Chapter 10: Brain Tumors

Chapter 10: Brain Tumors

Can occur in any brain region; occupy cranial space; classified by cell/tissue of origin.

Most Common: Cerebral tumors.

Types of Brain Tumors

Primary brain tumors

• Originate from neuroglial tissue.

• Rarely metastasize outside the brain.

• High mortality due to location and limited space within the skull.

Secondary (metastatic) brain tumors

• Originate from a primary cancer elsewhere.

• Common primary sources: breast, kidney, lung, skin (melanoma), GI tract.

• Frequently metastasize to the brain; cranial metastases most often from these cancers.

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Malignant tumors

• Include malignant gliomas (neuroglial cells).

• Cause aggressive local invasion and neurologic deficits.

Benign tumors

• Include meningiomas (meninges), pituitary adenomas, and acoustic neuromas (cranial nerve VIII).

• Do not metastasize.

• Have distinct boundaries but can still cause damage due to:

  • Pressure on intracranial structures

  • Impaired cranial nerve function
    (Benign ≠ harmless because of limited intracranial space)

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Supratentorial Tumors

• Occur above the tentorium cerebelli (cerebral hemispheres).

Infratentorial Tumors

• Occur below the tentorium cerebelli (brainstem and cerebellum).

(Location determines symptoms because it dictates which structures are compressed.)

Tumor Pathophysiology

Compress surrounding brain tissue, causing:

• Decreased CSF outflow → ↑ intracranial pressure (ICP)

• Cerebral edema

• Neurologic deficits (from pressure on functional areas)

Affecting the pituitary gland → endocrine dysfunction (due to altered hormone regulation).

Health Promotion / Disease Prevention for Brain Tumors

No routine screening exists for early detection

Brain Tumor Risk Factors

(Cause unknown; several associations identified)

• Genetics

• Environmental agents

• Exposure to ionizing radiation

• Exposure to electromagnetic fields

• Previous head injury

Brain Tumor Expected Findings

Physical Assessment Findings

• Dysarthria (difficulty speaking due to motor dysfunction)

• Dysphagia (swallowing impairment)

• Positive Romberg sign (loss of balance with eyes closed → cerebellar/vestibular dysfunction)

• Positive Babinski sign (upper motor neuron involvement)

• Vertigo

• Hemiparesis (weakness on one side)

• Cranial nerve dysfunction

  • Inability to discriminate sounds

  • Loss of gag reflex

  • Loss of blink response

• Papilledema (optic disc swelling due to ↑ ICP)

Supratentorial Brain Tumors (Above the tentorium; cerebral hemispheres) S/S

Severe headache

• Worsens on awakening

• Improves over time

• Worse with coughing/straining (↑ ICP)

Visual changes

• Blurring

• Visual field deficits

Focal or generalized seizures

Loss of voluntary movement / impaired motor control

Cognitive changes

• Memory loss

• Language impairment

Personality changes

• Emotional dysregulation

Nausea ± vomiting

Paralysis

Infratentorial Brain Tumors (Below the tentorium; brainstem + cerebellum) S/S

Hearing loss or tinnitus

Visual changes

Facial drooping

Difficulty swallowing

Nystagmus, crossed eyes, or decreased vision

Autonomic nervous system (ANS) dysfunction
(brainstem involvement → HR, BP, RR instability)

Ataxia / clumsy movements (cerebellar involvement)

Hemiparesis

Cranial nerve dysfunction

• Inability to discriminate sounds

• Loss of gag reflex

• Loss of blink response

Brain Tumor Exams

Laboratory Tests

• CBC and differential → rule out anemia or malnutrition.

• Blood alcohol and toxicology screening → rule out these causes of altered assessment findings.

• TB and HIV screening → if social conditions warrant.

Diagnostic Procedures Imaging

Used to determine size, location, and extent:

• X-ray

• CT scan

• MRI

• Brain scan

• PET scan

• Cerebral angiography

Other Diagnostic Tests

• Lumbar puncture (LP) and EEG → provide additional diagnostic information.

  • Do NOT perform LP if ↑ ICP or manifestations suggest ↑ ICP
    → risk of brain herniation.

• Lab tests → evaluate endocrine function, renal status, electrolyte balance.

Cerebral Biopsy

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Client Education

(Medication and preprocedure instructions)

Antiepileptic Medications

• Must be continued to prevent seizure activity.

Aspirin Products

• Discontinue ≥ 72 hours prior to decrease risk of intracerebral bleeding.

Other Medications

• May be withheld before the procedure depending on provider instructions.

Postprocedure Care

• Most activities can resume after recovery from anesthesia.

• Incision care: keep clean and dry.

• Suture removal: typically 7–10 days after procedure.

• Avoid driving or dangerous activities until follow-up determines safety.

Cerebral Biopsy

Identifies cellular pathology.

Where Performed

• In a surgical suite or radiology specialty suite.

How It Works

• Biopsy may be CT- or MRI-guided using image-guiding systems.

• Surgeon removes a small piece of abnormal tissue identified on CT/MRI.

• Tissue is sent to pathology for diagnostic testing.

Pros

• Minimally disruptive to surrounding brain tissue.

• Shorter recovery time.

• Avoids the risks of an open craniotomy.

Cons

• Biopsy does not remove or debulk the tumor.

• Pathology may be inconclusive if:

  • Tissue sample is insufficient.

  • Tumor has many tissue types.

• Sampling error possible if only one area is taken.

Brain Tumor Care

Nursing Care

• Maintain airway

  • Monitor O₂ levels, administer oxygen PRN, assess lung sounds.

• Monitor neurologic status

  • Watch for changes in LOC, emerging neurologic deficits, and seizure activity.

• Maintain client safety

  • Assist with transfers/ambulation.

  • Provide assistive devices as needed.

• Implement seizure precautions.

• Administer medications as prescribed.

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Interprofessional Care

• Initiate referrals:

  • Social services

  • Support groups

  • Medical equipment

  • Physical, speech, and occupational therapy

• Treatments may include:

  • Steroids

  • Surgery

  • Chemotherapy

  • Conventional radiation therapy

  • Stereotactic radiosurgery

  • Clinical trials

• Chemotherapy and conventional radiation:

  • May be given before surgery to reduce tumor bulk

  • Or after surgery to prevent recurrence

• Benign tumors:

  • Surgery is often curative

  • May regrow → radiation/chemotherapy may be provided to prevent recurrence

• Tumors malignant by location:

  • Pathology = benign, but location increases mortality because of vital structures affected

• Metastatic brain lesions (from primary tumors elsewhere):

  • Treatment is palliative

  • May include surgery, radiation, and/or chemotherapy in any combination

  • Goal: control intracerebral lesions

Brain Tumor Drugs

Non-opioid Analgesics

• Used to treat headaches.

• Avoid opioids (can decrease LOC).

Corticosteroids

• Reduce cerebral edema
  → relieve headaches, improve altered LOC.

• Rapid administration provides fast edema reduction.

• Chronic use helps control edema related to benign or malignant brain tumors.

Osmotic Diuretics

• Decrease brain fluid content → ↓ intracranial pressure (ICP).

Anticonvulsants

• Used to control or prevent seizures.

• Suppress neuronal activity in the brain → prevents seizure activity.

• Multiple antiepileptic classes exist, each designed for specific seizure patterns.

H₂-Antagonists

• Decrease acid content in the stomach → reduces stress-ulcer risk.

• Administered during:

  • Acute or stressful periods (post-surgery, start of chemotherapy).

  • Early radiation therapy sessions.

• Corticosteroid use increases ulcer risk → H₂-antagonists provide preventative protection.

Antiemetics

• Used for nausea/vomiting (from ↑ ICP, tumor site, or treatment).

• Given as prescribed; may be used prophylactically during treatments known to cause nausea/vomiting.

Chemotherapy

• Used alongside radiation therapy.

• Blood–brain barrier can limit adequate chemotherapy dosing from reaching the tumor.

Brain Tumor Therapeutic Procedures

Craniotomy

• Complete or partial resection of a brain tumor through a surgical skull opening.

Preoperative Nursing Actions

• Explain the procedure; answer all appropriate questions; provide emotional support.

• Questions about surgery/outcomes should be documented in writing to ensure accuracy.

• Ensure presence of the client’s partner to avoid miscommunication and support involvement.

• If the client takes aspirin, stop ≥ 72 hours prior.

• No alcohol, tobacco, anticoagulants, or NSAIDs for 5 days before surgery.

• Report any alternative/complementary medications to provider.

• Ensure completion of:

  • Living will

  • Durable power of attorney for health care

• Administer prescribed medications.

• Anti-anxiety or muscle relaxants may be given if ordered and if the client requests them.

Postoperative Nursing Actions

• Closely monitor vital signs and neurologic status, including Glasgow Coma Scale.

• Provide adequate pain control.

• Positioning:

  • Supratentorial surgery:

    • Elevate HOB 30°

    • Neutral head position

    • Turn side-to-side with support

    • Prevent pressure injuries and pneumonia

  • Infratentorial surgery:

    • Lie flat or side-lying

    • Turn q2h for 24–48 hours

• Avoid straining activities (moving up in bed, attempting to have a bowel movement) to prevent ↑ ICP.

• Postoperative bleeding and seizure activity are highest risk complications.

• Periorbital edema and ecchymosis are common; treat with cold compresses.

• Assess head dressing every 1–2 hours for drainage.

Brain Tumor Complications

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Definition

• Condition where fluid is retained due to overproduction of ADH (antidiuretic hormone) from the posterior pituitary gland.

Causes

• Occurs when the hypothalamus is damaged and can no longer regulate ADH release.

Treatment

• Fluid restriction

• Oral conivaptan

• Treat hyponatremia

  • Mild: restrict fluids

  • Severe: 3% hypertonic saline

Manifestations

• Disorientation

• Headache

• Vomiting

• Muscle weakness

• Decreased LOC

• Irritability

• Loss of thirst

• Weight gain

Severe or Untreated

• Seizures

• Coma

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Diabetes Insipidus (DI)

• Condition with large amounts of dilute urine due to ADH deficiency.

Most Common After

• Supratentorial surgery, especially if pituitary or hypothalamus are involved.

Cause

• Hypothalamic damage → unable to regulate ADH release.

Treatment

• Massive fluid replacement

• Synthetic vasopressin

• Monitor laboratory values closely.

• Replace essential nutrients as indicated.