BRAIN TUMOR

Canosa, Shyrene
Cantos, Olivia
Capuno, Cherilyn

WILM’S TUMOR
Carag, Allison Mae
Caraos, Emma Llyne
BRAIN TUMOR
 localized intracranial lesion that occupies space within the skull
 usually grows as a spherical mass but can also grow diffusely and infiltrate tissue

PHYSIOLOGIC CHANGES RESULTS TO THE FF. PATHOPHYSIOLOGIC EVENTS

 increased ICP and cerebral edema
 seizure activity and focal neurologic signs
 Hydrocephalus
 Altered pituitary function

PRIMARY BRAIN TUMORS- originate from cells and structures within the brain
SECONDARY BRAIN TUMORS- develop from structures outside the brain and occur in
10% to 20% of patients with cancer; more common

TUMOR GRADING
 Grade I-cells differ slightly from normal cells and are well differentiated (mild
dysplasia)
 Grade II-cells are more abnormal and are moderately differentiated (moderate
dysplasia)
 Grade III-cells are very abnormal and are poorly differentiated(severe dysplasia)
 Grade IV-cells are very immature (anaplasia) and undifferentiated; cell of origin is
difficult to determine

Known risk factor in Primary Brain Tumor

• Exposure to ionizing radiation
Additional Possible Causes
• Use of cellular telephone
• Exposure to increase tension wires
• Use of hair dyes
• Head trauma
• Dietary exposure to such factors as nitrates
Highest Incidence
• 5th, 6th, 7th decades
• Slightly in male
Most brain tumors originate
• Glial cells (cells that make up the structure & support system of the brain and
spinal cord.
• Supratentorial (above the covering of cerebellum)

CLASSIFICATION OF PRIMARY BRAIN TUMORS IN ADULT

I. INTRACEREBRAL TUMORS
A. Glioma
1. Astrocytomas (Grade I and II)
2. Glioblastoma multiforme(Astrocytoma grade III and IV)
3. Oligodendrocytoma (low &high grades)
4. Ependymoma (Grade I and IV)
5. Medulloblastoma
II. TUMORS ARISING FROM SUPPORTING STRUCTURES
 A. Meningiomas
B. Neuromas (acoustic)
C. Pituitary Adenomas
III.DEVELOPMENTAL TUMORS
A. Angiomas
B. Dermoid, Epidermoid, teroma. Craniopharyngioma
IV. METASTATIC LESIONS

CLINICAL MANIFESTATIONS:
• Increased ICP
• Headache
• Vomiting
• Visual disturbances

LOCALIZED SYMPTOMS:
• Hemiparesis
• Seizures
• Mental status changes

MOTOR CORTEX TUMOR

 Jacksonian seizures

OCCIPITAL LOBE TUMOR

 Contralateral homonymous hemianopsia
 Visual disturbances

CEREBELLAR TUMOR
 Dizziness
 Ataxic or staggering gait
 Marked muscle incoordination
 nystagmus

FRONTAL LOBE TUMOR

 Personality disorders
 Changes in emotional state and behavior
 Apathetic mental attitude

CEREBELLOPONTINE ANGEL TUMOR

 Tinnitus and vertigo
 Progressive ear deafness
 Numbness and tingling of the face and tongue
 Weakness or paralysis of face
 Abnormalities in motor function

DIAGNOSTIC EXAMINATION
• CT SCAN (COMPUTERIZED TOMOGRAPHY) - creates detailed images of various
cross-sections of tissues and bony structures, which can help identify the tumor’s
location and can sometimes help determine the tumor’s type. CT scans can also
detect swelling, bleeding, or other conditions associated with the tumor.
• MAGNETIC RESONANCE IMAGING (MRI) - produces highly detailed images from
different angles and often make it easier to identify abnormal tissue, especially when
tumors are located near bone.
• PET - measures the consumption rate of the sugar substance in different parts of the
brain. This is helpful in detecting recurrent tumor growth, and may help distinguish the
grade of malignancy in an existing tumor.
• X-RAYS- may be used to determine the condition of the skull and the effect of the
tumor on bony structures.
• BONE SCAN-also known as nuclear imaging, are used to detect areas of unusual
activity in the bones using low levels of radioactive elements.
• LUMBAR PUNCTURE
A lumbar puncture, or spinal tap, may be used to obtain a sample of cerebrospinal
fluid to look for substances that indicate the presence of a tumor.
• EVOKED POTENTIAL STUDIES
Evoked potential testing involves stimulating the nerves using an electrical impulse.
The transmission of that impulse along the spinal cord to the brain is then monitored
via electrodes on the scalp.
• ENDOCRINE EVALUATION
Samples of blood and urine may be taken during the diagnostic process to measure
hormone levels. This can help in diagnosing pituitary tumors.
• EEG
An electroencephalogram (EEG) is a test that measures the electrical activity of the
brain and looks for abnormalities
• BRAIN TUMOR BIOPSY
After preliminary diagnostic tests are done, the exact diagnosis for a brain tumor is
usually obtained through a biopsy, a surgical procedure in which the surgeon gathers
a sample of the tumor. The tumor tissue and cells are then examined under a
microscope.

MEDICAL MANAGEMENT
• Chemotherapy
• External-brain radiation therapy
• RADIATION THERAPY – cornerstone of treatment
-decreases the incidence of recurrence of incompletely resected tumors
• BRACHYTHERAPY – surgical implantation of radiation sources to deliver high doses
at a short distance
-has had promising results for primary malignancies
-usually used as an adjunct to conventional radiation therapy or as a rescue
measure for recurrent disease.
• INTRAVENOUS AUTOLOGOUS BONE MARROW TRANSPLANTATION
-used in some patients who will receive chemotherapy or radiation therapy, because
it can “rescue” the patient from the bone marrow toxicity associated with high
dosage of chemotherapy and radiation.
-A fraction of patient’s bone marrow is aspirated, usually from the iliac crest, and
stored. The patient receives large doses of chemotherapy or radiation therapy to
destroy large numbers of malignant cells. The marrow is then reinfused
intravenously after treatment is completed.
• CORTICOSTEROIDS - may be used before and after treatment to reduce cerebral
edema and promote smoother and more rapid recovery.
• GENE TRANSFER THERAPY - uses retroviral vectors to carry genes to the tumor,
reprogramming the tumor tissue for susceptibility for treatment.
• PHOTODYNAMIC THERAPY - treatment of primary malignant brain tumors that
delivers targeted photodynamic therapy while conserving healthy brain tissue.
SURGICAL MANAGEMENT
1. Craniotomy- a surgical operation in which a bone flap is (temporarily) removed
from the skull, to access the brain.
- performed under general anesthesia but can be also done with the patient
awake using a local anaesthetic.
2. Stereotactic radiosurgery- is a minimally invasive form of surgical intervention
which makes use of a three-dimensional coordinates by system to locate small
targets inside the body and to perform on them some action such
as ablation (removal), biopsy, lesion, injection, stimulation or implantation.

NURSING INTERVENTIONS
*pre-operative nursing management*
 Instruct patient and family about the necessity and importance of diagnostic tests
to determine the exact location of the tumor.
 Monitor and record vital signs and neurological status accurately q2-4h, or as
ordered. Report changes to professional nurse immediately.
 Institute measures to prevent inadvertent increases in intracranial pressure.
 Elevate head of bed 30º.
 Stool softeners to prevent straining at stool (which increases intracranial
pressure).
 Institute seizure precautions at patient's bedside.
 Supportive nursing care is given depending upon the patient's symptoms
and ability to perform activities of daily living.
 Administer all doses of steroids and antiepileptic agents on time.
 Withholding steroids can result in adrenal crisis.
 Withholding of antiepileptic agents frequently precipitates seizure.
 Surgery (craniotomy) is performed to remove neoplasm and alleviate
symptoms.

*post operative nursing Management*

 Meticulous nursing management and care aimed at prevention of postoperative
complications are imperative for the patient's survival.
 Accurately monitor and record all vital signs and neurological signs.
 Postoperative cerebral edema peaks between 48 and 60 hours following
surgery.
 (b) Patient may be lucid during first 24 hours, then experience a decrease
in level of consciousness during this time.
 Administer artificial tears (eye drops) as ordered, to prevent corneal
ulceration in the comatose patient.
 Maintain skin integrity.
 Bone flap may not have been replaced over surgical site; turning patient to the
affected side, if the flap has been removed, can cause irreversible damage in the
first 72 hours.
 Maintain head of bed at 30ºelevation.
 Perform passive range of motion exercises to all extremities every 2-4 hours.
 Maintain body temperature.
  Increases of body temperature in the neurosurgical patient may be due to
cerebral edema around the hypothalamus.
 Monitor rectal temperature frequently.
 Place patient on hypothermia blanket, as ordered.
 Institute seizure precautions at patient's bedside. (Tongue blade, airway.)
 Maintain accurate record of intake and output.
 Prevent pulmonary complications associated with bedrest.
 Cough and deep breath every 2 hours.
 Perform gentle chest percussion, with the patient in the lateral decubitus
position, if tolerated.
 Continuously talk to the patient while providing care, reorienting him to
person, place, and time.

WILM’S TUMOR
 Or Nephroblastoma
 Is a tumor of the kidney that may present unilaterally and localized or bilaterally,
sometimes with metastasis to other organs
 the peak incidence is at 3 years of age
 Occurrence is associated with genetic inheritance, and several congenital
anomalies
 Accounts for 20% of solid tumors in childhood
 No increased incidence based on race/sex
 Usually discovered early in life, 6 months to 5 years (peaks at 3-4 years)
 Some children with disorder have a deletion of chromosome 11

ASSESSMENT
1. A firm, non-tender mass in the upper quadrant of the abdomen is usually the
presenting sign. It may be on either side.
2. Abdominal pain which is related to rapid growth of the tumor.
3. As the tumor enlarges, pressure may cause constipation, vomiting, abdominal
distress, anorexia, weight loss and dyspnea.
4. Less common manifestation are hypertension, fever, hematuria, and anemia.
5. Associated anomalies includes aniridia (absence of the iris), hemihypertrophy of
the vertebrae, and genitourinary anomalies.

DIAGNOSTIC EVALUATION
1. Abdominal untrasound detects the tumor and assesses the status of the opposite
kidney.
2. Chest X-ray and CT scan may be done to identify matastasis.
3. MRI or CT scan of the abdomen may be done to evaluate local spread to lymph
nodes.
4. Urine specimens show hematuria; no increase in vanillylmandelic acid and
homovanillic acid levels as occurs with neuroblastoma.
5. Complete blood count, blood chemistries, especially serum electrolytes, uric acid,
renal function tests, and liver functions tests, are done for baseline measurement
and to detect metastasis

GOAL OF MANAGEMENT
 - Is to eradicate the tumor before metastasis occur

SURGICAL MANAGEMENT
 RADICAL NEPHRECTOMY
- Is the desired treatment if the tumor can be removed.
- Includes removal of kidney, adrenal gland, Gerota’s fascia and lymph
nodes
- Laparoscopic nephrectomy can be performed for removal of small tumor.
 NEPHRON-SPARING SURGERY
- Used for patient with solid renal lesions
- Its technical success rate is excellent and operative morbidity and
mortality are low

 RENAL ARTERY EMBOLIZATION

- The renal artery may be occluded to impede the blood supply to the
tumor and thus kill the tumor cells
-
PHARMACOLOGIC THERAPY
 Radiation Therapy
 Interleukin-2 with lymphokine-activated killer cells
 Drug combinations include vincristine and doxorubicin or vincristine and
actinomycin D, depending on stage

NURSING INTERVENTIONS
 Observe the surgical incision for erythema, drainage or separation. Report any of
theses changes.
 Maintain a patent urinary tract, to remove drainage and to permit accurate
measurement of urine output.
 Encourage DBE, coughing, use of incentive spirometry
 Assist patient in turning side to side.
 When bowel sounds have returned, begin administering small amounts of clear
fluids
 Allow the child to participate in the selection of foods.
 As the child recovers, encourage child to eat progressively larger meals.
 Analgesic as ordered by physician.
 Assist and support patient to cope with the diagnosis and uncertainties about
prognosis
 Prepare the child and parents for loss of hair associated with chemotherapy and
encourage use of hat as desired. Reassure the hair will grow back