BSN

1. BRAIN TUMORS

2. Brain Tumors
 Localized intracranial lesion that occupies space
within the skull.
 Usually grow as spherical mass, but they can grow
diffusely and infiltrate tissue.
 The effects of neoplasms occur from the compression
& infiltration of tissue.
 A variety of physiological changes result, causing any
or all of the following pathophysiologic events such as:
 Increased ICP & cerebral edema
 Seizure activity & focal neurologic signs
 Hydrocephalus
 Altered pituitary function

3. Types
1. Primary - arise from tissues within the brain.
2. Secondary – results from a metastasis from a
malignant neoplasm elsewhere in the body.
- the most common type
Note: Brain tumors are generally classified
according to the tissue from which they arise.

4. Primary Brain Tumor
 Originates from cells & structures within the brain
 Cause is unknown
 The only known risk factor is exposure to ionizing
radiation.
 Possible causes have been investigated but
results of studies are conflicting & unconvincing
such as:
> use of cellphones
> exposure to high-tension wires
> use of hair dyes
> head trauma
> dietary exposure to such factors as nitrates
(found in some processed & barbecued foods)

5. Secondary or Metastatic Brain
Tumors
 Develop from structures outside the brain
 Occur in 20% to 40% of all patients with
cancer.
 Rarely metastasize outside the CNS, but
metastatic lesions to the brain occur commonly
from lung, breast, LGI tract, pancreas, kidney
& skin (melanomas)

6. Brain Tumors may be classified into
several groups
1. those arising from the coverings of the brain (eg.
dural meningioma)
2. Those developing in or on the cranial nerves (eg.
Acoustic neuroma)
3. Those originating within brain tissue (eg. Gliomas)
4. Metastatic lesion originating elsewhere in the body.
5. Tumors of the pituitary & pineal gland & of cerebral
blood vessels are also types of brain tumors.
6. Tumors maybe benign or malignant ( a benign
tumor can occur in a vital area and can grow largely
enough to have effects as serious as those of
malignant tumor.

7. Classification of Adult Brain Tumor
I. Intracerebral Tumors
A. Gliomas – infiltrate any portion of the brain;
most common type of brain tumor.
Originates in astrocytes.
1. Astrocytomas (grades I & II) can range
from low-grade to moderate-grade
malignancy.
Tissue of origin: supportive tissue, glial
cells & astrocytes
2. Glioblastoma multiforme (astrocytoma
grades III and IV) Highly malignant &
invasive; among the most devastating of
primary tumors.

8. 3. Oligodendrocytoma
(Oligodendroglioma)(low & high
grades) Benign (encapsulation &
calcification)
Tissue of origin: Oligodendrocytes
4. Ependymoma (grades I & IV) Range
from benign to highly malignant; most
are benign & encapsulated.
Tissue of origin: Ependymal epithelium
5. Medulloblastoma – highly malignant &
invasive; metastatic to spinal cord &
remote areas of brain.

9. II. Tumors Arising from supporting
structures
a. meningiomas – can be benign or
malignant; most are benign.
 Represent 20% of all primary brain
tumors.
 Slow-growing & common in women at
middle age adult.
 Standard treatment is surgery with
complete removal or partial dissection.
Tissue of origin: meninges

10. b. neuromas (acoustic neuroma, schwannoma) many
grow on both sides of the brain; usually benign or low-
grade malignancy.
Acoustic neuroma – tumor of the eight cranial nerve
(responsible for hearing & balance)
 grow slowly & attain considerable size before it is
correctly diagnosed.
 Patient usually experiences loss of hearing,
tinnitus, & episodes of vertigo & staggering gait.
 As the tumor becomes larger, painful sensations
of the face may occur due to the compression of
the fifth cranial nerve.
Tissue of origin: cells that form myelin around
nerves; commonly affects cranial nerve VIII

11. c. pituitary adenomas – usually benign
 Represent about 8% to 12% of all brain tumors
 The pituitary gland, also called hypophysis, is a relatively small
gland located in the sella turcica.
 Attached to the hypothalamus by a short stalk (hypophyseal stalk)
and is divided into two lobes: the anterior (adenohypophysis) and the
posterior (neurohypophysis).
 Pressure effects on the optic nerves, optic chiasm, or optic tracts or
on the hypothalamus or third ventricle results into:
- headache
- visual dysfunction
- hypothalamic disorders ( disorders of sleep, appetite,
temp & emotions)
- increased ICP
- enlargement & erosion of the sella turcica
- hormonal effects
Tissue of origin: Pituitary gland

14. Hormonal Effects of Pituitary
Adenomas
 Amenorrhea or galactorrhea (excessive or
spontaneous flow of milk) due to
excessive secretion of prolactin by the
pituitary gland for the female patient.
 Impotence & hypogonadism for male
patients with prolactinomas.
 Acromegaly caused by excess growth
hormone,
> produces enlargement of the hands
& feet
> distortion of the facial features
> pressure on the peripheral nerves

15. Hormonal Effects of Pituitary
Adenomas
 Clinical features of Cushing’s disease ( a
condition associated with prolonged
overproduction of cortisol, occur with
excessive production of ACTH;
 obesity with redistribution of fat to the facial,
supraclavicular & abdominal areas
 hypertension
 purple striae & ecchymoses
 osteoporosis
 elevated blood glucose levels
 emotional disorders

16. III. Developmental tumors
a. angiomas – massess composed largely of abnormal
blood vessels.
- occur in the cerebellum in 83% of cases
- some persist throughout life without symptoms; others
cause symptoms of a brain tumor
- patients are at risk for cerebral vascular accident
(stroke), because the walls of the blood vessels are thin.
b. dermoid, epidermoid, teroma, craniopharyngioma
IV. Metastatic lesions

17. CLINICAL MANIFESTATIONS
 Headache – worse at night & may awaken the patient
- usually constant but occasionally throbbing.
 Seizures
 Nausea & vomiting from increased ICP
 Cognitive dysfunction including memory problems & mood or
personality changes.
 Muscle weakness
 Sensory losses
 Aphasia
 Visuospatial dysfunction
 Increased ICP
 Cerebral edema
 Obstruction of the CSF pathways

18. Tumor Location & Presenting
Manifestations
 Cerebral Hemisphere
 Frontal lobe (unilateral)
unilateral hemiplegia
seizures
memory deficit
personality & judgment changes
visual disturbances
 Frontal Lobe (bilateral)
same as above; ataxic gait

19.  Parietal Lobe
Speech disturbance (if tumor is in the
dominant hemisphere: inability to write,
spatial disorders, unilateral neglect)
Occipital Lobe
Blindness & seizures
Temporal lobe
Few symptoms; seizures &
dysphagia

20.  Subcortical
 hemiplegia
 other symptoms may depend on area of infiltration
 Meningeal Tumors
 symptoms are associated with compression of the
brain & depend on tumor location
 Metastatic Tumors
 headache, n/v because of ↑ICP, others depend on
tumor location

21.  Thalamus & sellar tumors
 headache, nausea, vision disturbances,papilledema
& nystagmus occur from ↑ICP, diabetes insipidus
may occur
 Fourth ventricle & cerebellar tumors
 headache, nausea, & papailledema from ↑ICP;
ataxic gait & changes in coordination, Tinnitus &
vertigo & deafness
 Braistem Tumors
 Headache on awakening, drowsiness, vomiting,
ataxic gait, facial muscle weakness, hearing loss,
dysphagia, dysarthria, “crossed eyes” or other
visual changes, hemiparesis

22. COMPLICATIONS
 Hydrocephalus
- if the tumor mass obstruct the ventricles or
occludes the outlet.
 Surgical treatment- ventriculoatrial or
ventriculoperitoneal shunt, in which a catheter
with one-way valves is placed in the lateral
ventricle & then tunneled through the skin to
drain CSF into the right atrium or the
peritoneum.

23.  Signs of Increased ICP
decreasing LOC
restlessness
headache
blurred vision
vomiting without nausea
 Signs of infected shunt
high fever
persistent headache
stiff neck

24. DIAGNOSTIC STUDIES
 MRI & PET allows for detection of very small tumors &
may provide more reliable diagnostic information.
 CT and brain Scanning – used to diagnose the location
of the lesion
 SPECT (single photon emission computed tomography)
 EEG useful but less importance
 Lumbar puncture – seldom diagnostic & carries with it
the risk of cerebral herniation
 Angiography – used to determine blood flow to the
tumor & further localize the tumor
 Endocrine Studies – helpful when pituitary adenoma is
suspected
 Histologic study ( smear or frozen section)

25. Collaborative Care
 Treatment goals are aimed at
 Identifying the tumor type & location
 Removing or decreasing tumor mass
 Preventing or managing increased ICP

26.  Surgical removal is the preferred treatment for
brain tumors.
 Radiation therapy & Radiosurgery
 Chemothedirectlyrapy: methotrexate,
procarbazine
temodar ( firs oral chemotherapeutic agent
found to cross the blood-brain barier..

27. Nursing Diagnosis
 Impaired tissue perfusion (cerebral) related to cerebral
edema
 Acute pain (headache) r/t cerebral edema and increased
ICP
 Self-care deficits r/t neuromuscular fuction secondary to
tumor growth & cerebral edema
 Anxiety r/t diagnosis & treatment
 Potential complication: seizures r/t abnormal electrcal
activity of the brain
 Potential complication: increased ICP r/t presence of
tumor & failure of normal compensatory functinong.

28. THANKS!!!