Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Neurology Module:Neurology Module:

Brain Tumour.Brain Tumour.

RadiotherapyRadiotherapy

Brain Tumour: DescriptionBrain Tumour: Description

A brain tumour is a localised space-A brain tumour is a localised space-occupying lesion increasing pressure occupying lesion increasing pressure within the cranium: (ICP)within the cranium: (ICP)It may be:It may be:A defined spherical mass A defined spherical mass Widespread infiltration of cerebral tissueWidespread infiltration of cerebral tissueBenignBenignMalignantMalignantPrimary or metastaticPrimary or metastatic

BrainTumour: AetiologyBrainTumour: Aetiology

Unknown aetiologyUnknown aetiology

Genetic pre-dispositionGenetic pre-disposition

Environmental pollution:Environmental pollution:

Radiation (Chernobyl nuclear disaster)Radiation (Chernobyl nuclear disaster)

Electric Pylons have been implicatedElectric Pylons have been implicated

Brain Tumour: Brain Tumour: Classification/ MorphologyClassification/ Morphology

Intracerebral gliomas (malignant: 45% of all Intracerebral gliomas (malignant: 45% of all brain tumours)brain tumours)

Tumours of specific structures(15%: usually Tumours of specific structures(15%: usually benign)benign)

Developmental tumours (20-30%: benign)Developmental tumours (20-30%: benign)

Metastases (10%: malignant)Metastases (10%: malignant)

Brain Tumour: Brain Tumour: Intracerebral GliomaIntracerebral Glioma

Malignant and infiltrates neural tissue Malignant and infiltrates neural tissue therefore difficult to remove:therefore difficult to remove:

Astrocytoma (grade I, II)Astrocytoma (grade I, II)

Glioblastoma multiforme (Astrocytoma Glioblastoma multiforme (Astrocytoma grade III, IV) grade III, IV)

OligodendrocytomaOligodendrocytoma

EpendymomaEpendymoma

MedulloblastomaMedulloblastoma

Brain Tumour:Brain Tumour:Tumours of Specific StructuresTumours of Specific Structures

Usually benignUsually benign

Meningioma (meninges)Meningioma (meninges)

Neuroma (nerves): accoustic neuroma, Neuroma (nerves): accoustic neuroma, auditory nerveauditory nerve

Adenoma (glands): pituitary adenoma Adenoma (glands): pituitary adenoma

Brain Tumour: Brain Tumour: Developmental TumoursDevelopmental Tumours

Benign remnants/ anomalies of embryonic Benign remnants/ anomalies of embryonic development:development:

Angiomas (blood vessels)Angiomas (blood vessels)

DermoidDermoid

EpidermoidEpidermoid

TeromaTeroma

CraniopharyngiomaCraniopharyngioma

Brain Tumour: MetastasesBrain Tumour: Metastases

Always malignantAlways malignant

Seeded from a primary malignant tumour Seeded from a primary malignant tumour in another part of the bodyin another part of the body

Treatment (radiotherapy, maybe also with Treatment (radiotherapy, maybe also with chemotherapy) is chemotherapy) is palliative,palliative, to relieve pain to relieve pain or symptoms associated with ↑ ICPor symptoms associated with ↑ ICP

Brain Tumour: Brain Tumour: Clinical ManifestationsClinical Manifestations

Space-occupyingSpace-occupying lesionlesion (↑ ICP). Leads to: (↑ ICP). Leads to:

Headache especially early morning, worse Headache especially early morning, worse with coughing or strainingwith coughing or straining

Projectile vomiting (without nausea)Projectile vomiting (without nausea)

Diploplia, visual disturbance, papilloedemaDiploplia, visual disturbance, papilloedema

Brain Tumour: Brain Tumour: Localised Clinical ManifestationsLocalised Clinical Manifestations

Sensory/ motor impairment:Sensory/ motor impairment:

Motor cortex tumour: seizures (Jacksonian Motor cortex tumour: seizures (Jacksonian epilepsy)epilepsy)

Cerebellar: ataxia, dizziness, nystagmusCerebellar: ataxia, dizziness, nystagmus

Frontal: Personality disorder, depressionFrontal: Personality disorder, depression

Brain Tumour: DiagnosisBrain Tumour: Diagnosis

Patient history and clinical picturePatient history and clinical picture

Papilloedema: (cerebral oedema) seen in Papilloedema: (cerebral oedema) seen in the fundus of the eye by ophthalmoscopethe fundus of the eye by ophthalmoscope

CT scanCT scan

MRIMRI

Electro-encephalogram (EEG) locates Electro-encephalogram (EEG) locates region affectedregion affected

Lumbar Puncture/ CSF for cytologyLumbar Puncture/ CSF for cytology

Brain Tumour: Brain Tumour: Medical ManagementMedical Management

SurgerySurgery

**RadiotherapyRadiotherapy: the corner-stone of treatment: : the corner-stone of treatment: pre/post-surgery or if inoperable. Reduces pre/post-surgery or if inoperable. Reduces tumour sizetumour size

Chemotherapy may complement Chemotherapy may complement radiotherapy, including intra-thecal doses radiotherapy, including intra-thecal doses

Brain Tumour: Surgery Brain Tumour: Surgery

Craniotomy to remove tumour if possible. Craniotomy to remove tumour if possible. While astrocytoma cannot be completely While astrocytoma cannot be completely removed, surgery will:-removed, surgery will:-↓ ↓ Intra-cranial pressure (ICP)Intra-cranial pressure (ICP)↓ ↓ tumour size for radiation/ chemotherapytumour size for radiation/ chemotherapy

Trans-sphenoidal excision: (pituitary Trans-sphenoidal excision: (pituitary adenoma)adenoma)Gamma knife: radio-surgery (precise “brain-Gamma knife: radio-surgery (precise “brain-mapping” and multiple beams) mapping” and multiple beams)

Brain Tumour: Brain Tumour: Nursing ConsiderationsNursing Considerations

Emotional/psychological support of the patient Emotional/psychological support of the patient and familyand family

Ensure awareness of aspects of safetyEnsure awareness of aspects of safety

Orientation to time, place, personOrientation to time, place, person

ICU: head elevated post-surgery ICU: head elevated post-surgery

Neurological assessment (Glasgow Coma Neurological assessment (Glasgow Coma Scale): motor function, sensation, speechScale): motor function, sensation, speech

Watch for signs of ↑ ICP; also disordered fluid Watch for signs of ↑ ICP; also disordered fluid balance (if posterior pituitary affected)balance (if posterior pituitary affected)

MedicationsMedications

Dexamethasone (reduces cerebral Dexamethasone (reduces cerebral oedema)oedema)

Epanutin (anti-convulsive)Epanutin (anti-convulsive)

Post-craniotomy, additional drugs are:Post-craniotomy, additional drugs are:

Analgesia Analgesia

AntibioticsAntibiotics

Mannitol as a diuretic to reduce oedemaMannitol as a diuretic to reduce oedema

Notes on RadiotherapyNotes on Radiotherapy

Usually daily session for several weeksUsually daily session for several weeks

Advise to keep the marked area dryAdvise to keep the marked area dry

Advise about effect on bone marrow Advise about effect on bone marrow function (regular blood count) function (regular blood count)

Patient will experience fatigue/ must restPatient will experience fatigue/ must rest

Should see physician if extreme fatigue, Should see physician if extreme fatigue, any infection, bruisingany infection, bruising

Reasonable isolation at homeReasonable isolation at home