• Classify brain tumors according to type and location

• Discuss unique characteristics of primary and metastatic brain tumors

• Recognize common signs and symptoms• List 3 types of spinal cord tumors• Discuss 3 spinal cord tumors according to

histology, location, and clinical manifestations• Discuss nursing care re: management of S/S and

treatment interventions

• Incidence of primary brain tumors(benign or malignant) 12.8/100,000• 10%–15% of cancer patients developbrain metastases

• Primary – unknown• Genetic – hereditary• Metastatic

o 35% - lungo 20% - breasto 10% - kidneyo 5% - gastrointestinal tract

• Often unknown• Under investigation:

o Genetic changeso Heredityo Errors in fetal developmento Ionizing radiationo Electromagnetic fields (including cellular phones)o Environmental hazards (including diet)o Viruseso Injury or immunosuppression

• Tissue of origin• Location• Primary or secondary (metastatic)• Grading

• Microscopic appearance• Growth rate• Different for other types of CA• For CNS, per WHO:

o GX Grade cannot be assessed (Undetermined)o G1 Well-differentiated (Low grade) o G2 Moderately differentiated (Intermediate grade) o G3 Poorly differentiated (High grade) o G4 Undifferentiated (High grade)

• Depends on location, size, and type of tumor• Neurological deficit 68%

o 45% motor weaknesso Mental status changes

• HA 54%• Seizures 26%

• Generalo Cerebral edemao Increased intracranial pressureo Focal neurologic deficitso Obstruction of flow of CSFo Pituitary dysfunctiono Papilledema (if swelling around optic disk)

• Cerebral Tumorso Headacheo Vomiting unrelated to food intakeo Changes in visual fields and acuityo Hemiparesis or hemiplegiao Hypokinesiao Decreased tactile discriminationo Seizures o Changes in personality or behavior

• Brainstem tumorso Hearing loss (acoustic neuroma)o Facial pain and weaknesso Dysphagia, decreased gag reflexo Nystagmuso Hoarsenesso Ataxia (loss of muscle coordination) and dysarthria (speech

muscle disorder) (cerebellar tumors)

• Cerebellar tumorso Disturbances in coordination and equilibrium

• Pituitary tumorso Endocrine dysfunctiono Visual deficitso Headache

• Frontal Lobeo Inappropriate behavioro Personality changeso Inability to concentrateo Impaired judgmento Memory losso Headacheo Expressive aphasiao Motor dysfunctions

• Parietal lobeo Sensory deficits

Paresthesia Loss of 2 pt discrimination Visual field deficits

• Temporal lobeo Psychomotor seizures – temporal lobe-judgment,

behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousness

• Occipital lobeo Visual disturbances

• Gliomaso Astrocytoma (Grades I & II)o Anaplastic Astrocytomao Glioblastoma Multiforme

• Oligodendroglioma • Ependymomas• Medulloblastoma• CNS Lymphoma

• Grade I• Non-infiltrating

• Grade II• Infiltrating • Slow growing

• Grade III• Infiltrating• Aggressive

• Grade IV• Highly infiltrative• Rapidly growing• Areas of necrosis

• Grades II-IV• Mixed astro/glio

• Slow growing• Benign• HCP/ICP• Surgery, RT, Chemo

• Small cell embryonal neoplasms

• Malignant• HCP/ICP

• Primary CNS lymphoma• B lymphocytes• Increased ICP• Brain destruction

• Meningioma• Metastatic• Acoustic neuromas (Schwannoma)• Pituitary adenoma• Neurofibroma

• Usually benign• Slow growing• Well circumscribed• Easily excisable

• Peritumoral edema• Necrotic center

• Benign• Schwannoma cells• CN VIII

• Benign• Anterior pituitary• Endocrine dysfxn

• Cystic tumor• Hypothalamic-pituitary axis dysfunction

• Radiological Imagingo Computed Tomography scan (CT scan) with/without

contrasto Magnetic Resonance Imaging (MRI) with/without

contrasto Plain filmso Myelographyo Positron Emission Tomography scan (PET scan)

• LP/CSF analysis• Pathology

• Resection • Craniotomy• Stereotaxis Surgery• Biopsy• Transsphenoidal

http://youtu.be/d95K3unaNCs

• Drug therapy – Palliative o Done for symptom treatment and to prevent

complications NSAIDs Analgesics – Vicodin, Lortab, MS Contin Steroids (Decadron, medrols, prednisone) Anti-seizure medications (phenytoin) Dilantin &

Cerebyx Histamine blockers Anti-emetics Muscle relaxers (for spasms) Mannitol for ICP –New Hypertonic saline

• Pre-op care• Post-op care• Patient teaching

o Activityo Wound careo Dieto Medso F/U

• Neuro assessment • Vital signs• H & P• Teaching

o Diagnostic test infoo Pre & Post-op careo ICUo Dressings, edema, bruising, hair removalo Sensations if done partially awakeo Emotional supporto Avoid false hope

• Anxiety• Risk for infection• Risk for injury: seizures • Pain (Acute) • Impaired cognitive ability• Impaired physical mobility• Altered nutrition: less than body requirements• Urinary retention• Risk for constipation• Disturbed self-esteem

• Increased ICP• Hematoma• Hypovolemic shock• Hydrocephalus• Atelectasis• Pulmonary edema• Meningitis• Fluid and electrolyte

imbalances (ADH)

• Wound infection• Seizures• CSF leak• Edema

• Follow-up appointments and procedures• Medications• Exercise• Diet

o Patient may need referral to dietician to help with diet planning while undergoing chemotherapy

• Seizures o Are a risk for 1 or more years following surgery

• If expecting long term changes, coordinate discharge planning with appropriate members of health care team

• Damages DNA of rapidly dividing cells• 4000–6000 Gy total dose• Duration of 4–8 weeks• Brachytherapy• Stereotactic radiosurgery

• Side Effectso Skin burns, hair loss, fatigue, local swelling

• Patient teaching o Do not erase markingso Steroidso S/S of cerebral edema

• Radiation necrosis

• Slows cell growth• Cytotoxic drugs

o CCNU, BCNU, PCV, Cisplatin, Etoposide, Vincristine, Temozolomide (Temodar)

• Gliadel wafers• Ommaya Reservoir

• Side effectso Oral mucositis, bone marrow suppression,

fatigue, hair loss, nausea/vomiting, anxiety, peripheral neuropathy

• Patient teachingo Meds/MVo Nutrition/hydration/activityo Avoid pregnancyo Resources

• Ineffective Tissue Perfusion• Ineffective Airway Clearance• Impaired Communication• Decreased Intracranial Adaptive Capacity• Activity Intolerance• Disturbed Sensory disturbance• Acute Confusion

• Subjective data?

• Interventions?

• Goals?

• Evaluation?

• A patient is being directly admitted to the medical-surgical unit for evaluation of a brain mass seen in the frontal lobe on a diagnostic CT scan. Which of the following signs and symptoms would the patient most likely present with?a. Personality changes

b. Visual field cuts

c. Difficulty hearing

d. Difficulty swallowing

• The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits

a. A positive Brudzinski’s sign

b. A negative Kernig’s sign

c. Absence of nuchal rigidity

d. A Glascow Coma Scale score of 15

• AANN Core Curriculum for Neuroscience Louis, MO. Nursing, 4th Ed. 2004. Saunders. St.

• Greenberg, Mark. (2006). Handbook of Neurosurgery. Greenberg Graphics, Tampa, Florida.