Brain Tumor

Introduction:

A brain tumor is a growth of abnormal cells within the brain tissue. The tumor may
be a primary site that originated in the brain or a secondary site that has metastasized
from a cancer site elsewhere in the body. Because the tumor is growing within the
confined space of the skull, the patient will eventually develop signs of increased
intracranial pressure. Some cell types grow faster than others; the patients with the
more aggressive, fast-growing cancers will develop symptoms more quickly.

PROGNOSIS

Meningiomas are typically benign tumors that begin from the meninges (covering
the brain). They are more common in women and in people as they age. Treatment
is surgical removal, but the growth tends to recur.
Gliomas are malignant brain tumors of the neuroglial cells that tend to be fast-
growing. Patients have nonspecific symptoms of increased intracranial pressure.
Treatment typically includes surgical debulking of the tumor; complete removal is
often not possible at the time of diagnosis. Surgery is followed by radiation and
chemotherapy. Astrocytoma is the most common glioma and has a variable progno-
sis. Oligodendroglioma is more slow-growing and may be calcified. Glioblastoma is
a poorly differentiated glioma with a poor prognosis.

SIGNS AND SYMPTOMS

• Cerebellum or brain stem:
• Lack of coordination—cerebellum helps coordinate gross movements
• Hypotonia of limbs
• Ataxia
• Frontal lobe:
• Inability to speak (expressive aphasia)
• Slowing of mental activity
• Personality changes
• Anosmia (loss of sense of smell)
• Occipital lobe:
• Impaired vision—defect in visual fields; patient may deny or be unaware
of defect
• Prosopagnosia (patient is unable to recognize familiar faces)
• Change in color perception
• Parietal lobe:
• Seizures
• Sight disturbances result in visual field defect
• Sensory loss—unable to identify object placed in hand without looking
• Temporal lobe:
• Seizures
• Taste or smell hallucinations
• Auditory hallucinations
• Depersonalization
• Emotional changes
• Visual field defects
• Receptive aphasia
• Altered perception of music

TREATMENT

• Chemotherapeutic agents alone or in combination with radiation and surgery.
May be given orally, intravenously or through an Ommaya reservoir. Drugs
are chosen based on cell type:
• carmustine, lomustine, procarbazine, vincristine, temozolomide, erlotinib,
gefitinib
• Irradiation of the area to decrease tumor size.
• Craniotomy to remove the tumor if appropriate; this depends on location,
size, primary site of cancer, and number of tumors. Some patients may have
several small, scattered tumors, making surgery impractical.
• Administer glucocorticoid to reduce swelling or inflammatory response
within confined space inside skull (no room to expand, bone does not give):
• dexamethasone
• Administer osmotic diuretic to reduce cerebral edema:
• mannitol
• Administer anticonvulsant to reduce chance of seizure activity:
• phenytoin, phenobarbital, carbamazepine, divalproex sodium, valproic
acid, levetiracetam, lamotrigine, clonazepam, topiramate, ethosuximide
• Administer mucosal barrier fortifier to reduce risk of gastric irritation:
• sucralfate
• Administer H2 receptor antagonists to reduce risk of gastric irritation:
• ranitidine, famotidine, nizatidine, cimetidine
• Administer proton pump inhibitors (PPIs) to reduce risk of gastric irritation:
• lansoprazole, omeprazole, esomeprazole, rabeprazole, pantoprazole


NURSING DIAGNOSES

• Disturbed sensory perception
• Risk for injury

NURSING INTERVENTION

• Monitor neurologic function.
• Check for side effects to medications.
• Seizure precautions per institution protocol.
• Assess for pain control.
• Explain to the patient:
• Home care needs.
• Possible need for hospice.