6 Cancer of the Brain & CNS
Cancer of the Brain & CNS
Introduction
Central nervous system (CNS) tumors are managed differently from tumors in other parts of the body.
Benign tumors in the brain or spinal cord can have devastating outcomes.
Malignant CNS tumors are aggressive and refractory to current treatments.
Epidemiology
Brain tumors account for about 1.4% of all cancers, with higher incidence in men and Caucasians.
Metastatic lesions from lung and breast cancer are common origins of brain tumors.
Etiology and Risk Factors
Factors like ionizing radiation, genetic predisposition, and diet are linked to CNS tumors.
Molecular genetics play a significant role in understanding tumor formation.
Prevention, Screening, and Detection
Early detection is crucial for positive outcomes in CNS tumors.
Awareness of symptoms leads to early diagnosis and better prognosis.
Classification
WHO classification system grades brain tumors based on cell characteristics.
Ki-67 index and p53 gene mutations are used to predict tumor behavior.
Common Brain Tumors
Gliomas, meningiomas, nerve sheath tumors, and pituitary tumors are the most common types.
Gliomas are the most prevalent, affecting all age groups.
Treatment and Management
Different types of gliomas have varying characteristics and prognoses.
Surgical resection and other treatments are essential for managing different types of brain tumors.
Metastatic Brain Lesions
Metastatic brain lesions originate from distant sites like lung and breast cancer.
Radiotherapy is the primary treatment for metastatic brain lesions.
Conclusion
Various primary tumors can metastasize to the brain, requiring different treatment approaches.
Cancer of the Brain & CNS
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Clinical features of brain tumors depend on tumor type, biologic characteristics, and location.
Some tumors cause increased intracranial pressure (ICP) due to blood-brain barrier disruption.
Rapid-growing tumors lead to neurologic deficits, while slow-growing tumors may grow large before symptoms.
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Increased ICP causes symptoms like headache, nausea/vomiting, and papilledema.
Mental status changes can occur due to shifting associated with ICP or hydrocephalus.
Aggressive tumors are more likely to cause mental status changes and seizures.
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Seizure activity is common in low-grade or frontal lobe tumors.
Headaches, mental status changes, and seizures can lead to early detection and treatment.
Focal neurologic signs may be reversible if due to brain swelling.
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Radiologic screening studies are obtained for differential diagnosis of headaches, seizures, or other neurologic symptoms.
Magnetic resonance angiography (MRA) and spectroscopy are used for evaluation.
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Actively growing tumors show specific metabolite levels in noninvasive studies.
Different levels of metabolites indicate tumor characteristics.
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PET/CT and MR imaging are used for evaluating tumor activity and function.
Physiologic changes are noted during tasks in the MR scanner.
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Tumor classification, grade, and location are prognostic indicators.
Metastasis within the CNS is unlikely due to the absence of a lymphatic system.
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Medical treatment includes steroid therapy, antacids, anticonvulsants, and other drugs.
Prophylactic antiepileptic treatment may be used.
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Stereotactic biopsy and craniotomy are performed for diagnosis and tumor removal.
Craniotomy aims to decrease mass effect caused by the tumor.
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Tumor debulking can provide symptom relief and decrease ICP.
Biodegradable therapy or radiation implants may be used in selected cases.
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Nursing care involves providing information, referrals, and support for patients and families.
Social worker and rehabilitative needs referrals are important.
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Radiation therapy is essential for treating malignant tumors.
RT specialist and oncologist determine treatment based on tumor characteristics.
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Nursing care considerations for radiation therapy include discussing treatment before surgery and informing about possible complications.
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Chemotherapy is used in combination with other treatments for brain cancer.
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Chemotherapy side effects include nausea and vomiting.
Patients should report any side effects or new symptoms immediately.
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Serious side effects of chemotherapy include high temperature, breathing difficulties, and chest pain.
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Serious problems from chemotherapy can include bleeding gums, ulcers affecting eating, and excessive diarrhea.
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Prognosis for malignant brain tumors is poor, requiring a combination of surgery, radiation, and chemotherapy.
Research efforts aim to improve survival statistics through combination therapy approaches.
Cancer of the Brain & CNS
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Complications of brain tumors:
Increased ICP, seizures, mental status changes
Focal neurologic signs, deep vein thrombosis, pulmonary embolus
Complications of brain tumor treatments:
Intracranial hemorrhage, infection, treatment effect like necrosis
Immunosuppression, cognitive sequelae, steroid myopathy
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Spinal Cord Tumors:
Make up about 4% of CNS tumors
May be benign or malignant, primary or metastasize
Most common spinal cord tumors are extra-dural
Pain control is the primary goal of treatment
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Classification of spinal cord tumors:
Intramedullary, Intradural-extramedullary, Extradural
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Classification of spinal cord tumor:
Extradural (ED) tumor, Intradural extramedullary (IDEM) tumor, Intramedullary (IM) tumor
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Intradural extramedullary tumors:
Rarely metastatic, generally benign
Common types: glial, astrocytoma, ependymoma, oligodendroglioma
Ependymoma most common in adults, generally well circumscribed
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Considerations for Older Adults:
Improved nutrition, increased exercise, better medical care leading to increased longevity
Older adults actively involved in maintaining a healthy lifestyle
Geriatric patients with brain tumors:
Unique needs and concerns
Prognosis: many