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Brain cancer


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    • Estimated 19,000 new cases was diagnosed in U.S
    • Approx. 13,000 people die each year (American Cancer Society, 2006)
    • Occurs in any age group, highest in adults ages 50 to 70
  • 3.
    • In adult population, most common is glioblastoma multiforme followed by meningioma & cytoma
    • Glioblastoma represents more than 50 % of all intracranial lesions
    • The cause is unknown
  • 4. Risk factors
    • Unknown for Primary Brain Tumor
    • Ionizing radiation of the cranium
    • Metastasis from lung, breast, lower GIT, pancreas, kidneys and skin
    • Also hereditary, exposure to some chemicals (Porth, 2005)
  • 5.
    • Suggested causes:
      • Cellphone (radiation)
      • Exposure to high tension wires
      • Use of hair dyes
      • Head trauma
      • Dietary exposure to nitrates
  • 6. Classification of brain tumors
    • I . Intracerebral Tumor
      • a. Gliomas- infiltrate any portion of the brain; most common type of brain tumor
        • 1. Astrocytomas
        • 2. Glioblastoma multiforme
        • 3. Oligodendrocytoma
        • 4. Ependymoma
        • 5. Medulloblastoma
  • 7.
    • II. Tumors arising from from supporting structures
      • A. Meningiomas
      • B. Neuromas (Acoustic neuroma, Schwannoma)
      • C. Pituitary Adenomas
      • III. Developmental Tumors
        • A. Angiomas
        • B. Dermoid, epidermoidteroma, craniopharyngioma
        • IV. Metastatic Lesion
  • 8. Pathophysiology: Compression of Brain Tissues Infiltration or Direct Invasion of Brain Parenchyma Destruction of Neural Tissues Malfuntion of Brain Cells Tumor Growth
  • 9. Clinical Manifestations
    • Mental status changes
    • Headache
    • Nausea and Vomiting
    • Papilledema
    • Seizures
  • 10. Localized Manifestations
    • Frontal lobe tumors
    • -Inappropriate behavior
    • -Personality changes
    • -Inability to concentrate
    • -Impaired judgment
    • -Recent memory loss
    • -headache
  • 11.
    • Parietal lobe tumors
    • -Sensory deficits; paresthesia, loss of two-points descremination, visual field deficits
    • Temporal lobe tumors
    • -Psychomotor seizures
    • Occipital lobe tumors
    • -Visual disturbances
    • Cerebellum Tumors
    • -Disturbances in coordination and equilibrium
  • 12.
    • Pituitary tumors
    • -Endocrine dysfunction
    • -Visual deficits
    • -Headache
  • 13. Diagnostic Findings
    • CT Scans
    • MRI (Magnetic Resonance Imaging)
    • PET (Positron Emission Tomography)
    • Computer Assisted Stereotactic
    • Cerebral Angiography
    • EEG (Electroencephalogram)
  • 14.  
  • 15. Surgery
    • Used to remove tumors, reduce the size of tumor or palliation (for symptom relief)
    • Intracranial neurosurgical procedures
    • 1. Burr hole – use of special drill. The hole may facilitate the evacuation of extracerebral clot, or series of holes may be made in preparation for craniotomy
  • 16. Surgery
    • 2. Craniotomy – surgical opening into cranial cavity. Series of or burr holes are made. The bone between the holes is then cut with craniotome. The tumor is excised, and the bone flap is returned to the opening. Performed to repair traumatic head injury or cerebral aneurysm.
      • Supratentorial craniotomy – above the tentorium
      • Infratentorial craniotomy – below the tentorium
  • 17.
    • 3. Craniectomy – excision of a portion of skull and complete removal of bone flap. May be done to provide decompression after cerebral edema.
    • 4. Cranioplasty – plastic repair to the skull in which synthetic material is inserted to replace the cranial bone that was removed. This restores the contour and integrity of the cranium.
  • 18. Radiation Therapy
    • May be administered alone or as adjunctive therapy with surgery
    • Tx choice for surgically inaccessible tumors
    • Used to decrease the size of tumor prior to surgery
    • Used to tumors that were not completely excised by surgery
  • 19.
    • Specialty Procedures
    • Microsurgery – operating with microscope and microinstruments and illumination equipment
    • - Stereotaxic techniques - precisely locate a specific target point allows for location of discrete areas
    • - Laser beam - excision in less damage to surrounding tissue and less pre-op swelling
    • - Gamma knife – a unit consisting of heavily shielded helmet containing 201 sources of cobalt-60
  • 20.
    • New area of chemotherapy is that of biodegradable anhydrous wafers, which are impregnated with chemotherapy drug and implanted into the tumor at the time of surgery.
    • The wafers are made so they slowly release the drug over a period of many months.
  • 21. Pharmacologic Therapy
    • CORTICOSTEROIDS – relieve headache and alterations in the level of consciousness; reduce inflammation
      • Dexamethasone (Decadron)
      • Prednisone (Deltasone)
      • Mannitol (Osmitrol) – decreasefluid content of the brain that leads to decreased intracranial pressure (ICP)
      • Phenytoin (Dilantin) – prevent and treat seizures
  • 22. Nursing Management
    • Providing Preoperative Care
    • A. The nurse assesses:
    • Weakness, Muscle wasting, Spasticity, Sensory changes, Bowel and Bladder dysfunction, Potential respiratory problems
    • Assessing the patient after surgery
    • The patient is monitored for deterioration in neurologic status
  • 23. Nursing Management
    • Frequent neurologic checks are carried out, with emphasis on movement, strength, and sensation of the upper and lower extremities
    • Managing Pain
    • Pain is the hallmark of spinal metastasis. Patients with sensory root involvement or vertebral collapse may suffer excruciating pain, which requires effective pain management.
  • 24. Nursing Management
    • The bed is usually kept flat initially.
    • The nurse turns the patient as a unit, keeping shoulders and hips aligned and the back straight
    • The side lying position is usually the most comfortable, because this position imposes the least pressure on the surgical site
    • Placement of a pillow between the knees of the patient in a side lying position helps to prevent extreme knee flexion
  • 25. Nursing Management
    • Monitoring and Managing Potential Complication
    • Cervical area
    • the nurse monitors the patient for asymmetric chest movement, abdominal breathing, and abnormal breath sounds.
    • For a high cervical lesion, the endotracheal tube remains in place until adequate respiratory function is ensured.
  • 26. Nursing Management
    • The patient is encouraged to perform deep breathing and coughing exercises.
  • 27. The end.