BRAIN TUMOR

Prof: Shanmuga
Meenakshi.G.
MSN,RN QHCP
BRAIN TUMOR
Brain tumor occupies space within the skull, getting as a spherical mass or
diffusing infuriating tissue .The brain tumour causes inflammation, compression
and infiltration of tissue.
The major physiologic changes produced by brain tumour are:-
- Increased intracranial pressure
-Cerebral oedema
-Seizure activity
-Focal Neurological signs
-Hydrocephalus
-Alerted pituitary functions
Neoplasm in brain tissue causes death by increased intracranial pressure and
impairing vital signs.
Types/classification of brain tumor:-
1) Intracerebral tumor:-
a) Gliomas- infiltrate any portion of the brain; the most common type of brain
tumor.
i) Astrocytoma - arising from Astrocytic cells, the most common type of
malignancy grade I and II based on cellular density, cell mitosis and degree of
differentiation from the original cell type.
ii) Glioblastoma - Grade III and IV have some resemblance to the original cell
type.
iii) Oligodendroglioma - tumours arising from Oligodendrocytes, categorised by
low or high grade anaplastic tumours.
iv)Ependymoma- Tumours originating from ependymal cells another type of glial
cells graded from I to IV
v) Medulloblastoma
2) Tumours arising from supportive structures:-
Meningioma’s - common benign encapsulated tumour of arachnoid cells in the
meninges
Slow growing tumors
Common among middle aged adults
Commonly occurring areas proximal to the Venous sinuses
Clinical manifestations vary in the area involved and often as a result of
compression.
3) Neuromas:-
i) Acoustic neuroma - Tumors of the 8th cranial nerve vestibulocochlear
responsible for hearing and balance.
Grows slowly and obtains considerable size before it is diagnosed.
The clinical manifestations are loss of hearing, tinnitus and episodes of vertigo
and staggering gait, painful sensation in the face on the affected side.
ii) Schwannoma
4) Pituitary adenomas:-
Rare malignant disorders produce symptoms as a result of pressure in the
adjacent structures or hormonal changes.
a) Clinical manifestation related to pressure effect:-
-Headache
-Visual dysfunction
Hypothalamic disorder - disorders of sleep, appetite, temperature and
emotions.
-Increased intracranial pressure
-Enlarged and erosion of the sella turcica
b) Clinical manifestation related to hormonal effects:-
Prolactinoma- Female - Amenorrhea or Galactorrhea
- Male - Impotence or Hypogonadism
Growth hormone- Acromegaly
ACTH - Cushing syndrome
- Obesity of supraclavicular and abdominal areas
- Hypertension
- Purple striae and ecchymosis
- Osteoporosis, elevated blood glucose level and emotional disorders.
5) Common clinical manifestations
1) Increased intracranial pressure
●enlarging tumor and cerebral oedema
●equilibrium between brain, CSF and blood(compensatory mechanism)
●Compression of intracranial vein
●Increased absorption decreased production of CSF
●Reduction of CSF volume
●Decreased cerebral blood flow
●Reduction of intra and extracellular brain tissue masses
●failure of compensatory mechanism
●Signs and symptoms of increased ICP
-Headache, nausea, vomiting, papilledema, personality changes, focal motor,
Sensory, cranial dysfunction
2) Headache- mostly in the early morning and become worse by coughing,
straining or sudden movement characterized by deep, expanding, dull, co
relating type.
3) Vomiting- occurs as a result of irritation or the vagal centres in the medulla.
Characterized by projectile vomiting and it relieves headache.
4) Visual disturbance- produced by optic disc swelling or papilledema.
Characterized by diplopia, hemianopia, varying level of blindness.
5) Seizures - can be focal or generalised.
6) Localised symptoms -
• Alteration in cognition and motor disturbance
• Language disturbance (aphasia)
• Tumour specific areas symptoms
i) Motor cortex of the frontal lobe- hemisphere and partial seizure
ii) Change in emotional state and behaviour, aphetic mental attitude, impulsive
and inappropriate in speech, gesture and behaviour
iii) Parietal lobe tumour- decreased sensation in the opposite side, generalised
seizure
iv) Temporal lobe tumour- visual manifestation
- Contralateral homonymous hemianopia
- Visual hallucinations
v) A cerebral tumour - dizziness
●Ataxic and staggering gait (a tendency to fall towers the side of the lesion.
●Marked muscle incoordination
●Nystagmus ( usually in the horizontal direction)
●Cerebellopontine angle tumour
●Tinnitus, vertigo (involvement of 8th cranial nerve)
●Progressive nerve dysfunction
●Numbness or tingling of the face and tongue (incumbent of 5th cranial nerve).
●weakness and paralysis of face ( incident of 7th cranial nerve)
●abnormalities in the Motor functions
vi) Brain stem tumors- computer motor and sensory functions impairment
Assessment and diagnostic findings:-
• History collection- about symptoms and Jerry components assessment
of illness.
• Neurologic Assessment- involvement of cranial nerve and area of CNS.
• CT scan- number, Size, density and location of lesion.
• MRI - Tumors of small lesions, region identification where the base is
thick.
• Computer assisted stereotactic (three dimensional) biopsy- to diagnose
deep seated tumors.
• Brain mapping technologies- to determine the proximity of diseased
areas of the brain to structures essential for normal brain functions.
• PET- shows hyper metabolism of tumors.
• CSF analysis - cytological studies.
Medical management
Chemotherapy, extended beam radiotherapy, hormone suppressing/
replacement therapy.
Palliative care only, Radiation therapy, stereotactic radiosurgery, chemotherapy
that crosses the BBB
Analgesic agents- Morphine infusion through epidural or arachnoid space
through spinal needle and catheter.
Surgical management - for decompression
based on types of tumor, its location, and its accessibility.
i) Craniotomy- meningiomas, Acoustic neuroma, cystic astrocytoma of cerebellum,
colloid cysts of the thyroid ventricle, congenital Tumors as Dermoid cysts and some of
the granulomas.
ii) Small craniotomy - improved imaging techniques (operating microscope and micro
surgical instruments)
- malignant gliomas
iii) Transsphenoidal microsurgical removal - Pituitary adenomas
Radiation therapy
i) Gamma radiation via external beam
ii) Brachytherapy - surgical implant of RADIATION resources to deliver high dose at a
short distance.
iii) Radioisotopes such as iodine 131
iv) Stereotactic procedures
- Linear accelerator or gamma knife to perform radio surgery.
- Multiple narrow beams
Chemotherapy - may be used along with radiation therapy or alone.
i) Temozolomide (Temodar) - oral for 6 weeks for malignant gliomas
ii) Temozolomide - oral for 6-12 weeks
Autologous bone marrow transplantation
Pharmacology - Medical management of oncology
Sr.no Drug group Action Example Nursing responsibility
1 Anti neoplastic Inhibit DNA and RNA Procarbazine
synthesis ,rapid cell
division

2 Carmustine Repeated dose is not administered.

3 Arrest Miosis and Vincristine Monitor for cardiac arrest ,paralytic ileus,bone marrow,
immature cell division. tumor lysis syndrome.

4 Lomustine
5 Temozolomide
6 Corticosteroid Relieve inflammation dexamethasone Given as a low dose and reduced gradually. Monitor the
and cerebral edema immune system for infections.
around the tumors ,so
controls the headache

7 Osmotic diuretics Decrease fluid in brain Mannitol, hypertonic Monitor for cerebral symptoms like confusions, dizziness.
and decrease ICP solution

8 Anticonvulsant Treat and control Phenytoin (Dilantin) Advice the patient to follow the medicine schedule strictly
drugs seizure to maintain the serum drug level for beneficial effects.

9 Anticoagulant Reduce Deep vein Low molecular Monitored closely for symptoms of cerebral haemorrhage.
drugs thrombosis and weight Heparin (High risk for)
pulmonary embolism. (Warfarin)
Complications:-Cerebral metastasis:
Characterized by neurologic signs and symptoms include headache, gait
disturbance, visual impairment, personality changes, Altered memory, focal
weakness, paralysis, aphasia and seizure.
Metastasis to the CSF and meninges known as lepto meningeal metastasis can
produce symptoms of headache of headache and isolated cranial nerve
deficiency.
Nursing management
Nursing diagnosis
1.Risk for ineffective cerebral tissue perfusion related to cerebral edema.
2.Acute pain related to cerebral edema and increased intracranial pressure.
3.Anxiety related to disease condition and surgery, treatment.
4.Potential for seizures related to abnormal electrical activities of the brain.
 Thank you
Prof: Shanmuga Meenakshi.G.
MSN,RN QHCP