Brain tumor is one of the leading cause of mortality and morbidity among human beings. In this chapter, fundamental principles, concepts related to brain tumors and related management are explored. Nurses provide sensitive, supportive care to the patient and family.

1. Dr. Vishwanath S Biradar. Ph D N
Associate Professor & HOD Medical Surgical Nursing
MGM Mother Teresa College of Nursing, Aurangabad.

2. At the end of the session, students will be able to:
 understand incidence of tumor.
 enumerate causes of brain tumor.
 classify of brain tumor.
 understand pathophysiology of brain tumor.
 explain signs & symptoms brain tumor.
 enumerate diagnostic tests used in brain tumor.
 describe management of brain tumor.

3.  The diagnosis of brain tumor begins a journey of
uncertainty, fear and hope for patient and family.
 To care for the patient and family in a sensitive,
compassionate, hopeful and humanistic manner,
the health care professional needs a broad
knowledge base and particular skills.

4.  The Surveillance, Epidemiology, and End Results (SEER) program
projected 16500 new brain and other nervous system cancers for the year
2000 in the US.
 Incidence of brain and other nervous system cancers is second after
leukemia in children under the age of 15 years, third for those between 15
to 34 years and fourth for men between ages 35 and 54.
 Among children, the most common primary brain tumors are astrocytomas
(31%), medulloblastomas (21% - 25%) & ependymomas (9%-19%).
 Metastasis to the brain is found in 10% to 15% of cancer patients, which
totals 80000 annually.

5.  Unknown.
 Inherited genetic syndromes.
 Environmental agents.
 Ionizing radiation.
 Other carcinogens.

6. I. WHO Classification
 Tumors of neuroepithelial tissue
 Tumors of cranial and spinal nerves
 Tumors of meninges
 Hematopoietic neoplasms
 Germ cell tumors
 Cysts and tumor like lesions
 Tumors of the anterior pituitary
 Local extensions from regional tumors
 Metastatic tumors

7. II. Based on cell & tissue involvement – Major brain tumors
 Astrocytic tumors
 Astrocytoma
 Glioblastoma
 Ependymomal tumors (ependymoma)
 Oligodendroglioma
 Medulloblastoma
 Unclassified (Mostly gliomas)
 Meningiomas
 Pituitary adenoma
 Neurinoma (Schawannoma, acoustic neuroma)
 Angiomas
 Sarcomas
 Miscellaneous (Chordoma, granuloma, lymphoma)

8. Multiple,
specific
structural
molecular
genetic
alterations
(Mutation)
Inappropriate
cell
proliferation
Activation of
protooncogenes
(Enhances
proliferation)
Space
occupying
lesion
Compression
of cerebral
tissue
Neurological
deficits (based
on location,
rate of growth
& level of
increased ICP)
Activation of
Tumor Supressor
gene (Complete
cessation or
partial decrease in
cellular activities)

9. General Signs & Symptoms
 Headache – 1/3rd Patients experience
 Intermittent & moderately severe
 Usually worse in morning
 Aggravated by increased ICP – coughing, straining
 Nausea & Vomiting
 Change in the level of consciousness (LOC)
 Seizures

11.  Focal signs & symptoms
 Frontal lobe
 Cognitive, executive, behavioural, speech &
motor deficit.
 Parietal lobe
 Sensory changes – Hypo or hyperathesia,
Paresthesia, Loss of two point discrimination
 Recognition deficits -
 Inability to recognise numbers, letters
 Astereognosis
 Autotopagnosia
 Anosognosia
 Finger agnosia
 Orientation deficits
 Loss of right – left discrimination
 Neglect syndrome
 Construction apraxia
 Temporal lobe
 Psychomotor seizures
 Weakness
 Memory deficits
 Speech and language deficits

12.  Occipital lobe
 Visual field defects
 Visual hallucinations
 Pituitary & hypothalmus region
 Visual field deficits
 Headache
 Endocrine dysfunction
 Hypothalamus – affect fat, carbohydrate
metabolism, water balance, sleep patterns,
appetite, sexual drive.
 Lateral third ventricles
 Obstruct flow of CSF – vomiting, headache
 Brain stem – Lower cranial nerve deficits –
dysphagia, nystagmus, ataxia, incoordination,
nausea, vomiting, respiratory or cardiac arrest.
 Midbrain (rare) – abnormal posture, ptosis
 Fourth ventricle – Obstruct flow of CSF,
headache, vomiting, nuchal rigidity.
 Cerebellum – Cerebellar signs – ataxia,
incoordination, nystagmus, vertigo
 Associated Signs – Papilledema, increased ICP

13.  History & neurological examination
 CT, MRI
 CT guided biopsy (Biopsy is not
recommended for vascular tumors &
brainstem tumors because fear of precipitating
hemorrhage or respiratory distress)

14. Fig. MRI scan of brain tumor

15.  General drug therapy
 Surgery
 Radiation
 Chemotherapy
 Nursing

16. General drug therapy
 Corticosteroids (Dexamethasone, prednisone or
methylprednisolone)
 H2 blocker (Famotidine)
 Anticonvulsant drugs (Phenytoin, carbamazepine, phenobarbital)
Surgery
 Surgical removal or “debulking”
 Craniotomy

17. Radiotherapy
 Destroy tumor cells.
 Radiation dose ranges from 4 to 6 Gy in daily fractions of 150 -200
cGy and is administered over 4 – 8 wks.
 Stereotactic radiotherapy
 Interstitial brachytherapy
 Temporary
 Permanent

18. Chemotherapy
 Alkalytaing agents – Nitrosureas
 Synthetic alkalytic agent – Carmustine, Lomustine
 Cisplatin (Platinol)
 Synthetic antineoplastic agent – Procarbazine hydrochloride
 Etoposide
 Plant alkaloid – Vincristine

19. Nursing diagnoses related to emotional needs of patient and family
 Fear
 Anxiety
 Personal identity disturbance’Grief
 Change in role performance
 Social isolation
 Impaired family processes
 Impaired adjustment
 Ineffective individual and family coping

20.  Ineffective cerebral tissue perfusion related to cerebral edema.
 Imbalanced nutritional status less than body requirements related to
nausea, vomiting.
 Discomfort: acute nausea/vomiting related to chemotherapy.
 Body image disturbance related to hair loss.
 Anxiety related to approaching treatment.
 Knowledge deficit regarding disease, treatment, discharge, follow up.
 Risk for infection related to bone marrow depression.
 Risk for injury related to thrombocytopenia.
 Risk for impaired skin integrity related to radiation induced dermatitis.

21. Nursing management for the patient with
brain tumor spans a wide variety of
circumstances, situations and treatment
modalities.

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 Greenlee RT. Murphy T. Bolden S. Wingo PA. Cancer
Statistics.2000.CA: Cancer Journal for clinicals.50.7-33.
 Sugar SM. Israel MA. Tumors of the nervous system. Harrison’s
principles of internal medicine. New york: McGraw-Hill.14 edition.
P 2398.