BRAIN TUMOURS

PRESENTED BY:

INUSAH D. IDDRISU

(MTC, NANDOM)

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Learning ObjectivesBy the end of this session, colleagues will be able to;

a. explain the term brain tumour

b. give the types of brain tumour

c. enumerate the causes/risk factors of brain tumours

d. explain the pathophysiology of brain tumours

e. state at least 7 signs and symptoms of brain tumours

f. state the diagnosis of brain tumours

g. enumerate the treatment of brain tumours

h. list at least 5 complications of brain tumours

i. outline the nursing management of brain tumour

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Brain tumor: Introduction

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Definition of Brain Tumor

A brain tumor is a localized intracranial lesion which occupies space within the skull and tends to cause a risein intracranial pressure.

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Intro. Cont`d

• It is possible for any cell in the brain to undergo neoplastic change.

• The bony confines of the skull means that mere growth and displacement of exsistingtissue causes tissue causes disturbance –hence the phrase space occupying lesion

• Some are invasive and replace normal tissue

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Incidence • Brain tumours rarely metastasis outside the brain

• 20% are secondary metastases; commonly from the lungs, then breast and kidney

• For primary brain tumours

43% are gliomas

10% meningiomas

10% pituitary adenomas

Others

Brain tumour can occur at any age but shows 2 age peaks

• In children b/n 5-9 years old

• middle age

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Incidence Cont`d • Children and adults tend to be affected by

different tumours

Children and adolescents

• Medullablastoma (most common)

• Pilocytic cerebellar astrocytomas

• Teratomas

• Pinealomas

• Craniopharyngiomas

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Incidence cont`d

Adults

• Meningiomas

• Neurinomas

• Pituitary adenomas

• Metastases tumours

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Causes and Risk factors• The exact cause is unclear

• Risk factors includes:

Ionizing radiation from X`ray

Family history

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Pathophysiology

• When most normal cells grow old or get damaged, they die, and new cells take their place.

• Sometimes, this process goes wrong.

• New cells form when the body doesn’t need them and old or damaged cells don’t die as they should.

• The buildup of extra cells often forms a mass of tissue called a growth or tumor.

• Primary brain tumors can be benign or malignant

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Pathophysiology cont`d• Benign brain tumors do not contain cancer cells:

• Usually, benign tumors can be removed and they seldom grow back.

• Benign brain tumors usually have an obvious border or edge.

• Cells from benign tumors rarely invade tissues around them.

• They don’t spread to other parts of the body.

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

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

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Pathophysiology cont`d

Malignant brain tumors (also called brain cancer)

contain cancer cells:

• Malignant brain tumors are generally more serious and often are a threat to life.

• They are likely to grow rapidly and crowd or invade the nearby healthy brain tissue.

• Cancer cells may break away from malignant brain tumors and spread to other parts of the brain or to the spinal cord.

• They rarely spread to other parts of the body.

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Types & Grading • The most common brain tumour are:

Primary tumour of the neurones

secondary metastases tumours

• Brain tumours are grped into grade, the higher the grade number the more abnormal the cells appear and more aggressively the tumour usually behaves.

• Brain tumours are classified as grade I, II, III, and IV

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Metastasis Tumour

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Types of Primary Brain TumorsThere are many types of primary brain tumors.

• Primary brain tumors are named according to the type of cells or the part of the brain in which they begin.

• e.g, most primary brain tumors begin in glial cells.

• This type of tumor is called a glioma.

Among adults, the most common types are:

1. Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. It can be any grade.

• In adults, an astrocytoma most often arises in the cerebrum.

• Grade I or II astrocytoma: called low-grade glioma.

• Grade III astrocytoma: sometimes called a high-grade

• Grade IV astrocytoma: called glioblastoma or malignant astrocytic glioma.

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Types of Brain Tumours con`d2. Meningioma: The tumor arises in the

meninges. It can be grade I, II, or III. It’s usually benign (grade I) and grows slowly.

3. Oligodendroglioma: The tumor arises from cells that make the fatty substance that covers and protects nerves.

• It usually occurs in the cerebrum.

• It’s most common in middle-aged adults.

• It can be grade II or III.

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Types of Brain Tumours cont`dAmong children, the most common types are:4. Medulloblastoma: The tumor usually arises in the

cerebellum. • It’s sometimes called a primitive neuroectodermal

tumor. • It is grade IV.5. Grade I or II astrocytoma:• In children, this low grade tumor occurs anywhere in

the brain. • The most common astrocytoma among children is

juvenile pilocytic astrocytoma.• It’s grade I.

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Types of Brain Tumours cont`d6. Ependymoma:

• The tumor arises from cells that line the ventricles or the central canal of the spinal cord.

• It’s most commonly found in children and young adults.

• It can be grade I, II, or III.

7. Brain stem glioma:

• The tumor occurs in the lowest part of the brain.

• It can be a low-grade or high-grade tumor.

• The most common type is diffuse intrinsic pontine glioma.

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Clinical Features • The symptoms of a brain tumor depend on tumor size,

type and location.

• Symptoms may be caused when a tumor presses on a nerve or harms a part of the brain.

• Also, they may be caused when a tumor blocks the fluid that flows through and around the brain or when the brain swells because of the buildup of fluid.

• Onset is gradual over weeks to years with little emotional and intellectual impairment

• Common s/s include; headaches, numbness or tingling in the arms and legs, seizures, memory problems, mood and personality changes, balance and walking problems, nausea and vomiting, changes in speech, vision or hearing.

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Investigations /Diagnosis

Aims • To confirm the presence of the tumour

• To confirm the site of growth

• To confirm the pathology

• To establish the risk factors

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Investigations cont`d1. Medical history

2. Physical examinations

3. Chest X`ray:- to see whether primary tumour or metastasis

4. Skull X`ray: – for signs of raised ICP e.g. Suture seperation;

calcification

5. CT-scan:- the investigation of choice for tumours to note site of tumour. An x-ray machine linked to a computer takes a series of detailed pictures of the head. contrast material injected into a blood vessel.

6. MRI:- for tumour around the skull base and the posterior fossa. A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside the head. Sometimes a special dye is used .

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CT-Scan Image

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Investigations cont`d8. Angiography:- helps differentiate certain tumours and

gliomas. A dye injected into the bloodstream makes blood vessels in the brain show up on an x-ray. If a tumor is present, the x-ray may show the tumor or blood vessels feeding the tumor.

9. Biopsy :- burr hole, stereotactic, open with decompression

10. CSF examination:- from ventricular drainage and shunt insertion.

11. Neurologic exam: vision, hearing, alertness, muscle strength, coordination and reflexes to look for swelling caused by a tumor pressing on the nerve that connects the eye and the brain.

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Differential Diagnosis

1. Vascular originHaematomaGient anureymArteriovenous

malformationInfarction with

oedemaVenous thrombosis

2. TraumaHaemotomaContusion3. InfectionAbscessTuberculomaSarcoidosisEncephalitis4. cysts

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Management of Brain Tumours

Options: Surgery, radiation and chemotherapy

Consider;

1. Grade :- benign or malignant

2. Site:- how approachable

3. Type:- known with certainty and if so does it lend itself to conservative.

4. Size of tumour

5. Age

6. Health of the patient26

Mgt of Brain Tumours cont`d• If benign, should be excised if not

complicated.

• If edema, use dexamethasone with diuretics e.g. mannitol

• Monitor with CT-scan

• Radiotherapy

• Burr hole or stereotactic biopsy

• Chemotherapy: difficult because of the BBB e.g. Vincristine, Methotrexate

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Mgt cont`d - Surgery

• Surgery is the usual first treatment for most brain tumors.

• scalp is shaved.

• craniotomy is done

• an incision is made into the scalp, tumourremoved and the opening covered with a piece of bone or with a piece of metal or fabric.

• Shunt is created to drain excess fluid

• Steroids may be given to reduce the swelling in the brain.

• Antibiotics is given to control infection

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Mgt con`t - Radiation Therapy• Radiation therapy kills brain tumor cells with high

energy x-rays, gamma rays, or protons.

• Radiation therapy usually follows surgery.

• The radiation kills tumor cells that may remain in the area.

• Sometimes, people who can’t have surgery have radiation therapy instead.

1. External radiation therapy:

• A large machine outside the body aims beams of radiation at the head.

• Because cancer cells may invade normal tissue around a tumor, the radiation may be aimed at the tumor and nearby brain tissue, or at the entire brain. 29

Mgt- Radiation2. Internal radiation therapy (implant radiation

therapy or brachytherapy): this is not commonly used for treating brain tumors and is under study.

• The radiation comes from radioactive material usually contained in very small implants called seeds.

• The seeds are placed inside the brain and give off radiation for months.

• They are not removable once the radiation is gone.

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Mgt cont`d – Chemotherapy

• Chemotherapy, the use of drugs to kill cancer cells,

• is sometimes used to treat brain tumors.

• Drugs may be given by mouth or vein

• Common side effects include nausea and vomiting, loss of appetite, headache, fever and chills and weakness.

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Mgt cont`d – Chemotherapy

• Wafers that are put into the brain: For some adults with high-grade glioma, several wafers are implanted into the brain.

• Each wafer is about the size of a dime.

• Over several weeks, the wafers dissolve, releasing the drug into the brain.

• The drug kills cancer cells.

• It may help prevent the tumor from returning in the brain after surgery to remove the tumor.

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Mgt cont`d - Urgent referrals• Progressive subacute neurological deficit

developing over days to weeks (weakness, Sensory loss, Ataxia, Dysphasia)

• New onset seizures

• Patient with vomiting, headache and papilloedema

• Cranial nerve palsy (e.g. visual failure, Diplopia, Unilateral, sensorineural deafness)

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Urgent referral cont`d • Patients with non-migranous headaches of

recent onset, that have been present for at least one month, when accompanied by features suggestive of raised ICP (patient woken by headaches, drowsiness and vomiting).

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Complications• Increased ICP

• Hematoma

• Hypovolemic shock

• Hydrocephalus

• Atelectasis

• Pulmonary edema

• Meningitis

• Fluid and electrolyte imbalances (ADH)

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Nursing management

1. Assessment

2. Nursing intervention

3. Pre and Post operativeNursing care considerations

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Common nursing problems presented

1. Ineffective Tissue Perfusion

2. Ineffective Airway Clearance

3. Impaired Communication

4. Decreased Intracranial

5. Adaptive Capacity

6. Activity Intolerance

7. Sensory disturbance

8. Acute Confusion

9. Risk for infection

10. Risk for injury: seizures

11. Pain (Acute)

12.Impaired cognitive ability

13.Impaired physical mobility

14. Altered nutrition: less than body requirements

15. Urinary retention

16. Risk for constipation

17. Disturbed self-esteem

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REFERENCES• Bateman, H., Hillmore, R., Jackson, D,. Lusznat, S., McAdam, K. &

Regan, C. (2005). Dictionary of Medical Terms (4th ed.). London: A & C Black publishers.

• International Classification of Diseases for Oncology (ICD-O). (2015). International standard for the classification and nomenclature of histologies (3rd ed.) . Retrieved on 10th October, 2015, from http://www.healthcommunities.com/cancer-treatment-and-care/cancer-staging.shtml.

• Jain, V. (2009). Tumours at Glance. New Delhi: Peepee Publishers and Distributors.

• Kumar, V., Abass, K. A., Fausto, N. & Mitchell, C. J. (2007). Robins and Cotran Pathology Basis of Diseases, (8th ed.). China: Saunders Elesier.

• Kumar, V., Abbas, A. K., Fausto, N. & Mitchell, N. R. (2007). Robins Basic Pathology (8th ed.). Philadelphia: Saunders Elsevier.

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