14. Brain Tumour.pptx

Easy description

1. Presented by: Ms. Elizabeth M.Sc (N) Asst. Professor, Dept of MSN NNC, GNSU.

2. Brain

3. Brain tumour is a collection, or mass, of abnormal cells in Brain. Skull, which encloses the brain, is very rigid, any growth inside this restricted place can cause problems. W hen these tumors grow inside the brain it increases intra cranial pressure, which can cause bra i n damage and may be even life threatening.

4. Incidence & Prevelance Last year , 62,930 new cases were reorded in United states for adult brain tumors, while for children 4,030 new cases for were recorded for the same period, of which 2,880 children were under 15 year of age. White american > Black Americans In US, brain tumor typically occur in 2 distinct categories Children aged 0-15years Adults in there 5 th to 7 th decade Meningioma, a benign primary tumor - 33.8% of primary brain tumor , Glioblastoma Multiforme, a malignant tumor - 17.1% of adult primary tumor The largest percentage of childhood tumor i.e. 17% located in frontal, parietal and occipital lobe followed by cerebellum (16%) and Brain Stem (11%)

5. Distribution of all primary brain and CNS tumors

6. Tumors were classified into 2 categories : 1. Primary Brain Tumors 2. Secondary Brain Tumors

7. Primary tu m o r s can be B enign or Malignan t . Primary tumors originates in the CNS

8. Benign brain tumors - Charecteristics It doesnt contain cancer cells Usually, benign tumors can be removed and the rarely grow back. Benign brain tumors have an obvious border or edge. They dont spread to other parts of the body They don't invade tissues around them However, benign tumors can press on sensitive area of brain and can cause serious health problems. Unlike benign tumor of other parts of the body, benign tumor of the brain are sometimes life threatening. with time benign brain tumors can become malignant.

9. Malignant brain tumors - Charecteristics Also called Brain Cancer Most serious and often are threat to life It contain cancer cells Rapid Growth Invade or crowd nearby healthy brain tissue Cancer cell may spread to other parts of the brain or to the spinal cord rarely spread to other parts of the body.

10. P rimary brain tumors named according to the type of cells or the part of the brain in which they begin. Gliomas Astrocytomas Glioblastoma Multiforme Oligodendrogliomas Ependymomas & Ependymoblastomas Medulloblastomas Meningiomas Pituitary adenomas Schwannomas Primary CNS lymphoma

11. Grading

12. Secondary Brain Tumor Secondary brain tumors also called as Metastatic Brain Tumor originates from malignancies outside of the CNS and spread to the brain, typically through arterial circulation.

13. Clinical Manifestation of

14. Diagnosis Medical History including the specific nature of S&S Neurological Examination - Testing of reflexes & assess visual, cognitive, sensory, and motor function.

15. Tumor Imaging It is classified into 3 categories Static Imaging Dynamic Imaging Computer Integration Imaging

16. Static Imaging Static neurological imaging includes CT and MRI, which are noninvasive techniques that provide accurate anatomical and functional analysis of intracranial structures.

17. CT Scan To determin e tumor size. Contrast enhancement helps to identify isodense tumor from surrounding parenchyma, hypodense lesions in edematous areas, and optimal sites for tumor biopsy. After surgical intervention, CT can be used to confirm the proper tissue biopsy site and determine the success of tumor resection. T o detect calcification and bony involvement.

18. MRI To de tect & localizing tumor as well as evaluating edema, hydrocephalus or hemorrhage. Contrast enhancement with gadolinium sharpens the definition of lesion MRI enhanced with gadolinium can distinguish between edema and tumor

19. Dynamic Imaging It includes Positron emission tomography (PET) Single photon emission CT (SPECT) Magnetic Resonance Spectroscopy (MRS) Functional MRI

20. PET Scan It uses radioactive markers to measure glucose metabolism which is useful to determine the grade of primary brain tumor. It also helps in study of metabolic effect of chemotherrapy, Radiation therapy and steroids on the tumor.

21. SPECT Scan T o assess cerebral blood flow and determining tumor location. It is used to identify high- & low- grade tumor to differentiate between tumor recurrence and radiation necrosis. It is used pre-op with static imaging to localize highest metabolic area of tumor for biopsy.

22. Magnetic Resonance Spectroscopy T o measure the metabolism of brain tumors. It has been proved to differentiate successfully normal brain from malignant tumor and recurrent tumor from radiation necrosis. It also has been used to document early treatment response and provide information regarding histological grade of astrocytomas.

23. Magnetic resonance angiography (MRA) It generates images of blood vessels without dye or ionizing radiation to evaluate the blood flow and position of vessels leading to the brain tumor.

24. Functional M R I T o map cerebral blood flow at the capillary level. Its intended purpose is to provide information regarding the diffusion of contrast into tumor, resulting in better resolution of tumor and edema. It can also be used to identify tumor in motor, sensory, and language areas of the brain

25. Computed Integration Imaging Computed integration imaging involves the simultaneous display of images from different techniques in a single imaging system that is transposed to a reference stereotactic frame. C ombining tumor images from different modalities, including CT, MRI, PET, and SPECT. This development has resulted in significant advances in stereotactic biopsy, interstitial radiotherapy, and laser-guided stereotactic resection. It provides a safer, more accurate method of tissue acquisition and biopsy. A correct tissue diagnosis can be made in 95% of cases

26. B i opsy Surgical biopsy is performed to obtain tumor tissue as part of tumor resection or as a separate diagnostic procedure. Stereotactic biopsy is a computer-directed needle biopsy. When guided by advanced imaging tools, stereotactic biopsy yields the lowest surgical morbidity and highest degree of diagnostic information. This technique is frequently used with deep-seated tumors in functionally important or inaccessible areas of the brain in order to preserve function .

27. Laboratory Diagnosis Perimetry is the measurement of visual fields used when evaluating tumors near the optic chiasm. Electroencephalography (EEG) is used to monitor brain activity and detect seizures Lumbar puncture is used to analyze CSF, which is useful in the diagnosis and detection of dissemination of certain brain tumors. Audiometry and vestibular testing are useful for diagnosing tumors in the cerebellopontine angle. Endocrine testing is used to examine endocrine abnormalities with tumors in the pituitary gland and hypothalamus.

28. Treatment Traditional Surgery Chemotherapy Radiation Therapy Stereotactic Radiosurgery

29. Traditional Surgery Primary Goal : Maximal tumor resection with the least amount of damage to neural or supporting structures. Purpose Biopsy to establish a diagnosis Partial resection to decrease the tumor mass to be treated by other methods Complete resection of the tumor Provision of access for adjuvant treatment techniques. or adjuvant treatment techniques.

30. Biops y It is performed through open, needle, and stereotactic needle techniques. Open biopsies involve exposure of the tumor followed by removal of a sample through surgical excision. Needle biopsies involve insertion a needle into the tumor through a hole in the skull and the excision of the tissue sample drawn through the needle. s tereotactic needle biopsies use computers and MRI or CT scanning equipment to assisst in directing the needle into the tumor.

31. Partial & Complete Resections It is accomplished through craniotomy. Craniotomy involves removal of a portion of the skull and seperation of the dura mater to expose the tumor. Stereotactic craniotomy uses technologyto guide neurosurgeon duing the procedure.

32. Traditional Surgery Pre - op Intra - op Post - op Limitation

33. Preoperative Management Before surgery, clients are evaluated for general surgical risks and the possibility of tumors in additional locations. Unless medically contraindicated, steroids & anticonvulsant medications are administered before surgery

34. Intraoperative Management During surgery, precautions are taken to prevent an increase in edema or ICP. Mannitol(vasodiuretic) & Hyperventilation is used to decrease ICP, Steroid use is continued Antibiotics are administered to prevent infection.

35. Postoperative Management Patients are observed in an intensive care unit for at least 24 hours for possible intracranial bleeding or seizures. Blood pressure is monitored continuously. Post-op these patients are more prone to DVT but due to the risk of intracranial bleeding, acoagulants cannot be given so Compression stockings are used prophylactically. Steroids are tapered in 5-10 days post-op.

36. Limitations Medical Complication such as Hematoma, Hydrocephalus, infection , infarction from procedure. Complications resulting from GA Increased cost of hospital stay and surgical procedure.

37. Chemotherapy It can be used independently or as an adjuvant t o surgery or radiation. Chemotherapy drugs impede cellular replication of the tumor cells, interfering with their ability to copy deoxyribonucleic acid (DNA) and reproduce. Methotrexate (Highly neuro-toxic) is admnistered with Leucovorin (Antidote) Temozolomide is orally available chemotherapeutic agent for the R x of Gliomas. The antiangiogenesis agent monoclonal antibody - Avastin (bevacizumab) V ascular endothelial growth factor (VEGF) is administered intravenously.

38. Radiation Therapy It can be used alone or in conjunction with surgery or chemotherapy to treat malignant brain tumors. It is typically chosen as a treatment option for tumors that are too large or inaccessible for surgical resection and to eradicate residual neoplastic cells after a surgical debulking. This type of treatment includes the Gamma Knife, linear accelerators, and the cyberknife.

39. Stereostatic Radiosurgery Stereotactic radiosurgery is used to treat benign and malignant tumors, vascular malformations, and functional disorders. The primary modes of administration for stereotactic radiosurgery include the Gamma Knife, linear accelerators, and the cyberknife The Gamma Knife is typically used for deeply embedded small tumors that require precise delivery of radiation. Linear accelerators used for conventional radiation can be modified for stereotactic radiosurgery. The brain lesion to be targeted is stereotactically placed in the center of the arc of rotation of the machine. A single, highly focused beam of radiation is delivered over multiple sweeps around the brain lesion. Linear accelerators can be used to treat larger tumors with precise shape while maintaining uniform dose.

40. Cyberknife The Cyberknife uses a compact linear accelerator mounted on a robotic arm, with the robotic arm moving around the linear accelerator to multiple precalculated positions. At each position the accelerator fires a beam of radiation at the tumor or lesion. A high cumulative dose of radiation is achieved at the tumor or lesion because of the convergence of the beams. This dose is typically strong enough to destroy the abnormal cells while minimizing the damaging effects of radiation to healthy surrounding tissue.

41. Rehabilitation Rehabilitation can be a very important part of the treatment plan. The goals of rehabilitation depend on needs and how the tumor has affected patients ability to carry out daily activities. Several types of therapists can help Physical Therapists Speech Therapists Occupational Therapists