Brain tumor

Property Neurosurgery Department, Department of General Surgery, Faculty of Medicine, University of Zagazig, Egypt

1. 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
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Treatment of brain tumorTreatment of brain tumor
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Nursing managementNursing management

2. Brain tumorBrain tumor
IntroductionIntroduction

3. Brain tumorsBrain tumors

4. Brain tumorsBrain tumors

5. Brain tumorsBrain tumors

6. 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 in
intracranial pressure.intracranial pressure.

8. Incidence of tumorsIncidence of tumors

10-2510-25 per 100.000 population per yearper 100.000 population per year

5-15%5-15% among all tumorsamong all tumors

9. •Tissue of origin
tumor location
•Primary or secondary (metastatic(
•Grading (benign or malignant(

10. Classification of brain tumorsClassification of brain tumors
1.1.Tumors 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 tumorsNeuronal and mixed neuronal-glial tumors
►Pineal parenchymal tumorsPineal parenchymal tumors
►Embryonal tumorsEmbryonal tumors

11. Classification of brain tumorsClassification of brain tumors
2.2.Tumors of cranial and spinal nervesTumors of cranial and spinal nerves
3.3.Tumors of the meningesTumors of the meninges
►Tumors of meningothelial cellsTumors of meningothelial cells
►Mesenchymal nonmeningothelial tumorsMesenchymal nonmeningothelial tumors
►Primary melanocytic lesionsPrimary melanocytic lesions
2.2.Tumors of sellar regionTumors of sellar region
3.3.Germ cell tumorsGerm cell tumors
4.4.Lymphomas and hemopoietic neoplasmsLymphomas and hemopoietic neoplasms
5.5.Cysts and tumor-like lesionsCysts and tumor-like lesions
6.6.Local extensions from regional tumorsLocal extensions from regional tumors
7.7.Metastatic tumorsMetastatic tumors
8.8.Unclassified tumorsUnclassified tumors

12. Classification of brain Classification of brain
tumorstumors
Brain tumors can be benign or malignantBrain tumors can be benign or malignant
Benign brain tumors:Benign brain tumors:

Benign brain tumors Benign brain tumors do notdo not contain contain
cancer cells: usually, benign tumors cancer cells: usually, benign tumors
can be removed, and they seldom can be removed, and they seldom
grow back.grow back.

The border or The border or edgeedge of a benign brain of a benign brain
tumor can be clearly seen. Cells from tumor can be clearly seen. Cells from
benign tumors do not invade tissues benign tumors do not invade tissues
around them or spread to other parts around them or spread to other parts
of the body. of the body.

13. Classification of brain tumorsClassification of brain tumors
(cont(cont……((
However, benign tumors can However, benign tumors can presspress on on
sensitive areas of the brain and cause sensitive areas of the brain and cause
serious health problems.serious health problems.

Unlike benign tumors in most other Unlike benign tumors in most other
parts of the body, benign brain tumors parts of the body, benign brain tumors
are sometimes are sometimes life threateninglife threatening..

Very rarely, a benign brain tumor may Very rarely, a benign brain tumor may
becomebecome malignant. malignant.

14. Classification of brain tumorsClassification of brain tumors
(cont(cont……((
Malignant brain tumors:Malignant brain tumors:

Malignant brain tumors are generally Malignant brain tumors are generally
more serious and often is life more serious and often is life
threatening. It may be threatening. It may be primaryprimary (the (the
tumor originate from the brain tumor originate from the brain
tissue) or tissue) or secondarysecondary (metastasis (metastasis
from others tumor elsewhere in the from others tumor elsewhere in the
body).body).

They are likely to grow They are likely to grow rapidlyrapidly and and
invade the surrounding healthy brain invade the surrounding healthy brain
tissue.tissue.

15. Classification of brain tumorsClassification of brain tumors
(cont(cont……((

Very rarely, cancer cells may Very rarely, cancer cells may break break
awayaway from a malignant brain tumor from a malignant brain tumor
and spread to other parts of the and spread to other parts of the
brain, to the spinal cord, or even to brain, to the spinal cord, or even to
other parts of the body.other parts of the body.

16. Surgical classification of brain Surgical classification of brain
tumorstumors

IntracerebralIntracerebral

IntraventricularIntraventricular

ExtracerebralExtracerebral
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SupratentorialSupratentorial
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InfratentorialInfratentorial

Exact localization (lobes, basal ganglia, brain Exact localization (lobes, basal ganglia, brain
stem, ventriclesstem, ventricles((

17. •Primary – unknown
•Metastatic
o35% - lung
o20% - breast
o10% - kidney
o5% - gastrointestinal tract

18. •Often unknown
•Under investigation:
oGenetic changes
oHeredity
oErrors in fetal development
oIonizing radiation
oElectromagnetic fields (including cellular phones(
oEnvironmental hazards (including diet(
oViruses
oInjury or immunosuppression

19. Risk factors of the brain Risk factors of the brain
tumortumor

BBeing maleeing male

AAgege

FFamily historyamily history

BBeing exposed to radiation eing exposed to radiation
or certain chemicals at or certain chemicals at
workwork

20. 
Symptoms related to increased intracranial Symptoms related to increased intracranial
pressure such as:pressure such as:

HeadacheHeadache most common in the most common in the
early morning and made worse early morning and made worse
by coughing or strainingby coughing or straining

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

21. Vomiting
Papilledema ( edema of
optic nerve) and visual
disturbance
Alteration in mental status.
Signs and symptoms of brain tumor Signs and symptoms of brain tumor
(cont(cont……((

22. Signs and symptoms of brain tumor Signs and symptoms of brain tumor
(cont(cont……((
Localized symptoms such as:Localized symptoms such 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

23. •Cerebellar tumors
oDisturbances in coordination and equilibrium
•Pituitary tumors
oEndocrine
dysfunction
oVisual deficits
oHeadache

24. •Frontal Lobe
oInappropriate behavior
oPersonality changes
oInability to concentrate
oImpaired judgment
oMemory loss
oHeadache
oExpressive aphasia
oMotor dysfunctions

25. •Parietal lobe
oSensory deficits
Paresthesia
Loss of 2 pt discrimination
Visual field deficits
•Temporal lobe
oPsychomotor seizures – temporal lobe-judgment,
behavior, hallucinations, visceral symptoms, no
convulsions, but loss of consciousness
•Occipital lobe
oVisual disturbances

26. Diagnosis of brain tumorDiagnosis of brain tumor

NNeurological examinationeurological examination

BBrain CT scanrain CT scan

MMRI on brainRI on brain

AAngiogram ngiogram

BBiopsyiopsy

27. Neuroimaging of brain tumorsNeuroimaging of brain tumors

Major diagnostic modality. Useful for Major diagnostic modality. Useful for
preoperative planningpreoperative planning

The diagnosis of a primary brain tumor is best The diagnosis of a primary brain tumor is best
made by cranial MRI. This should be the first made by cranial MRI. This should be the first
test obtained in a patient with signs or symptoms test obtained in a patient with signs or symptoms
suggestive of an intracranial mass. The MRI suggestive of an intracranial mass. The MRI
scan should always be obtained both with and scan should always be obtained both with and
without contrast material (gadoliniumwithout contrast material (gadolinium(.(.

MRI superior to CT scan for evaluating MRI superior to CT scan for evaluating
meninges, subarachnoid space, posterior fossa meninges, subarachnoid space, posterior fossa
and defining the vascular abnormality of the and defining the vascular abnormality of the
lesionlesion

28. NeuroimagingNeuroimaging

High-grade or malignant gliomas appear as High-grade or malignant gliomas appear as
contrast-enhancing mass lesions, which arise in contrast-enhancing mass lesions, which arise in
white matter and are surrounded by edemawhite matter and are surrounded by edema

Multifocal malignant gliomas are seen in ~ 5% of Multifocal malignant gliomas are seen in ~ 5% of
patientspatients..

Low-grade gliomas typically are nonenhancing Low-grade gliomas typically are nonenhancing
lesions that diffusely infiltrate brain tissue and lesions that diffusely infiltrate brain tissue and
may involve a large region of brain. Low-grade may involve a large region of brain. Low-grade
gliomas are usually best appreciated on T2-gliomas are usually best appreciated on T2-
weighted MRI scansweighted MRI scans..

29. NeuroimagingNeuroimaging

A contrast-enhanced CT scan may be used if A contrast-enhanced CT scan may be used if
MRI is unavailable. CT may be false-negative in MRI is unavailable. CT may be false-negative in
patients with a low-grade tumor and can have patients with a low-grade tumor and can have
significant artifact through the posterior fossa, significant artifact through the posterior fossa,
which may obscure a lesion in this areawhich may obscure a lesion in this area. .

Calcification, which may suggest the diagnosis Calcification, which may suggest the diagnosis
of an oligodendroglioma, is often better of an oligodendroglioma, is often better
appreciated on CT than on MRIappreciated 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 mets to vascular involvement, or for detecting mets to
skull base. Also, in ER situation or if MRI is skull base. Also, in ER situation or if MRI is
contraindicatedcontraindicated..

30. Brain Meningioma CTBrain Meningioma CT

31. Meningioma MRI /T2Meningioma MRI /T2

32. 
Coronal T1-weighted magnetic resonance images Coronal T1-weighted magnetic resonance images
show a parasagittal malignant meningioma (left) and show a parasagittal malignant meningioma (left) and
its recurrence (right) 8 months after gross total its recurrence (right) 8 months after gross total
resection and external beam radiation therapyresection and external beam radiation therapy..

34. 
Postcontrast Postcontrast
computed computed
tomography tomography
showing relatively showing relatively
homogeneous homogeneous
enhancement in enhancement in
medulloblastomamedulloblastoma..

35. Radiologic features of metastatic Radiologic features of metastatic
diseasedisease
-Multiple lesions
-Localization at the grey-white
junction
-More circumscribed margins
-Relatively large amount of
edema compared to size of
lesion

36. Treatment of brain tumorTreatment of brain tumor

A variety of medical treatment A variety of medical treatment
modalities, including modalities, including
chemotherapychemotherapy and radiotherapy, and radiotherapy,
are used alone or in combination are used alone or in combination
with with surgical resectionsurgical resection..

Supportive care include:Supportive care include:

SteroidsSteroids

Anticonvulsant drugsAnticonvulsant drugs

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

38. •Slows cell growth
•Cytotoxic drugs
oCisplatin, Etoposide, Vincristine, Temozolomide
(Temodar(
•Ommaya Reservoir

39. Do you know whatDo you know what’’s in peoples in people’’s heads head??