Stereotactic radio surgery
 Traditional surgery

• The primary goal of the traditional surgery is

maximal tumor resection with least amount of
damage to neural or supporting structures.
• Gross total resection:
 Associated with longer survival rates
 Decreased neurological impairments.
Benign tumor if accessible, are resected completely,
while malignant tumor are typically partially resected
secondary to location and size of the tumor.
• The purpose of surgery include
– Biopsy to establish a diagnosis performed
through open needle & stereotactic needle
techniques
– Partial or complete resection of tumour
• Done through a craniotomy.
 CHEMOTHERAPY

• It can be used independently or in adjuvant to surgery

or radiation.
• Chemotherapeutic drugs are not effective in all types
of tumor.
• Chemotherapeutic drugs are Impede cellular
replication of tumor cells.
• Drugs include methotrexate, cisplaltin, Carboplatin,
procarbazine, vincristine, etoposide.
 HORMONES

• Tamoxifen hormone therapy appears to inhibit tumor

growth
• This estrogen antagonist is currently being tested for
efficacy in tumour treatment
 Gene therapy

• There are two major components to gene therapy:

– Delivery system & therapeutic gene
• The delivery system most commonly used is a
virus
– retroviruses, adenoviruses & herpes viruses
• Gene therapy lends itself to treatment of brain
tumors because the retroviruses insert into
dividing cells
– Tumor cells now carrying gene are destroyed
when an anti viral agent such as ganciclovir is
introduced
 ANTIANGIOGENESIS

• Arrest vascular supply of tumour

• Inhibition of tumor-associated blood vessel growth
could retard tumor growth & become a potentially
useful treatment
 RADIATION THERAPY
• Radiation therapy can be used alone or in
conjunction with surgery or chemotherapy to treat
malignant brain tumors
• Chosen for large tumors inaccessible for surgical
resection & to eradicate residual neoplastic cells
following a surgical resection
• Radiotherapy consist of delivery of high powered
photons, with energies in a much greater range
than that of standard x ray, as an external beam
directly applied to the tumor.
 STEREOTACTIC RADIO SURGERY

• Delivery of high dose of ionising radiation in a

single fraction to a small well defined volume of
tissue
• Improve physical effect of radiation
• Goal is to arrest tumor growth
• Beneficial for treating centrally located lesions less
than 3cm in size & for patients with surgical risk
factors
 OVERVIEW

• Rehabilitation is the key component of client with

brain tumor.
• By preventing complication, maximizing functions
and providing support rehabilitation specialist have
improved quality of life of patients.
• The most effective rehabilitation plan is flexible, to
allow for increasing impairment, and sensitive to
accommodate the highly emotional impact and
accompanies the diagnosis of a primary brain tumor.
• The disease process are the target of rehabilitation
team so in terms side effects occur it will affect the
functional progress.
• So functional progress may be affected by cerebral
edema, hydrocephalus, tumor regrowth , infection
and radiation necrosis.
• Evaluation, clinical analysis, intervention, discharge
planning and psychological; issues specific to the
management of client with brain tumor.
 EVALUATION

• Evaluation:
1. Comprehensive examination
2. Assessment of system in order to established problem
list, prognosis and plan of care
• Before a neurological assessment,
1. Review of medical history
2. Understanding of medical diagnosis
• Psychological factors:
1. Client occupation
2. Goal
3. Role in family
• Neurological examination includes:
 Strength
 Reflexes
 Sensation
 Vision
 Cognition
GOAL SETTING:
• functional impairment
• Neurological observation
• To assess prognosis
• Establish goals
• Determine a treatment plan
To set realistic and client oriented goals, important for
clinician to check where the patient will be discharged.
Client who have the potential to return to work may require
additional intervention from neuropsychology,
multidisciplinary day programmers.
• Because the rehabilitation potential for clients with
brain tumor greatly varies, it is imperative that client,
family members, rehabilitation team and third party
payers with the purpose of the client.
FUNCTIONAL ASSESSMENT
• It provides objective evidence that rehabilitation is
effective and worthwhile for these clients.
• Functional assessment is critical component for
development of treatment intervention.
• Functional outcome scale such as functional
independence measure provide client response in
terms of treatment protocol as well as evaluations.
SIDE EFFECTS AND CONSIDERATION:
• The side effects and special consideration that arise
with population range from physical to cognitive to
psychosocial to emotional.
• The possibilities includes hairloss,fatigue, nausea,
skin burns or irritation, difficulty in eating and
digesting food, anorexia and dry and sore throat.
• The side effects of drugs are caused by toxic effects of
drugs.
• The toxic effect chemotherapy has on bone marrow
impairs the clients ability to produce red and white blood
cells and platelet.
• The client may develop anemia, infection or hemorrhage
as a result of depressed hematological values.
• The lining of the mouth, esophagus and intestines
may become inflamed and irritated and interfere with
the ability to eat or digest food.
• The client may experience nausea,
vomiting,diarhea,constipation any of which may
impair mobility and activities of daily living.
• Hair loss is common side effects of brain radiation
and chemotherapy, it require because patient may
have drastic change due to side effects.
INTERVENTION:
• The ultimate goal of rehabilitation intervention to
restore function in client preferred environment.
• Treatment plan must be flexible to effectively manage
fluctuation in client presentations.
REHABILITATION PHASE:
1. Intensive care unit
2. Inpatient rehabilitation
3. Outpatient rehabilitation
4. Home health care
 Intensive care unit

• Communication with nursing staff regarding

patient medical past and present status.
• Equipment should be properly monitored by staff
as well as physician.
• As the client became more stable, the clinician
upgrade mobility and prepare the client for next
stage.
• Clinical must continue with follow up regarding
patient functional and neurological status.
 Inpatient rehabilitation
Outpatient rehabilitation
• Goal of inpatients is to provide the independent
lifestyle of the patient and train family members as
well as caregivers to train patient in home
environments.
• The rehabilitation programme should prepare the
client and caregivers for an efficient transition from
structured care setting to home.
• Using motor learning principle to provide functional
movement of the patient.
• Teach functional mobility protocol includes transfer
activity,repetation of skilled components.
 Home health setting
• For caregiver training and education to be successful,
good rapport must be established among clinician, client
and family members.
• Caregiver training includes mobility training and
education and education regarding the effects of tumor
may present and future mobility.
PSYCHOSOCIAL CARE:
• It is important to measure functional as well as
quality of life care
• HEALTH RELATED QUALITY OF LIFE(HRQOL)
plays major role for tumor patient as in terms of their
physical, emotional, spiritual, intellectual functioning.