nursingcare

2. We classify primary brain tumors by type and
the World Health Organization (WHO) grade
• Types of primary tumors are classified by the cell from which they
originate. A glioma, for instance (which is the focus of this
discussion) is a common type of primary brain tumor.
Originating from specialized cells of the central nervous system called
astrocytes or oligodendrocytes, this type of brain tumor is called
astrocytomas or oligodendrogliomas.

3. • Grading of primary brain tumors helps distinguish their clinical
behavior and provide insight with regards to tumor growth,
recurrence and prognosis.
• With regards to gliomas, a WHO Grade 1 tumor is the most benign
and referred to as pilocytic astrocytoma. These are more commonly
encountered in children.

4. • Grade 2 gliomas are often referred to as “infiltrative glioma” or “low-
grade gliomas” (LGGs) given their slow, infiltrative growth patterns.
• Grades 3 and 4, anaplastic glioma and glioblastoma, or glioblastoma
multiforme (GBM), respectively are considered “high-grade gliomas"
(HGGs) because they behave more aggressively with a faster growth
rate and are considered malignant, or cancerous. High grade gliomas
can arise from low grade gliomas, or may be what's called “de novo”
(meaning they arise primarily as a high grade tumor) and have
specific mutations related to each.

5. What are symptoms of primary brain tumors?
• Symptoms of brain tumors depend on several factors, including the
location and size of the tumor. For instance, if a tumor is situated near
the motor part of the brain, the patient may experience weakness on
one side of the body. If the tumor is near the speech area, the
symptoms may include difficulty speaking or understanding language

6. • Even small brain tumors can influence brain function in the region
where they have grown, depending on the function of the brain the
tumor involves. Primary brain tumors can also cause seizures,
headaches, nausea, and vomiting.
•

7. How is a brain tumor diagnosed
• There are no regular screenings for brain tumors (unlike cancers of
the prostate or colon). Therefore most brain tumors are diagnosed in
patients who already have symptoms or signs of growth; less
commonly, brain tumors are found by chance after a head trauma.
• Doctors often diagnose primary brain tumors by performing a
computerized tomography (CT) scan or magnetic resonance imaging
(MRI).

8. • A full medical exam is also performed and a detailed medical history
is taken in order to help our doctors plan the best course of
management. Sometimes, as is the case with brain tumors near
“eloquent” parts of the brain with important function (i.e. speech and
motor areas), a more specialized MRI allows us to better understand
the relationship between the tumor and the function in the brain.
This can be invaluable for surgical planning.
•

9. How do we treat a low-grade (Grade 1 to 2) tumor?
Most brain tum
• Most brain tumors occur sporadically, or by chance without a specific
cause. Some can be associated with syndromes, but this typically
involves people who already have multiple and different types of
tumors.
• Nonetheless, primary brain tumors have specific underlying genetic
mutations and Yale researchers are world renowned for
understanding these abnormalities. By screening a tumor’s entire
genetic code, we can better decide on therapy and personalize it to
each individual. While standard of care (i.e. proven treatment) for
primary brain tumors is used in all patients at Yale Medicine, exciting
clinical trials are also available, giving the best chance for a successful
outcome.

10. • While people may be concerned about environmental risk factors for
brain tumors, there is currently not enough evidence to support a link
between cell phone radiation and brain cancer, for instance,” says Yale
Medicine neurosurgeon Jennifer Moliterno, MD.

11. How do you treat a high-grade (Grade 3 to 4) tumor
• Most brain tumors occur sporadically, or by chance without a specific
cause. Some can be associated with syndromes, but this typically
involves people who already have multiple and different types of
tumors.
• Nonetheless, primary brain tumors have specific underlying genetic
mutations and Yale researchers are world renowned for
understanding these abnormalities. By screening a tumor’s entire
genetic code, we can better decide on therapy and personalize it to
each individual. While standard of care (i.e. proven treatment) for
primary brain tumors is used in all patients at Yale Medicine, exciting
clinical trials are also available, giving the best chance for a successful
outcome.

12. • While people may be concerned about environmental risk factors for
brain tumors, there is currently not enough evidence to support a link
between cell phone radiation and brain cancer, for instance,” says Yale
Medicine neurosurgeon Jennifer Moliterno, MD.

13. How do you treat a high-grade (Grade 3 to 4) tumor
• At Yale Medicine, we treat every and any type of brain tumor in every
and any patient," says Dr. Moliterno. Each patient is evaluated quickly
and thoroughly. All cases are presented at our multidisciplinary tumor
board, where a team of brain tumor specialists (neurosurgeons,
neurologists, radiation specialists, pathologists, radiologists, etc) work
collaboratively to develop a treatment plan that provides the best
possible care and also takes into consideration the patient's wishes.
•

14. • Most brain tumors are treated surgically, often using stereotactic
image-guided biopsy for diagnosis and/or microsurgical resection (i.e.
removal of as much tumor as safely possible). Surgical removal can
help control or improve a patient’s symptoms. "Various factors
dictate which approach is taken, but it is our practice to try to be as
aggressive as possible because the amount of tumor removed
correlates with patient outcome, by which I mean, the more tumor
removed, the better outcome," explains Dr. Moliterno.

15. What happens after surgery
• Most patients with primary brain tumors, such as gliomas, will require
some additional therapy such as radiation and/or chemotherapy. “I
tell patients our reason for being as aggressive as we can with surgery
is because the less tumor in the brain for the chemotherapy and
radiation to work on, the better outcome for the patient,” says Dr.
Moliterno

17. What is a brain tumor
• brain tumor is a collection, or mass, of abnormal cells in your brain.
Your skull, which encloses your brain, is very rigid. Any growth inside
such a restricted space can cause problems.
• Brain tumors can be cancerous (malignant) or noncancerous (benign).
When benign or malignant tumors grow, they can cause the pressure
inside your skull to increase. This can cause brain damage, and it can
be life-threatening.
•

18. Brain tumors are categorized as primary or
secondary:
• A primary brain tumor originates in your brain. Many primary brain
tumors are benign.
• A secondary brain tumor, also known as a metastatic brain tumor,
occurs when cancer cells spreadTrusted Source to your brain from
another organ, such as your lung or breast

19. Benign vs. malignant brain tumors
• Though benign brain tumors can cause many serious issues, they are
not cancerous, meaning that they grow slowly and don’t typically
spread to other tissues.
• They also usually have more clearly defined borders, making them
easier to remove surgically, and they don’t usually come back after
removal.
• On the other hand, malignant brain tumors are cancerous, grow
rapidly, and can spread to other parts of your brain or central nervous
system, which can cause life-threatening complications.
•

20. Types of brain tumors
• Primary brain tumors
• Primary brain tumors originate in your brain. They can developTrusted
Source from your:
• brain cells
• the membranes that surround your brain, which are called meninges
• nerve cells
• glands, such as the pituitary of pineal
• Primary tumors can be benign or cancerous. In adults, the most common types of
brain tumors are gliomas and meningiomas.
•

21. Gliomas
• Gliomas are tumors that develop from glial cells. These cells normally:
• support the structure of your central nervous system
• provide nutrition to your central nervous system
• clean cellular waste
• break down dead neurons
• Gliomas can develop from different types of glial cells

22. • The types of tumors that begin in glial cells includeTrusted Source:
• astrocytic tumors, such as astrocytomas, which originate in the
cerebrum
• oligodendroglial tumors, which are often found in the frontal
temporal lobes
• glioblastomas, which originate in the supportive brain tissue and are
the most aggressive type
•

23. Other primary brain tumors
• Other primary brain tumors includeTrusted Source:
• pituitary tumors, which are usually benign
• pineal gland tumors, which can be benign or malignant
• ependymomas, which are usually benign
• craniopharyngiomas, which occur mostly in children and are benign but
can have clinical symptoms like changes in vision and premature puberty
• primary central nervous system (CNS) lymphomas, which are malignant
• primary germ cell tumors of the brain, which can be benign or malignant
• meningiomas, which originate in the meninges

24. • schwannomas, which originate in cells that produce the protective cover of
your nerves (myelin sheath) called Schwann cells
• Meningiomas are diagnosedTrusted Source more often in women than
men, according to a study that grouped participants into men and women.
• Schwannomas occurTrusted SourceTrusted Source
• PubMed Central
• Highly respected database from the National Institutes of Health
• Go to source
• equally in both men and women. These tumors are usually benign, but
they can cause complications because of their size and location. Cancerous
meningiomas and schwannomas are rare but can be very aggressive.

25. Secondary brain tumors
• Secondary brain tumors make up the majority of brain cancers. They
start in one part of the body and spread, or metastasize, to the brain.
The following can metastasizeTrusted Source to the brain:
• lung cancer
• breast cancer
• kidney cancer
• skin cancer
• Secondary brain tumors are always malignant. Benign tumors don’t
spread from one part of your body to another.

26. What are the risk factors for a brain tumor
• Risk factors for brain tumors includeTrusted Source:
• Family history
• Only about 5 to 10 percentTrusted Source of all cancers are
genetically inherited, or hereditary. It’s rare for a brain tumor to be
genetically inherited. Talk with your doctor if several people in your
family have received a brain tumor diagnosis. Your doctor can
recommend a genetic counselor for you.
• Age
• The risk for most types of brain tumors increases with age.

27. • Chemical exposure
• Being exposed to certain chemicals, such as those you might find in a work
environment, can increase your risk for brain cancer. The National Institute for
Occupational Safety and Health keeps a list of potentially cancer-causing
chemicals found in workplaces.
• Exposure to radiation
• People who have been exposed to ionizing radiation have an increased risk of
brain tumors. You can be exposed to ionizing radiation through high-radiation
cancer therapies. You can also be exposed to radiation from nuclear fallout.
• The nuclear power plant incidents in Fukushima and Chernobyl are examples of
how people can be exposed to ionizing radiation.
•

28. • No history of chickenpox
• According toa 2016 review published in Cancer Medicine, having a
history of childhood chickenpox is associated with a 21
percentTrusted Source lower risk of developing glioma

29. What are the symptoms of a brain tumor
• Symptoms of brain tumors depend on the location and size of the
tumor. Some tumors cause direct damage by invading brain tissue
and some tumors cause pressure on the surrounding brain.
• You’ll have noticeable symptoms when a growing tumor is putting
pressure on your brain tissue.
• Headaches are a common symptom of a brain tumor. You may
experience headaches that:
• are worse in the morning when waking up
• occur while you’re sleeping
• are made worse by coughing, sneezing, or exercise

30. • You may also experience:
• vomiting
• blurred vision or double vision
• confusion
• seizures (especially in adults)
• weakness of a limb or part of the face
• a change in mental functioning
•

31. • Other common symptoms include:
• clumsiness
• memory loss
• confusion
• difficulty writing or reading
• changes in the ability to hear, taste, or smell
• decreased alertness, which may include drowsiness and loss of consciousness
• difficulty swallowing
• dizziness or vertigo
• eye problems, such as drooping eyelids and unequal pupils
• uncontrollable movements
•

32. • ther common symptoms include:
• clumsiness
• memory loss
• confusion
• difficulty writing or reading
• changes in the ability to hear, taste, or smell
• decreased alertness, which may include drowsiness and loss of consciousness
• difficulty swallowing
• dizziness or vertigo
• eye problems, such as drooping eyelids and unequal pupils
• uncontrollable movements
• hand tremors
• loss of balance
• loss of bladder or bowel control
• numbness or tingling on one side of the body
• trouble speaking or understanding what others are saying
• changes in mood, personality, emotions, and behavior
• difficulty walking
• muscle weakness in the face, arm, or leg

33. • Symptoms of pituitary tumors
• The following symptoms can occur with pituitary tumors:
• nipple discharge, or galactorrhea
• lack of menstruation in women
• development of breast tissue in men, or gynecomastia
• enlargement of the hands and feet
• sensitivity to heat or cold
• increased amounts of body hair, or hirsutism
• low blood pressure
• obesity
• changes in vision, such as blurry vision or tunnel vision

34. • How are brain tumors diagnosed?
• Diagnosis of a brain tumor begins with a physical exam and a look at your
medical history.
• The physical exam includes a very detailed neurological examination. Your
doctor will conduct a test to see if your cranial nerves are intact. These are
the nerves that originate in your brain.
• Your doctor will look inside your eyes with an ophthalmoscope, which is an
instrument that shines a light through your pupils and onto your retinas.
•

35. • This allows your doctor to check how your pupils react to light. It also
allows your doctor to look directly into your eyes to see if there’s any
swelling of the optic nerve. When pressure increases inside the skull,
changes in the optic nerve can occur.
• The doctor may also evaluate your:
• muscle strength
• coordination
• memory
• ability to do mathematical calculations
• Your doctor may order more tests after they finish the physical exam. These
could include:

36. • CT scan of the head
• CT scans are ways for your doctor to get a more detailed scan of your body than they
could with an X-ray machine. This can be done with or without contrast.
• Contrast is achieved in a CT scan of the head by using a special dye that helps doctors see
some structures, like blood vessels, more clearly.
• MRI of the head
• If you have an MRI of your head, a special dye can be used to help your doctor detect
tumors. An MRI is different from a CT scan because it doesn’t use radiation, and it
generally provides much more detailed pictures of the structures of the brain itself.
• Angiography
• This study uses a dye that’s injected into your artery, usually in the groin area. The dye
travels to the arteries in your brain. It allows your doctor to see what the blood supply of
the tumors looks like. This information is useful at the time of surgery.

37. • Skull X-rays
• Brain tumors can cause breaks or fractures in the bones of the skull, and
specific X-rays can show if this has occurred. These X-rays can also pick up
calcium deposits, which are sometimes contained within a tumor. Calcium
deposits may be in your bloodstream if your cancer has moved to your
bones.
• Biopsy
• A small piece of the tumor is obtained during a biopsy. A specialist called a
neuropathologist will examine it. The biopsy will identify if the tumor cells
are benign or malignant. It will also determine whether the cancer
originated in your brain or another part of your body

38. Treatment of brain tumors
• The treatment of a brain tumor depends on:
• the type of tumor
• the size of the tumor
• the location of the tumor
• your general health
• The most common treatment for malignant brain tumors is surgery. The
goal is to remove as much of the cancer as possible without causing
damage to the healthy parts of the brain.
• While the location of some tumors allows for safe removal, other tumors
may be located in an area that limits how much of the tumor can be
removed. Even partial removal of brain cancer can be beneficial.

39. • Risks of brain surgery include infection and bleeding. Clinically
dangerous benign tumors are also surgically removed. Metastatic
brain tumors are treated according to guidelines for the type of
original cancer.
• Surgery can be combined with other treatments, such as radiation
therapy and chemotherapy.
• Physical therapy, occupational therapy, and speech therapy can help
you recover after neurosurgery.