Webinar on –

World Brain Tumor Day celebration (14th July,2021)

Presenter:
Dr. Shaveta Sharma , Professor cum HOD , Dept. of MSN ,
NNC, Rohtas 1
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 Theme :
• June 8 is observed as World Brain Tumor Day and it aims at
• educating people about the disease and celebrates the
contribution and strength of the patients, healthcare
professionals, families of the patients, and caregivers in
making this world a better place.
• In 2000, German Brain Tumour declared June 8 as World
Brain Tumor Day.
• As responsible humans, it is our responsibility to make
ourselves aware of the challenges that patients with the
disease face and try to make life easier for them.
• There are various types of brain tumours, some common types
include pituitary tumours, meningiomas, schwannomas, pineal
gland tumours, and primary central nervous system (CNS)
lymphomas.  3
 Message on Brain Tumour Day
— by Dr. Kamal Verma, Director, Neurosurgery at Asian Institute of Medical
Sciences
“This day is aimed to create awareness among the general public.
• My message on this day would be that kindly be aware regarding the signs and
symptoms. In case there is any suspicion, do take medical advice.

• Also I would like to emphasize that though the term brain tumour sounds very
panicky, there are tumours which can be cured. The outcome depends on early
diagnosis and proper treatment.

• I wish speedy recovery to all the patients who are suffering from this disease.

• I also pray to almighty god to give strength to the family and friends of people
who are coping with this disease. The support of family and society at large can
bring a positive impact on the outcome.
• I would also appreciate if more social groups, industrialist and the political class
join hands and create platforms to raise funds for brain tumour patients as well as
research.” 4
 Definition
• What is a brain tumour?
• It is an unnecessary growth of abnormal cells in the brain. A
brain tumour occurs in the body when abnormal cells are
produced within any part of the brain.

• Mostly, the symptoms and signs of a brain tumour depend on

the size and location of the tumour in the body. Some tumours
directly affect the brain tissue while some cause pressure on
the surrounding brain. But the major symptoms of brain
tumour include:
• - Headaches (all headaches are not due to tumours. Also,
severe headaches that are not relieved by common medicines
should be taken into note) 5
 Incidence and Prevalance
• The incidence and prevalence of brain tumour is growing in India. According to a study on
childhood cancer, brain tumour is commonest in girls and even in both sexes in adults
although there is some variation amongst states.

• Government of India has introduced National Cancer Control Programme with the
objectives of prevention, screening, early detection, diagnosis and treatment including
palliative care in end stage. 
• The incidence of central nervous system (CNS) tumors in India ranges from 5 to 10 per
100,000 population with an increasing trend and accounts for 2% of malignancies.Hospital-
based databases capturing CNS malignancies had been analyzed prospectively from
registrations in the neuro-oncology clinic of a tertiary care center over a period of 1 year.[3]
Astrocytomas (38.7%) were the most common primary tumors with the majority being
high-grade gliomas (59.5%).

-Nair M, Varghese C, Swaminathan R. Cancer: Current Scenario, Intervention Strategies and

Projections for 2015. NCMH Background Papers; 2015. [Google Scholar]
- Yeole BB. Trends in the brain cancer incidence in India. Asian Pac J Cancer
Prev. 2008;9:267–70. [PubMed] [Google Scholar]
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 Types of tumors
• There are two main types of tumors: cancerous
 (malignant) tumors and benign (non-cancerous) tumors.

• These can be further classified as primary tumors, which

start within the brain, and secondary tumors, which most
commonly have spread from tumors located outside the
brain, known as brain metastasis tumors.

•  All types of brain tumors may produce symptoms that

vary depending on the size of the tumor and the part of the
brain that is involved.

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 Types contd..
• Secondary, or metastatic, brain tumors are
about four times as common as primary brain
tumors, with about half of metastases coming
from lung cancer.
•  Primary brain tumors occur in around
250,000 people a year globally, and make up
less than 2% of cancers 

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 Govt. of India initiative
• The Government of India (GoI) has introduced the 
National Cancer Control Programme with the aim of prevention,
screening, early detection, diagnosis and treatment including
palliative care in the end stage. Meanwhile, doctors suggest the
following treatments for patients according to their type, grade, and
position of tumour:
• - Surgery
• - Radiotherapy
• - Chemotherapy
• - Steroids
• - Anti-seizure medication
• - Ventricular peritoneal shunt

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 GOI Contd..
• Despite the treatment, strong 
emotional support of family members and
friends is also required for patients who suffer
from the same illness. Therefore, such
patients need support in maintaining a
positive attitude for healing.

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 Risk factors of Brain tumor
• Some common risk factors of brain tumour are
as follows:
• Family history can play a role in the risk of
developing brain tumours.
• Tumour is progressive so age can contribute to
its growth.
• Exposure to chemicals or radiation in any
environment may cause brain tumours. 

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 Risk factors contd..
• Although studies have not shown any link between 
cell phone or mobile phone radiation and the
occurrence of brain tumors, the 
World Health Organization has classified mobile phone
radiation on the IARC scale into Group 2B – possibly
carcinogenic.
• IARC(INTERNATIONAL AGENCY FOR
RESEARCH ON CANCER).
• Group 2B: "The agent (mixture) is
possibly carcinogenic to humans. "
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 Signs and symptoms of brain tumor

Some common symptoms of brain tumour are as

follows:
Prolonged or recurring headaches
Memory loss 
Vomiting
Confusion
Blurred vision
Difficulty to read, focus, or write
Hand tremors
Altered ability to taste, smell, and hear
Weakened muscles of arm, face, or legs
Vertigo or dizziness 13
 Signs and symptoms
• The signs and symptoms of brain tumors are broad.

• People may experience symptoms regardless of whether the

tumor is benign (not cancerous) or cancerous. Primary and
secondary brain tumors present with similar symptoms,
depending on the location, size, and rate of growth of the tumor.

• For example, larger tumors in the frontal lobe can cause changes
in the ability to think. However, a smaller tumor in an area such
as Wernicke's area (small area responsible for language
comprehension) can result in a greater loss of function.

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 Headaches 

• Headaches as a result of raised intracranial pressure can be an early

symptom of brain cancer. .

•  Certain warning signs for headache exist which make the headache more
likely to be associated with brain cancer. 

• These are, as defined by the American Academy of Neurology: "abnormal

neurological examination, headache worsened by Valsalva maneuver,
headache causing awakening from sleep, new headache in the older
population, progressively worsening headache, atypical headache features,
or patients who do not fulfill the strict definition of migraine". 

• Other associated signs are headaches that are worse in the morning or that
subside after vomiting.

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 Location-specific symptoms
The main areas of the brain and Limbic system
• The brain is divided into lobes and each lobe or area has its own
function.

• A tumor in any of these lobes may affect the area's performance.

The symptoms experienced are often linked to the location of the
tumor, but each person may experience something different.
• Frontal lobe: Tumors may contribute to poor reasoning,
inappropriate social behavior, personality changes, poor planning,
lower inhibition, and decreased production of speech (Broca's area)
• Temporal lobe: Tumors in this lobe may contribute to poor
memory, loss of hearing, and difficulty in language comprehension
(Wernicke's area is located in this lobe).
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 Location-specific symptoms
• Parietal lobe: Tumors here may result in poor interpretation
of languages, difficulty with speaking, writing, drawing,
naming, and recognizing, and poor spatial and visual
perception.
• Occipital lobe: Damage to this lobe may result in poor
vision or loss of vision.
• Cerebellum: Tumors in this area may cause poor balance,
muscle movement, and posture.
• Brain stem: Tumors on the brainstem can cause seizures,
endocrine problems, respiratory changes, visual changes,
headaches and partial paralysis.
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 Behavior changes
• A person's personality may be altered due to the tumor damaging
lobes of the brain.
• Since the frontal, temporal, and parietal lobes control inhibition,
emotions, mood, judgement, reasoning, and behavior, a tumor in
those regions can cause inappropriate social behavior,temper
tantrums, laughing at things which merit no laughter, and even
psychological symptoms such as depression and anxiety. 

• More research is needed into the effectiveness and safety of

medication for depression in people with brain tumors.

• Personality changes can have damaging effects such as

unemployment, unstable relationships, and a lack of control.
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 Visual field changes
• A bilateral temporal visual field defect (due to
compression of the optic chiasm) or dilation of
the pupil, and the occurrence of either slowly
evolving or the sudden onset of 
focal neurologic symptoms, such as cognitive
 and behavioral impairment (including
impaired judgment, memory loss, lack of
recognition, spatial orientation disorders) can
occur.
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Grading of the tumors of the central nervous
system
 
• It commonly occurs on a 4-point scale (I-IV)
created by the World Health Organization in 1993.
• Grade I tumors are the least severe and
commonly associated with long term survival,
with severity and prognosis worsening as the
grade increases.
• Low grade tumors are often benign, while higher
grades are aggressively malignant and/or
metastatic.

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 Brain tumour - diagnosis and treatment

• Some common diagnosis methods include:

• Physical evaluation of coordination, muscle
strength, memory, and analytical skills
• Angiography
• CT scan of the head
• Biopsy
• MRI scan of the head
• X-ray of skull
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 Diagnostic tests Contd…
• Brain tumors, when compared to tumors in other areas of the body,
pose a challenge for diagnosis. Commonly, radioactive tracers are
uptaken in large volumes in tumors due to the high activity of
tumor cells, allowing for radioactive imaging of the tumor.

• However, most of the brain is separated from the blood by the 

blood-brain barrier (BBB), a membrane that exerts a strict control
over what substances are allowed to pass into the brain. Therefore,
many tracers that may reach tumors in other areas of the body
easily would be unable to reach brain tumors until there was a
disruption of the BBB by the tumor.

• Disruption of the BBB is well imaged via MRI or CT scan, and is

therefore regarded as the main diagnostic indicator for malignant
gliomas, meningiomas, and brain metastases. 22
 ICP Monitoring
• Swelling or obstruction of the passage of 
cerebrospinal fluid (CSF) from the brain may cause
(early) signs of increased intracranial pressure which
translates clinically into headaches, vomiting, or an
altered state of consciousness, and in children
changes to the diameter of the skull and bulging of
the fontanelles. More complex symptoms such as
endocrine dysfunctions should alarm doctors not to
exclude brain tumors.

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Benign brain tumors often show
up as hypodense (darker than
brain tissue) mass lesions on CT
scans.
On MRI, they appear either
hypodense or isointense (same
intensity as brain tissue)
on hyperintense (brighter than
brain tissue) on although the
appearance is variable.

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 Treatment options
• Treatment options and recommendations depend
on several factors:
• The size, type, and grade of the tumor
• Whether the tumor is putting pressure on vital
parts of the brain
• If the tumor has spread to other parts of the CNS
or body
• Possible side effects
• The patient’s preferences and overall health
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 Treatment
• The treatment of a brain tumour mainly
includes surgery combined with
chemotherapy and radiation therapy.
However, physical therapy, speech therapy,
and occupational therapy are also important
to post neurosurgery treatment methods.

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 Pharmacologic Management
• Treatment may include some combination of surgery, 
radiation therapy and chemotherapy.

• If seizures occur, anticonvulsant medication may be needed.

Dexamethasone and furosemide are medications that may be used to
decrease swelling around the tumor.
• Treatments that use a person's immune system are being
studied.Outcomes for malignant tumors vary considerably depending
on the type of tumor and how far it has spread at diagnosis.

•  The average five-year survival rate for all (malignant) brain cancers in

the United States is 33%.

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 Pharmacologic Management
Supportive care for people with a brain tumor includes:
• Drugs called corticosteroids. These are used to lower swelling in the brain,
which can lessen pain from the swelling without the need for prescription pain
medications. These drugs may also help improve neurological symptoms by
decreasing the pressure from the tumor and swelling in the healthy brain tissue.
• Anti-seizure medicines. These help control seizures, and there are several types
of drugs available. They are prescribed by your neurologist.
• Before treatment begins, talk with your doctor about the goals of each
treatment in the treatment plan.

• Patient should also talk about the possible side effects of the specific treatment
plan and palliative care options.
• This helps the health care team treat any symptoms and side effects as quickly as
possible. It can also help prevent more serious problems in the future.

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 Surgical management
• Surgery is one of the main treatments for brain and
spinal cord tumours. You might have an operation to:
• remove the whole tumour to try to cure it
• remove part of the tumour to slow its growth and help
with symptoms
• drain a build up of fluid on your brain
(hydrocephalus)
• help to give other treatments such as chemotherapy
• help diagnose a brain tumour.

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 Radiation Therapy
• Radiation therapy
• Radiation therapy is the use of high-energy x-rays or other particles to destroy
tumor cells. Doctors may use radiation therapy to slow or stop the growth of a brain
tumor. It is typically given after surgery and possibly along with chemotherapy.
• A doctor who specializes in giving radiation therapy to treat a tumor is called a
radiation oncologist.

• The most common type of radiation treatment is called external-beam radiation

therapy, which is radiation given from a machine outside the body.
• When radiation treatment is given using implants, it is called internal radiation
therapy or brachytherapy. A radiation therapy regimen, or schedule, usually
consists of a specific number of treatments given over a set period of time.
• External-beam radiation therapy can be directed at a brain tumor in the following
ways:

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 Systemic therapies: Chemotherapy & Targeted
•
therapy
The types of systemic therapies used for a brain tumor include:
• Chemotherapy
• Targeted therapy
Chemotherapy
• Chemotherapy is the use of drugs to destroy tumor cells, usually by keeping the tumor cells
from growing, dividing, and making more cells.
• A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given
over a set period of time. A patient may receive 1 drug at a time or a combination of different
drugs given at the same time. The goal of chemotherapy can be to destroy tumor cells
remaining after surgery, slow a tumor’s growth, or reduce symptoms.
• daily low-dose temozolomide (Temodar).
• (Matulane), and vincristine (Vincasar), have been used along with radiation therapy.
• The side effects of chemotherapy depend on the individual and the dose used, but they can
include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea.
These side effects usually go away after treatment is finished. Rarely, certain drugs may
cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid
by IV to protect their kidneys.
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 Targeted therapy
• In addition to standard chemotherapy, targeted therapy is a treatment that targets
the tumor’s specific genes, proteins, or the tissue environment that contributes to
a tumor’s growth and survival. This type of treatment blocks the growth and
spread of tumor cells and limits the damage to healthy cells.

• For a brain tumor, there are 2 types of targeted therapy that may be used:

• Bevacizumab (Avastin, Mvasi) Anti-angiogenesis therapy is focused on stopping

angiogenesis, which is the process of making new blood vessels. Because a
tumor needs the nutrients delivered by blood vessels to grow and spread, the goal
of anti-angiogenesis therapy is to “starve” the tumor. 
• Larotrectinib (Vitrakvi) is 
a type of targeted therapy that is not specific to a certain type of tumor but It
is approved as a treatment for some brain tumors that are metastatic or cannot be
removed with surgery and have worsened with other treatments.

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 Nursing Diagnosis for a Brain tumor
Patient
• Nursing Diagnosis 1
• Acute Pain as evidenced by Verbal complains of
pain
• Headache in the frontal or occipital area that is
worsen during the morning and becomes
worse with straining or if the head is dropped
• Changes in vital signs
• Hostile, tense behavior
• Restlessness
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 Nursing Diagnosis 2

Anxiety related to Increased apprehension as

the diagnosis is confirmed and the condition
worsens
Expressed concern and worry about
postoperative residual tumor and effects, hair
removal before surgery
Social isolation Insomnia

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 Nursing Diagnosis 3
• Risk for injury
• May be related to
• Sensory, integrative, and effector dysfunction
• Possibly evidenced by
• Behavioral changes
• Increased ICP
• Neuromuscular changes
• Neurosensory changes
• Seizure activity
• Vital signs changes 35
 Summarization
• Introduction
• Definition
• Causes/Risk factors
• Clinical manifestations
• Diagnostic tests
• Treatment – Medical, surgical, chemotherapy ,
radiation therapy
• Nursing Management
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 References
• "General Information About Adult Brain Tumors"
. NCI. 14 April 2014. Archived from the original on 5
July 2014. Retrieved 8 June 2014
• Merrell RT (December 2012). "Brain tumors". Disease-
a-Month.58(12):678-89. doi:
10.1016/j.disamonth.2012.08.009. PMID 23149521
• "Adult Brain Tumors Treatment". NCI. 28 February
2014. Archived from the original on 5 July 2014.
Retrieved 8 June 2014

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 References contd…
•  "Brain Tumors". Archived from the original on 12 August 2016. Retrieved 2
August 2016.

•  "Mood Swings and Cognitive Changes | American Brain Tumor Association"

. www.abta.org. Archived from the original on 2 August 2016. Retrieved 3
August 2016.

• "Coping With Personality & Behavioral Changes"

. www.brainsciencefoundation.org. Archived from the original on 30 July
2016. Retrieved 3 August 2016.

• Kahn K, Finkel A (June 2014). "It IS a tumor -- current review of headache and
brain tumor". Current Pain and Headache Reports. 18 (6): 421.

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 Any
Queries ?????
?
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 THANK YOU
FOR
PATIENT LISTENING

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