brain tumor

Brain tumorBrain tumor

OutlinesOutlines Introduction Introduction Definition Definition Classification of brain tumors Classification of brain tumors Risk factors for brain tumorsRisk factors for brain tumors Signs and symptoms of brain tumorSigns and symptoms of brain tumor Diagnosis of brain tumorDiagnosis of brain tumor Treatment of brain tumorTreatment of brain tumor Nursing managementNursing management

Brain tumorBrain tumorIntroductionIntroduction

Brain tumorsBrain tumors

Definition of brain tumorDefinition of brain tumor

A brain tumor is a A brain tumor is a localized intracranial localized intracranial

lesionlesion which occupies which occupies space within the skull space within the skull and may cause a and may cause a riserise

in intracranial in intracranial pressure.pressure.

Incidence of tumorsIncidence of tumors10-2510-25 per 100.000 population per per 100.000 population per

yearyear

5-15%5-15% among all tumorsamong all tumors

•Tissue of origin tumor location

•Primary or secondary (metastatic)•Grading (benign or malignant)

Classification of brain Classification of brain tumorstumors

.1.1Tumors of neuroepithelial tissueTumors of neuroepithelial tissue►Astrocytic tumorsAstrocytic tumors►Oligodendroglial tumorsOligodendroglial tumors►Ependymal tumorsEpendymal tumors►Mixed gliomasMixed gliomas►Choroid plexus tumorsChoroid plexus tumors►Neuronal and mixed neuronal-glial Neuronal and mixed neuronal-glial

tumorstumors►Pineal parenchymal tumorsPineal parenchymal tumors►Embryonal tumorsEmbryonal tumors


.2.2Tumors of cranial and spinal nervesTumors of cranial and spinal nerves

.3.3Tumors of the meningesTumors of the meninges►Tumors of meningothelial cellsTumors of meningothelial cells►Mesenchymal nonmeningothelial tumorsMesenchymal nonmeningothelial tumors►Primary melanocytic lesionsPrimary melanocytic lesions

.4.4Tumors of sellar regionTumors of sellar region

.5.5Germ cell tumorsGerm cell tumors

.6.6Lymphomas and hemopoietic Lymphomas and hemopoietic neoplasmsneoplasms

.7.7Cysts and tumor-like lesionsCysts and tumor-like lesions

.8.8Local extensions from regional Local extensions from regional tumorstumors

.9.9Metastatic tumorsMetastatic tumors.10.10Unclassified tumorsUnclassified tumors


Brain tumors can be benign or malignantBrain tumors can be benign or malignantBenign brain tumors:Benign brain tumors: Benign brain tumors Benign brain tumors do notdo not

contain cancer cells: usually, contain cancer cells: usually, benign tumors can be removed, benign tumors can be removed, and they seldom grow back.and they seldom grow back.

The border or The border or edgeedge of a benign of a benign brain tumor can be clearly seen. brain tumor can be clearly seen. Cells from benign tumors do not Cells from benign tumors do not invade tissues around them or invade tissues around them or spread to other parts of the body. spread to other parts of the body.

Classification of brain Classification of brain tumorstumors(cont(cont……))

However, benign tumors can However, benign tumors can presspress on sensitive areas of the brain and on sensitive areas of the brain and cause serious health problems.cause serious health problems.

Unlike benign tumors in most other Unlike benign tumors in most other parts of the body, benign brain parts of the body, benign brain tumors are sometimes tumors are sometimes life life threateningthreatening..

Very rarely, a benign brain tumor Very rarely, a benign brain tumor may may becomebecome malignant. malignant.

Classification of brain Classification of brain tumorstumors(cont(cont……))Malignant brain tumors:Malignant brain tumors:

Malignant brain tumors are Malignant brain tumors are generally more serious and often generally more serious and often is life threatening. It may be is life threatening. It may be primaryprimary (the tumor originate (the tumor originate from the brain tissue) or from the brain tissue) or secondarysecondary (metastasis from (metastasis from others tumor elsewhere in the others tumor elsewhere in the body).body).

They are likely to grow They are likely to grow rapidlyrapidly and invade the surrounding and invade the surrounding healthy brain tissue.healthy brain tissue.

Classification of brain Classification of brain tumorstumors(cont(cont……))

Very rarely, cancer cells may Very rarely, cancer cells may break awaybreak away from a malignant from a malignant brain tumor and spread to other brain tumor and spread to other parts of the brain, to the spinal parts of the brain, to the spinal cord, or even to other parts of cord, or even to other parts of the body.the body.

Surgical classification of brain Surgical classification of brain tumorstumors

IntracerebralIntracerebralIntraventricularIntraventricularExtracerebralExtracerebral

SupratentorialSupratentorialInfratentorialInfratentorial

Exact localization (lobes, basal ganglia, Exact localization (lobes, basal ganglia, brain stem, ventricles)brain stem, ventricles)

•Primary – unknown•Metastatic

o35% - lungo20% - breasto10% - kidneyo5% - gastrointestinal tract

•Often unknown•Under investigation:

oGenetic changesoHeredityoErrors in fetal developmentoIonizing radiationoElectromagnetic fields (including cellular phones)oEnvironmental hazards (including diet)oVirusesoInjury or immunosuppression

Risk factors of the brain Risk factors of the brain tumortumor

BBeing maleeing male AAgege FFamily historyamily history BBeing exposed to eing exposed to

radiation or certain radiation or certain chemicals at workchemicals at work

Symptoms related to increased Symptoms related to increased intracranial pressure such as:intracranial pressure such as:

HeadacheHeadache most common in most common in the early morning and made the early morning and made worse by coughing or worse by coughing or strainingstraining

Decrease in level of Decrease in level of consciousnessconsciousness such as such as confusion and lethargy.confusion and lethargy.

Signs and symptoms of brain Signs and symptoms of brain tumortumor

Vomiting

Papilledema ( edema of optic nerve) and visual disturbance

Alteration in mental status.

Signs and symptoms of brain Signs and symptoms of brain tumor (conttumor (cont……))

Signs and symptoms of brain Signs and symptoms of brain tumor (conttumor (cont……))

Localized symptoms such Localized symptoms such as:as:

AAphasiaphasia PPersonality changes as in ersonality changes as in

case of frontal lobe tumorcase of frontal lobe tumor SSensory defects ( smell, ensory defects ( smell,

hearing).hearing). SSeizures.eizures. MMotor abnormalitiesotor abnormalities

•Cerebellar tumorsoDisturbances in coordination and equilibrium

•Pituitary tumorsoEndocrine dysfunctionoVisual deficitsoHeadache

•Frontal LobeoInappropriate behavioroPersonality changesoInability to concentrateoImpaired judgmentoMemory lossoHeadacheoExpressive aphasiaoMotor dysfunctions

•Parietal lobeoSensory deficits

ParesthesiaLoss of 2 pt discriminationVisual field deficits

•Temporal lobeoPsychomotor seizures – temporal lobe-judgment,

behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousness

•Occipital lobeoVisual disturbances

Diagnosis of brain tumorDiagnosis of brain tumor

NNeurological examinationeurological examination BBrain CT scanrain CT scan MMRI on brainRI on brain AAngiogram ngiogram BBiopsyiopsy

Neuroimaging of brain Neuroimaging of brain tumorstumors

Major diagnostic modality. Useful for Major diagnostic modality. Useful for preoperative planningpreoperative planning

The diagnosis of a primary brain tumor is The diagnosis of a primary brain tumor is best made by cranial MRI. This should be best made by cranial MRI. This should be

the first test obtained in a patient with the first test obtained in a patient with signs or symptoms suggestive of an signs or symptoms suggestive of an

intracranial mass. The MRI scan should intracranial mass. The MRI scan should always be obtained both with and without always be obtained both with and without

contrast material (gadolinium)contrast material (gadolinium)..MRI superior to CT scan for evaluating MRI superior to CT scan for evaluating

meninges, subarachnoid space, posterior meninges, subarachnoid space, posterior fossa and defining the vascular fossa and defining the vascular

abnormality of the lesionabnormality of the lesion

NeuroimagingNeuroimagingHigh-grade or malignant gliomas appear High-grade or malignant gliomas appear

as contrast-enhancing mass lesions, which as contrast-enhancing mass lesions, which arise in white matter and are surrounded arise in white matter and are surrounded

by edemaby edema Multifocal malignant gliomas are seen in ~ Multifocal malignant gliomas are seen in ~

5% of patients5% of patients..Low-grade gliomas typically are Low-grade gliomas typically are

nonenhancing lesions that diffusely nonenhancing lesions that diffusely infiltrate brain tissue and may involve a infiltrate brain tissue and may involve a

large region of brain. Low-grade gliomas large region of brain. Low-grade gliomas are usually best appreciated on T2-are usually best appreciated on T2-

weighted MRI scansweighted MRI scans..

NeuroimagingNeuroimagingA contrast-enhanced CT scan may be used A contrast-enhanced CT scan may be used

if MRI is unavailable. CT may be false-if MRI is unavailable. CT may be false-negative in patients with a low-grade negative in patients with a low-grade

tumor and can have significant artifact tumor and can have significant artifact through the posterior fossa, which may through the posterior fossa, which may

obscure a lesion in this areaobscure a lesion in this area . .Calcification, which may suggest the Calcification, which may suggest the

diagnosis of an oligodendroglioma, is often diagnosis of an oligodendroglioma, is often better appreciated on CT than on MRIbetter appreciated on CT than on MRI . .

CT useful if there is a question of bone or CT useful if there is a question of bone or vascular involvement, or for detecting vascular involvement, or for detecting

mets to skull base. Also, in ER situation or mets to skull base. Also, in ER situation or if MRI is contraindicatedif MRI is contraindicated..

Brain Meningioma CTBrain Meningioma CT

Meningioma MRI /T2Meningioma MRI /T2

Coronal T1-weighted magnetic resonance Coronal T1-weighted magnetic resonance images show a parasagittal malignant images show a parasagittal malignant

meningioma (left) and its recurrence (right) 8 meningioma (left) and its recurrence (right) 8 months after gross total resection and external months after gross total resection and external

beam radiation therapybeam radiation therapy..

Postcontrast Postcontrast computed computed

tomography tomography showing relatively showing relatively

homogeneous homogeneous enhancement in enhancement in

medulloblastomamedulloblastoma..

Radiologic features of Radiologic features of metastatic diseasemetastatic disease

-Multiple lesions-Localization at the grey-white

junction-More circumscribed margins-Relatively large amount of

edema compared to size of lesion

Treatment of brain Treatment of brain tumortumor

A variety of medical treatment A variety of medical treatment modalities, including modalities, including

chemotherapychemotherapy and and radiotherapy, are used alone or radiotherapy, are used alone or

in combination with in combination with surgical surgical resectionresection..

Supportive care include:Supportive care include: SteroidsSteroids

Anticonvulsant drugsAnticonvulsant drugs

•Damages DNA of rapidly dividing cells•4000–6000 Gy total dose•Duration of 4–8 weeks•Brachytherapy•Stereotactic radiosurgery

•Slows cell growth•Cytotoxic drugs

oCisplatin, Etoposide, Vincristine, Temozolomide (Temodar)

•Ommaya Reservoir

Do you know whatDo you know what’’s in peoples in people’’s s headhead??

brain tumor

Health & Medicine