brain tumors and its management adults.pptx

nursing brain tumor

1. Brain tumor

2. Brain tumor is a neoplasm of the intracranial portion of the central nervous system that is usually invasive but does not spread beyond the cerebrospinal axis Brain tumor is a localized intracranial lesion that occupies space within the skull. Tumors usually grow as a spherical mass, but they can grow diffusely and infiltrate tissue Brain tumor

3. Brain tumors rank 4 th cause of death from cancer in individuals between 35-54 years of age. Incidence of brain tumors has increased in the past 20 years especially in older adults . Incidence

4. Primary tumor ; Develops from central nervous system tissue, or arising from tissues within the brain. Secondary tumor ; Have metastasized from other location in the body Types of tumors

5. Intra-axial tumors ; Those originating from glial cells and arise from within the cerebrum, cerebellum or brain stem. Extra-axial tumors ; Have their origin in skull, meninges, cranial nerves or pituitary glands. Types of tumors(cont….)

6. Intra cerebral tumors Gliomas ; (tumors originating from neuroglial cells) Astrocytomas (The most common type of glioma.) Oligodendroglioma Glioblastoma/ astrocytoma gradeIII&IV Ependymoma (tumor arising from the lining of the ventricles of the brain) Medulloblastoma; (rapid growing tumors of neuro epithelial origin occurring in childhood and usually seen near 4 th ventricles of the brain. Types of tumors(cont….)

7. Types of tumors(cont ….) Tumors arising from supporting structures Meningiomas (tumors of the meninges. They grow slowly, but are highly vascular. Commonly seen on the convexity of dura mater of the brain.) Acoustic neuromas (benign tumor composed of fibrous tissue and nerve fibers. May be soft or hard.) schwannoma (tumors of Schwann cells around the nerve, commonly seen from 8 th cranial nerve)

8. Benign Malignant Supratentorial ; In cerebrum Infratentorial ; In cerebellum and brain stem Types of tumors(cont….)

9. Etiology of secondary tumors can be traced to the primary site from which they are metastasized. This site is often the lung or breast. No clear etiologic factor has been established for any of the primary intracranial tumor. Etiology

10. Abnormal proliferation of cells in the brain Infiltration and compression of brain tissue Cerebral edema and brain stem herniation Decreased blood supply Ischemia and Necrosis Pathophysiology

11. Increasing ICP Headache ; dull and constant Nausea and Vomiting Papilledema and diplopia Seizures Dizziness and vertigo Lethargy or unconsciousness Drowsiness Confusion Disorientation Cognitive dysfunction ; memory problems, mood and personality changes. Muscle weakness, sensory loss, aphasia Personality changes. Clinical manifestations

12. Clinical manifestations (cont..) Brain tumor location Cerebral hemispheres Frontal lobe Parietal lobe Presenting manifestations Unilateral hemiplegia, seizures, memory deficit, visual disturbance, inappropriate behavior, inattentiveness, inability to concentrate, emotional liability, difficulty with abstraction, flat affect, Ataxic gait, visual disturbance Speech disturbance, decreased tactile sensitivity, loss of right and left discrimination, seizure activity.

13. Clinical manifestations (cont..) Brain tumor location Occipital lobe Temporal lobe Subcortical Meningeal tumor Metastatic tumor Presenting manifestations Blindness and seizures, visual halucination Seizures, dysphagia, halucination (auditory, visual, olfactory), receptive aphasia, irritability, depression, poor judgment, childish behavior. Hemiplegia Symptoms with compression of brain Headache, increased ICP

14. History and physical examination Neurological examination CT scan MRI EEG Cytologic studies of CSF PET Computer assisted stereotactic biopsy Visual field and fundoscopic examination. Skull films Cerebral angiography Endocrinal studies. Diagnostic findings and assessment

15. Drug therapy Osmotic diuretics ; Inj. Mannitol/ oral glycerol to reduce edema Corticosteroids ; Dexamethasone To reduce cerebral edema For rapid recovery Anticonvulsants ; Eptoin, tegratol, Sodium valproate, Dilantin Antibiotics Radiation therapy; Decreases the incidence of reoccurrence of incompletely resected tumors. E.g.. Brachitherapy (Radiation source is surgical implantation to deliver high doses at a short distance) Chemotherapy; e.g.; Methotrexate, Nitrosurea Management

16. Craniotomy ; surgical opening into the skull; made by various ways Craniectomy ; removal of part of cranium permanently Transnasal transphenoidal surgery ; for pituitary adenoma Laser surgeries Use of gamma knife Surgical management

17. Diabetes insipidus CSF leakage leading to meningitis Hydrocephalus Hemorrhage Sleep apnea Complications

18. Altered tissue perfusion, cerebral, related to cerebral edema Acute pain, headache, related to cerebral edema/ increased ICP. Pain related to scalp incision (post operative) Ineffective airway clearance related to cerebral edema, decreased level of consciousness. Altered body temperature related to loss of primary defenses Altered nutrition less than body requirements related to inability to eat. Self care deficit related to altered neuromuscular function secondary to tumor growth and cerebral edema. Anxiety related to diagnosis and treatment. Potential complications; seizure, Increased ICP, etc. Nursing diagnoses

19. RESULTS: overall survival were 50.0 %, 94.7 %, and 5.8 months, respectively. Neurological death occurred in 17.9 % of cases. The poor prognostic factors for new lesion-free survival time and functional preservation were >5 brain metastases and carcinomatous. CONCLUSIONS: GKS may be an effective option for controlling SCLC-associated brain metastases after WBRT and for preventing neurological death in patients without carcinomatous meningitis. 1. E fficacy and limitations of salvage gamma knife radiosurgery for brain metastases of small-cell lung cancer after whole-brain radiotherapy Nakazaki K, Higuchi Y, Nagan O Serizawa T.

20. Abstract Successful delivery of intraventricular radioimmunotherapy is contingent on adequate CSF flow. The authors present a patient with medulloblastoma in whom obstructed CSF flow was causing hydrocephalus. . The 18-month-old patient with medulloblastoma involving leptomeningeal dissemination presented for intraventricular radioimmunotherapy. but no activity over the cerebral convexities or spinal canal, consistent with obstruction at the level of the cerebral aqueduct. 2 . Establishing successful cerebrospinal fluid flow for radioimmunotherapy. Kramer K, McCrea HJ, Fischer C, Greenfield JP

21. Definition Incidence Types of tumors Etiology Pathophysiology Clinical Manifestations Diagnostic Findings & Assessment Management Complications Summarization

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