This document provides information about brain tumors. It defines a brain tumor as a localized intracranial lesion that occupies space within the skull and causes increased intracranial pressure. It discusses the types of brain tumors, which include gliomas, meningiomas, and pituitary adenomas. The signs and symptoms of brain tumors can include headaches, seizures, nausea and vomiting, and changes in vision, speech, or hearing. Diagnosis involves medical imaging like CT scans and MRIs. Treatment may involve surgery to remove the tumor, radiation therapy, and chemotherapy. Nursing management focuses on assessing neurological status, preventing complications like increased intracranial pressure, and providing pre- and post-operative care.

1. BRAIN TUMOURS
PRESENTED BY:
INUSAH D. IDDRISU
(MTC, NANDOM)
1

2. Learning Objectives
By the end of this session, colleagues will be able to;
a. explain the term brain tumour
b. give the types of brain tumour
c. enumerate the causes/risk factors of brain tumours
d. explain the pathophysiology of brain tumours
e. state at least 7 signs and symptoms of brain tumours
f. state the diagnosis of brain tumours
g. enumerate the treatment of brain tumours
h. list at least 5 complications of brain tumours
i. outline the nursing management of brain tumour
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3. Brain tumor: Introduction
3

4. Definition of Brain Tumor
A brain tumor is a localized
intracranial lesion which
occupies space within the
skull and tends to cause a rise
in intracranial pressure.
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5. 5

6. Intro. Cont`d
• It is possible for any cell in the brain to
undergo neoplastic change.
• The bony confines of the skull means that
mere growth and displacement of exsisting
tissue causes tissue causes disturbance –
hence the phrase space occupying lesion
• Some are invasive and replace normal tissue
6

7. Incidence
• Brain tumours rarely metastasis outside the brain
• 20% are secondary metastases; commonly from the
lungs, then breast and kidney
• For primary brain tumours
43% are gliomas
10% meningiomas
10% pituitary adenomas
Others
Brain tumour can occur at any age but shows 2 age peaks
• In children b/n 5-9 years old
• middle age
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8. Incidence Cont`d
• Children and adults tend to be affected by
different tumours
Children and adolescents
• Medullablastoma (most common)
• Pilocytic cerebellar astrocytomas
• Teratomas
• Pinealomas
• Craniopharyngiomas
8

9. Incidence cont`d
Adults
• Meningiomas
• Neurinomas
• Pituitary adenomas
• Metastases tumours
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10. Causes and Risk factors
• The exact cause is unclear
• Risk factors includes:
Ionizing radiation from X`ray
Family history
10

11. Pathophysiology
• When most normal cells grow old or get
damaged, they die, and new cells take their place.
• Sometimes, this process goes wrong.
• New cells form when the body doesn’t need
them and old or damaged cells don’t die as they
should.
• The buildup of extra cells often forms a mass of
tissue called a growth or tumor.
• Primary brain tumors can be benign or malignant
11

12. Pathophysiology cont`d
• Benign brain tumors do not contain cancer cells:
• Usually, benign tumors can be removed and they
seldom grow back.
• Benign brain tumors usually have an obvious border or
edge.
• Cells from benign tumors rarely invade tissues around
them.
• They don’t spread to other parts of the body.
• However, benign tumors can press on sensitive areas of
the brain and cause serious health problems.
• Unlike benign tumors in most other parts of the body,
benign brain tumors are sometimes life threatening.
12

13. Pathophysiology cont`d
Malignant brain tumors (also called brain cancer)
contain cancer cells:
• Malignant brain tumors are generally more
serious and often are a threat to life.
• They are likely to grow rapidly and crowd or
invade the nearby healthy brain tissue.
• Cancer cells may break away from malignant
brain tumors and spread to other parts of the
brain or to the spinal cord.
• They rarely spread to other parts of the body.
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14. Types & Grading
• The most common brain tumour are:
Primary tumour of the neurones
secondary metastases tumours
• Brain tumours are grped into grade, the higher
the grade number the more abnormal the
cells appear and more aggressively the
tumour usually behaves.
• Brain tumours are classified as grade I, II, III,
and IV
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15. Metastasis Tumour
15

16. Types of Primary Brain Tumors
There are many types of primary brain tumors.
• Primary brain tumors are named according to the type of cells
or the part of the brain in which they begin.
• e.g, most primary brain tumors begin in glial cells.
• This type of tumor is called a glioma.
Among adults, the most common types are:
1. Astrocytoma: The tumor arises from star-shaped glial cells
called astrocytes. It can be any grade.
• In adults, an astrocytoma most often arises in the cerebrum.
• Grade I or II astrocytoma: called low-grade glioma.
• Grade III astrocytoma: sometimes called a high-grade
• Grade IV astrocytoma: called glioblastoma or malignant 16

17. Types of Brain Tumours con`d
2. Meningioma: The tumor arises in the
meninges. It can be grade I, II, or III. It’s
usually benign (grade I) and grows slowly.
3. Oligodendroglioma: The tumor arises from
cells that make the fatty substance that covers
and protects nerves.
• It usually occurs in the cerebrum.
• It’s most common in middle-aged adults.
• It can be grade II or III.
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18. Types of Brain Tumours cont`d
Among children, the most common types are:
4. Medulloblastoma: The tumor usually arises in the
cerebellum.
• It’s sometimes called a primitive neuroectodermal
tumor.
• It is grade IV.
5. Grade I or II astrocytoma:
• In children, this low grade tumor occurs anywhere in
the brain.
• The most common astrocytoma among children is
juvenile pilocytic astrocytoma.
• It’s grade I.
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19. Types of Brain Tumours cont`d
6. Ependymoma:
• The tumor arises from cells that line the
ventricles or the central canal of the spinal cord.
• It’s most commonly found in children and young
adults.
• It can be grade I, II, or III.
7. Brain stem glioma:
• The tumor occurs in the lowest part of the brain.
• It can be a low-grade or high-grade tumor.
• The most common type is diffuse intrinsic
pontine glioma.
19

20. Clinical Features
• The symptoms of a brain tumor depend on tumor size,
type and location.
• Symptoms may be caused when a tumor presses on a
nerve or harms a part of the brain.
• Also, they may be caused when a tumor blocks the
fluid that flows through and around the brain or when
the brain swells because of the buildup of fluid.
• Onset is gradual over weeks to years with little
emotional and intellectual impairment
• Common s/s include; headaches, numbness or tingling
in the arms and legs, seizures, memory problems,
mood and personality changes, balance and walking
problems, nausea and vomiting, changes in speech,
vision or hearing.
20

21. Investigations /Diagnosis
Aims
• To confirm the presence of the tumour
• To confirm the site of growth
• To confirm the pathology
• To establish the risk factors
21

22. Investigations cont`d
1. Medical history
2. Physical examinations
3. Chest X`ray:- to see whether primary tumour or metastasis
4. Skull X`ray: – for signs of raised ICP e.g. Suture seperation;
calcification
5. CT-scan:- the investigation of choice for tumours to note site
of tumour. An x-ray machine linked to a computer takes a
series of detailed pictures of the head. contrast material
injected into a blood vessel.
6. MRI:- for tumour around the skull base and the posterior
fossa. A large machine with a strong magnet linked to a
computer is used to make detailed pictures of areas inside
the head. Sometimes a special dye is used .
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23. CT-Scan Image
23

24. Investigations cont`d
8. Angiography:- helps differentiate certain tumours and
gliomas. A dye injected into the bloodstream makes blood
vessels in the brain show up on an x-ray. If a tumor is
present, the x-ray may show the tumor or blood vessels
feeding the tumor.
9. Biopsy :- burr hole, stereotactic, open with decompression
10. CSF examination:- from ventricular drainage and shunt
insertion.
11. Neurologic exam: vision, hearing, alertness, muscle
strength, coordination and reflexes to look for swelling
caused by a tumor pressing on the nerve that connects the
eye and the brain.
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25. Differential Diagnosis
1. Vascular origin
Haematoma
Gient anureym
Arteriovenous
malformation
Infarction with
oedema
Venous thrombosis
2. Trauma
Haemotoma
Contusion
3. Infection
Abscess
Tuberculoma
Sarcoidosis
Encephalitis
4. cysts
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26. Management of Brain Tumours
Options: Surgery, radiation and chemotherapy
Consider;
1. Grade :- benign or malignant
2. Site:- how approachable
3. Type:- known with certainty and if so does it
lend itself to conservative.
4. Size of tumour
5. Age
6. Health of the patient
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27. Mgt of Brain Tumours cont`d
• If benign, should be excised if not
complicated.
• If edema, use dexamethasone with diuretics
e.g. mannitol
• Monitor with CT-scan
• Radiotherapy
• Burr hole or stereotactic biopsy
• Chemotherapy: difficult because of the BBB
e.g. Vincristine, Methotrexate
27

28. Mgt cont`d - Surgery
• Surgery is the usual first treatment for most brain
tumors.
• scalp is shaved.
• craniotomy is done
• an incision is made into the scalp, tumour
removed and the opening covered with a piece of
bone or with a piece of metal or fabric.
• Shunt is created to drain excess fluid
• Steroids may be given to reduce the swelling in
the brain.
• Antibiotics is given to control infection
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29. Mgt con`t - Radiation Therapy
• Radiation therapy kills brain tumor cells with high
energy x-rays, gamma rays, or protons.
• Radiation therapy usually follows surgery.
• The radiation kills tumor cells that may remain in the
area.
• Sometimes, people who can’t have surgery have
radiation therapy instead.
1. External radiation therapy:
• A large machine outside the body aims beams of
radiation at the head.
• Because cancer cells may invade normal tissue around
a tumor, the radiation may be aimed at the tumor and
nearby brain tissue, or at the entire brain. 29

30. Mgt- Radiation
2. Internal radiation therapy (implant radiation
therapy or brachytherapy): this is not
commonly used for treating brain tumors and
is under study.
• The radiation comes from radioactive material
usually contained in very small implants called
seeds.
• The seeds are placed inside the brain and give
off radiation for months.
• They are not removable once the radiation is
gone.
30

31. Mgt cont`d – Chemotherapy
• Chemotherapy, the use of drugs to kill cancer
cells,
• is sometimes used to treat brain tumors.
• Drugs may be given by mouth or vein
• Common side effects include nausea and
vomiting, loss of appetite, headache, fever
and chills and weakness.
31

32. Mgt cont`d – Chemotherapy
• Wafers that are put into the brain: For some
adults with high-grade glioma, several wafers are
implanted into the brain.
• Each wafer is about the size of a dime.
• Over several weeks, the wafers dissolve, releasing
the drug into the brain.
• The drug kills cancer cells.
• It may help prevent the tumor from returning in
the brain after surgery to remove the tumor.
32

33. Mgt cont`d - Urgent referrals
• Progressive subacute neurological deficit
developing over days to weeks (weakness,
Sensory loss, Ataxia, Dysphasia)
• New onset seizures
• Patient with vomiting, headache and
papilloedema
• Cranial nerve palsy (e.g. visual failure,
Diplopia, Unilateral, sensorineural deafness)
33

34. Urgent referral cont`d
• Patients with non-migranous headaches of
recent onset, that have been present for at
least one month, when accompanied by
features suggestive of raised ICP (patient
woken by headaches, drowsiness and
vomiting).
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35. Complications
• Increased ICP
• Hematoma
• Hypovolemic shock
• Hydrocephalus
• Atelectasis
• Pulmonary edema
• Meningitis
• Fluid and electrolyte imbalances (ADH)
35

36. Nursing management
1. Assessment
2. Nursing intervention
3. Pre and Post operative
Nursing care considerations
36

37. Common nursing problems presented
1. Ineffective Tissue
Perfusion
2. Ineffective Airway
Clearance
3. Impaired Communication
4. Decreased Intracranial
5. Adaptive Capacity
6. Activity Intolerance
7. Sensory disturbance
8. Acute Confusion
9. Risk for infection
10. Risk for injury: seizures
11. Pain (Acute)
12.Impaired cognitive
ability
13.Impaired physical
mobility
14. Altered nutrition: less
than body requirements
15. Urinary retention
16. Risk for constipation
17. Disturbed self-esteem
37

38. REFERENCES
• Bateman, H., Hillmore, R., Jackson, D,. Lusznat, S., McAdam, K. &
Regan, C. (2005). Dictionary of Medical Terms (4th ed.). London: A &
C Black publishers.
• International Classification of Diseases for Oncology (ICD-O). (2015).
International standard for the classification and nomenclature of
histologies (3rd ed.) . Retrieved on 10th October, 2015, from
http://www.healthcommunities.com/cancer-treatment-and-
care/cancer-staging.shtml.
• Jain, V. (2009). Tumours at Glance. New Delhi: Peepee Publishers
and Distributors.
• Kumar, V., Abass, K. A., Fausto, N. & Mitchell, C. J. (2007). Robins
and Cotran Pathology Basis of Diseases, (8th ed.). China: Saunders
Elesier.
• Kumar, V., Abbas, A. K., Fausto, N. & Mitchell, N. R. (2007). Robins
Basic Pathology (8th ed.). Philadelphia: Saunders Elsevier.
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