BRAIN TUMOUR Ms SAHELI C. 187 YEAR M.Sc NURSING. RINERTTRODUCTION :- e A brain tumour is an abnormal cell growth inside the brain, skull, which encloses the brain. © When normal cells grow old or get damaged, they die. And new cells take their place. Sometimes these process goes wrong and new cells grows when body does not need them and the old/damaged cells do not die as they should and leads to abnormal growth in the brain. Brain is a very rigid structure, any growth inside this restricted place , can cause problem. © When these tumours grow inside the brain, it increases intracranial pressure which can cause brain damage.© World Brain tumour day is observed on 8" of JU every year since 2000 . ® This day first observed by German Brain Tumour Association. This is a non profit organization which raises public awareness and educates people about brain tumour because malignant brain tumour is very common.EFINITIO © Brain tumour is a localized, intracranial lesion, mass , or abnormal cell growth that occupies space within the skull. © Brain tumours can be benign or malignant ,that grow quickly. © Some are primary brain tumours, which start in the brain. Others are metastatic, and they start somewhere else in the body © \ and move to the brain. nee issue it ‘Mayo Foundation for Medica! Education and Research, All rights reserved.© The incidence and prevalence of brain tumour is growing in India. © More than 500 new cases are diagnosed with brain tumour everyday worldwide. © More than 1 million cases per year in India, of these 20 percent are children. ° This is the most common type of cancer among children. a‘SSIFICATION OF BRAI OUR 1. PRIMARY BRAIN TUMOUR: Primary brain tumour originates from cells and structures within the brain. Primary brain tumour subdivided into following categories ~ a. Intracerebral tumour : also called as gliomas. This include- ¥ Astrocvtoma The tumour which arises from astrocytes (star shaped glial cell). ¥ Gligadendrocytomar This rare tumour arises from cells that make the fatty substance that covers and protects nerve, usually occurs in the cerebrum. » Glioblastoma multiforme- These are grade 3 and grade 4 astrocytoma. » Ependymoma- The tumour that arises from cells that line the ventricles or the central canal of the spinal cord. More common in children, » Medulloblastoma- This tumour arises in the cerebellum, sometimes called as primitive neuroectodermal tumour.b. Tumour arising from supporting structure : This include the following:- © Meningioma - This tumour arises in the meninges. © Acoustic neuroma- Tumour that arise in the cranial nerve VIIL. © Schwannoma- A tumour that arises from a Schwann cell of neuron. Pituitary adenoma- Tumour that arises in the pituitary gland. Pineal region tumour- this rare brain tumour arises in or near the pineal gland. © Germ cell tumour of the brain- this type of tumour arises from a germ cell.— es g Developmental tumour : This include the following: * Angiomas: Masses composed largely of abnormal blood vessels, are found either in or on the surface of the brain. They occur in the cerebellum. * Craniopharyngioma: This type of tumour grows at the base of the brain, near the pituitary gland. ® Dermoid tumour: It is a sac like growth that is present at birth, contains structures such as hair, Fluid, teeth and skin glands that can be found inside the skull. © Epidermoid tumour : This tumours occurs when the normal developmental cells are Heed within the growing brain. It has a thin outer layer of epithelial cells surrounding fluid, keratin and cholesterol. 2. SECONDARY BRAIN TUMOUR: This are metastasis brain t r developed from structures outside the brain and migrate to rain.> Being male. “Race. “Age. “> Family history. Genetic risk. “> Exposure to radiation , radiation to he head. *» Exposure to formaldehyde. “» Exposure to vinyl! chloride. ~~ HIV infection. “Smoking . * Use of cell phones. / Use of hair dyes,PATHOPHYSIOLOGY OF BRAIN TUMOUR. BaPathophysiology of brain tumers: Due to causes like chemicals and radiation exposure s Irritation and damage to cell structure ig [As adaptive mechanism, changes in cat! morphology occurs] ws ‘a5 radiation exposure continue, the changes become irreversible causing gene mutations in DNA & f inactivation of tumor supressor genes and activation of oncogenes ] uncontrolled cell division and decreased apoptosis Ss [ hyperpla: [ brain tumor }NICAL MA * Generalized symptoms:- > Increased Intra Cranial pressure. * Vomiting ( Projectile vomiting ). ~ Visual disturbances (Diplopia, Papilledema, loss of visual acuity). * Headache (Most common in the early morning and made worse by coughing or straining ). * Localized symptoms are- “» Hemiparesis (experiencing one sided weakness in arms, hands, face, chest, legs or feet) > Seizures. “» Mental status changes. ~ Alteration in cognition. “+ Personality changes as in case of frontal lobe tumour. > Sensory defects ( smell, hearing). > Language disturbances e.g. Aphasia (Aphasia is an inability to comprehend and formulate language because of damage to specific brain regions.)INCREASED INTRACRANIAL PRESSURE * CHANGES IN Loc * HEADACHE + PAPILLEDEMA *PUPILLARY CHANGES “IMPAIRED EVE MovEMENT CHANGES IN VITAL SIGNS: eee CGAnces IN, + VOMITING RESP PATTERD “+ SENSORY /MOToR FUNCTION e INFANTS: . BULGING FONTANELS eCRANIAL SUTURE SEPARATION ePHEAD CIRCOMFERENCE eHIGH PITCHED CRY* Impaired speech. © Inability to write. ° Memory disturbances. © Lack of recognition. © Seizures. e Confusion. e Depression. Frontal lobe tumour: ° Behavioural and emotional changes. © Impaired judgement. e Memory loss. e Hemiplegia (paralysis of one side of body). Vision loss. Papilledema ( inflammation of optic nerve). e Reduced mental capacity.e Asymptomatic but some times may cause memory disturbances, auditory hallucinations, visual field deficit. Occipital lobe tumour: Visual loss in half of visual field on the opposite side of tumour. e Visual hallucinations. Cerebellar area: © Coordination, gait and balance disturbances. Tinnitus and vertigo. e Numbness and tingling. © Weakness or paralysis of face.e Drowsiness. Difficulty in speaking and swallowing. e Muscle weakness of one side of face. © Uncoordinated gait. e Hemiparesis. © Behavioural and emotional changes. © Hearing loss. © Drooping eyelid. e Respiratory depression. © Cardio vascular instability. Cranial nerve dysfunction. * Coma.DIAGNOSTIC EVALUATION: 1. Neurological examination: be ery © Cranial Nerves Siem eC 0 Parte gm ati lela] 4 P= Be Ue tire | ead uel laa)2. CT Scan, MRI, Positron Emission Tomography- = Electroencephalogram 4) Angiogr. Electrooncephalogram (EEG)5. Skull X-ray 6) Biopsy Ve? © Mayfield ClinicSURGICAL MANAGEMENT: e Craniotomy : craniotomy is the treatment of choice of removal of tumour. The procedure is performed under general anaesthesia and involves opening the skull (cranium ). The neurosurgeon makes several holes (called as burr holes ) into the scalp and then a bone saw is used to join the holes together to create a flap of bone. The bone flap is then removed to expose the brain and to remove the tumour.ins sphenoidal micro-surgica removal of tumour: e It isan approach that gains access to pituitary gland old pituitary g en through nasal cavity and sphenoid sinuses. MRI is used to pinpoint the location of the tumour and a laser is used to destroy the tumour. This. procedure may be used after craniotomy to remove remaining tumour tissue.Debulking surgery: © Partial removal (debulking ) of the tumour can improve quality of life by alleviating symptoms and sometimes improve the effectiveness of radiation therapy or chemotherapy.Radiation therapy Conventional therapy is 5000 -6000 centrigray of external radiation over 5-6 weeks° The surgical implantation of radiation sources for eg, (Iodine 131 ) to deliver high dose of radiation at a short distance for high grade malignant tumour, while minimizing effects on surrounding brain tissue.Stereotactic radiation therapy: Narrow beams of radiation are directed at the tumour from different angles. For this procedure, the patient wears a rigid head frame. An MRI or CT Scan creates pictures of the tumour’s exact location. The doctor uses a computer to decide on the dose of the radiation needed, as well as the sizes and angles of the radiation beans. The therapy may be given during a single visit or several visit.Stereotactic RadiosurgeryChemotherapy : © Chemotherapy is the use of drug to kill the cancer cells. The drugs may be given by mouth or by injection. The drugs enters the blood stream and travels throughout the body and destroy the cancer cell. © Some example of this drug include- “ Procarbazine. “* Temozolomide. “Interferon. “> Cisplastin “CarboplatinSUPPORTIVE CARE:- © Steroids ; most patient with brain tumours need steroids to help relieve swelling of the brain. Eg, Dexamethasone may be used before and after treatment to reduce cerebral edema. e Anticonvulsant medicine: Brain tumours can cause seizure. Anticonvulsant are used to prevent and control seizures. ° Shunt : if fluid builds up in the brain, the surgeon may place a shunt to drain the fluid.rsing management ° History collection e Physical examination. e Monitor ICP and cerebral perfusion pressure. Use strict aseptic techniques. e Monitor and record vital signs and neurological status continuously. © Observe for signs of increased intracranial pressure. © Maintaining normal respiratory pattern. Assess respiratory parameters and monitor ABG. * Suction mouth and throat if needed to maintain the airway. © prevent the patient from injury.e Maintain body position without flexion of head, and reduce hip flexion. For patient with visual field deficits place materials in visual field. e Provide appropriate care and teaching for chemotherapy. e Maintain adequate hydration and nutrition. © Perform oral hygiene before and after meals to improve intake. © Monitor intake and output chart. Provide for total self care requirement. © Encourage planning for each day. e Maintain range of motion exercises for each joints. © Supporting nursing care based on the symptoms.ehabilitation after treatment for brain tumour: Physical therapy : it involves improving strength and motor function. © Speech therapy: in involves restoring the ability to speak clearly. ° Occupational therapy: in involves restoring normal daily functioning by the help of occupational therapists. Therapist help patient to manage activities of daily living such as eating, using the toilet, bathing , dressing, grooming etc.————— SS ASSIGNMENT eList the 4 nursing diagnosis and write the care plan in patients with brain tumour ,undergone for surgery.