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66 Cards in this Set

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What is a primary brain tumor?
Tumor that originates within the central nervous system (CNS) and rarely metastasize outside this area
What is a secondary brain tumor?
Tumor that results from metastasis from other areas of the body, such as the lungs, breast, kidney, and gastrointestinal tract

(i.e. breast cancer leading to brain cancer)
What is the pathophysiology of a brain tumor?
Regardless of origin, the tumor expands and invades, infiltrates, compresses, and displaces normal brain tissue
What problems are associated with brain tumors?
1. Cerebral edema/brain tissue inflammation
2. Increased intracranial pressure (ICP)
3. Focal neurologic deficits
4. Obstruction of the flow of cerebrospinal fluid (CSF)
5. Pituitary dysfunction
What causes cerebral edema/brain tissue inflammation?
Changes in capillary endothelial tissue permeability, which allows plasma to seep into the extracellular spaces
What causes increased ICP?
1. Cerebral edema

2. Compression of cerebral blood vessels secondary to cerebral edema

3. Hydrocephalus related to obstruction of the flow of CSF or displacement of the lateral ventricles by the expanding lesion
What are the complications of cerebral edema?
1. Increased ICP

2. Compression of cerebral blood vessels

3. Ischemia secondary to compression of cerebral blood vessels

4. Hemorrhage

5. Seizures

6. Pituitary dysfunction
What causes hemorrhage?
Cerebral edema causes compression and may infiltrate the walls of the vessel, causing it to rupture and hemorrhage into the tumor bed or adjacent brain tissue
What causes seizures?
Interference with the brain's normal electrical activity secondary to cerebral edema
How does a brain tumor lead to increased ICP?
1. Tumor obstructs the aqueduct of Sylvius or one of the ventricles or encroaches on the subarachnoid space

2. Posterior fossa tumors may obstruct the flow of CSF from the fourth ventricle to the foramen of Luschka or Magendie
What causes pituitary dysfunction?
Tumor compression on the pituitary gland and causes the syndrome of inappropriate antidiuretic hormone (SIADH) or diabetes insipidus (DI)
What are the complications of pituitary dysfunction?
Severe fluid and electrolyte imbalances and can be life threatening
What are the classifications of brain tumors?
1. Benign or malignant

2. Supratentorial or infratentorial

3. Depends on the cellular, histologic, or anatomic origins of the tumor
What is a benign tumor?
Tumor that is generally associated with a favorable outcomes, which is often not the case with malignant tumors
When would a benign tumor be classified as malignant?
1. By virtue of their location. If the tumor cannot be completely removed or treated, it continues to grow. As it invades other brain tissue, cerebral edema, focal neurologic deficits, and increased ICP occur. Herniation of brain tissue may eventually lead to death.

2. Benign tumors also may undergo histologic changes and become malignant
What is a supratentorial tumor?
1. Tumors, which occur most often in adults, that are located in the area above the tentorium cerebelli, the tentlike fold of dura that surrounds the cerebellar hemisphere and supports the occipital lobe.

2. In other words, supratentorial tumors are located within the cerebral hemispheres
What is an infratentorial tumor?
Tumor located beneath the tentorium, the area of the brainstem structures and cerebellum
What are the types of benign tumors?
1. Acoustic neuroma
2. Meningioma
3. Pituitary adenoma
4. Grade 1 Astrocytoma
5. Chondroma
6. Craniopharyngioma
7. Hemangioblastoma
What are the types of malignant tumors?
1. Grades 2, 3, or 4 Astrocytoma (Grade 4 is also known as Glioblastoma multiforme)

2. Oligodendroglioma

3. Ependymoma

4. Medulloblastoma

5. Chondrosarcoma

6. Glioma

7. Lymphoma
What are the cell types of the nervous system?
1. Neurons, which are responsible for nerve impulse conduction

2. Neuroglial cells, which provide support, nourishment, and protection for neurons
What are the neurons responsible for?
Nerve impulse conduction
What are the neuroglial cells responsible for?
Support, nourishment, and protection for neurons
What is a glioma?
1. Malignant tumor that infiltrates and invades the surrounding brain tissue

2. Accounts for 60% of all brain tumors in adults
What is the origin of gliomas?
The neuroglial cells of the brain and brainstem
What is the peak incidence of gliomas?
Occurs in people 40 to 60 years of age
What is the most common type of glioma?
Astrocytoma, which may be found anywhere within the cerebral hemispheres
What is the treatment for astrocytoma?
Surgery to remove as much tumor bulk as possible, followed by radiation and chemotherapy
What is an oligodendroglioma?
Another type of glioma that is generally located within the frontal lobes of the brain
What are the characteristics of an oligodendroglioma?
These tumors are slow-growing and are usually calcified
What is the treatment for oligodendroglioma?
Surgical removal is possible, and the long-term prognosis is good
What is a glioblastoma?
A highly malignant, grade 3 or higher, rapidly growing, and invasive astrocytoma
What is the treatment for glioblastoma?
Surgical techniques and advanced treatment have improved the outlook and quality of life for a client with this type of tumor, but fewer than 15% of affected clients survive 18 months after diagnosis
What is an ependymoma?
A glioma that arises from the lining of the ventricles and difficult to treat surgically because of its location
What is the treatment for ependymoma?
Radiation and shunting procedures to control the hydrocephalus caused by the blocking of normal CSF flow by the tumor. Chemotherapy may also be used to treat these tumors.
What are the grades of malignant tumors?
1. Grade X
2. Grade I
3. Grade II
4. Grade III
5. Grade IV
What is a grade X tumor?
Cannot be assessed
What is a grade I tumor?
Well differentiated– closely resembles tissue of origin
What is a grade II tumor?
Moderately differentiated—less resemblance to tissue of origin; more variation in size and shape of tumor cells
What is a grade III tumor?
Poorly differentiated– does not closely resemble tissue of origin. Much variation in size and shape of tumor cells
What is a grade IV tumor?
Very poorly differentiated– no resemblance to tissue of origin
What is the most common benign brain tumor?
Meningiomas
What is the origin of meningioma?
Arise from the coverings of the brain (the meninges)
What is the incidence of meningioma?
1. Peak incidence at age 50 years

2. Females are affected more than males by a 2:1 ratio
What are the characteristics of meningioma?
This tumor is encapsulated, globular, and well demarcated and causes compression and displacement of adjacent brain tissue
What is the treatment for meningioma?
Although complete removal of the tumor is possible, it tends to recur
What are the characteristics of pituitary tumors?
1. Occur in the anterior lobe account for 10% to 25% of brain tumors and may cause endocrine dysfunction

2. These tumors are benign and often occur in young and middle-aged adults
What is the most common type of pituitary tumors?
Adenoma
What are the signs and symptoms of pituitary tumors?
1. Visual disturbances

2. Hypopituitary signs
a. Loss of body hair
b. Diabetes Insipidus, sterility
c. Visual field defects
d. Headaches
What is the origin of acoustic neuromas?
The sheath of Schwann cells in the peripheral portion of cranial nerve VIII

(they are also referred to as cerebellar pontine angle (CPA) tumors to describe their anatomic location)
What are the characteristics of acoustic neuromas?
1. Compression of brain tissue and the surrounding adjacent cranial nerves (VII, V, IX, X), making surgical removal difficult without causing permanent cranial nerve dysfunction

2. Females are twice as likely as males to have acoustic neuromas
What are the signs and symptoms of acoustic neuromas?
1. Hearing loss
2. Tinnitus (ringing in the ears)
3. Dizziness or vertigo
What is the proportion of metastatic (secondary) brain tumors?
Nearly 30% of all brain tumors
What causes brain tumors?
Exact cause is unknown
What are the risk factors of brain tumors?
1. Genetic changes
2. Heredity
3. Errors in fetal development
4. Ionizing radiation
5. Electromagnetic fields
6. Environmental hazards
7. Diet
8. Viruses
9. Injury
10. Use of cellular phones, but findings are inconclusive
What are the clinical manifestations of brain tumors?
Vary with the site of the tumor, but in general:

1. Headaches that are usually more severe on awakening in the morning

2. Nausea and vomiting

3. Visual symptoms

4. Seizures

5. Changes in mentation or personality

6. Papilledema (swelling of the optic disc)
What are the signs and symptoms of cerebral tumors?
1. Headache (most common feature)

2. Vomiting unrelated to food intake

3. Changes in visual acuity and visual fields; diplopia (visual changes caused by papilledema)

4. Hemiparesis or hemiplegia

5. Hypokinesia

6. Hyperesthesia, paresthesia, decreased tactile discrimination

7. Seizures

8. Aphasia

9. Changes in personality or behavior
What are the signs and symptoms of brainstem tumors?
1. Hearing loss (acoustic neuroma)

2. Facial pain and weakness

3. Dysphagia, decreased gag reflex

4. Nystagmus

5. Hoarseness

6. Ataxia and dysarthria (cerebellar tumors)
What are the complications of supratentorial tumors?
1. Paralysis
2. Seizures
3. Memory loss
4. Cognitive impairment
5. Language impairment
6. Vision problems
What are the complications of infratentorial tumors?
1. Ataxia
2. Autonomic nervous system dysfunction
3. Vomiting
4. Drooling
5. Hearing loss
6. Vision impairment
7. As the tumor grows, ICP increases, and the symptoms become progressively more severe
What is the goal of treatment of brain tumors?
1. Decrease tumor size
2. Improve quality of life
3. Improve survival time
What treatments are available for brain tumors?
The treatment of brain tumors may include radiation, chemotherapy, and surgery
What are the common drugs to treat brain tumors?
1. Alkylating agents, especially nitrosoureas such as carmustine (BCNU) and lomustine (CCNU)

2. A combination of procarbazine, lomustine, and vincristine (PCV) may be given for selected clients

3. Tamoxifen may also be used for selected types of tumors

4. Temozolomide (Temodar)
How is chemotherapy delivered to treat brain tumors?
Disk-shaped drug wafers called Gliadel wafers may be placed directly into the cavity created during surgical tumor removal because chemotherapy cannot cross the blood brain barrier
What is the major drug in the wafer?
Carmustine
What are wafers usually used for?
Newly diagnosed high-grade malignant gliomas, but recurrent tumors may also be treated with this method
How are the other signs and symptoms of brain tumors treated?
1. Analgesics, such as codeine and acetaminophen (Tylenol, Ace-Tabs ), are given for headache

2. Dexamethasone (Decadron) is usually given to control cerebral edema

3. Glucocorticoids for the treatment of edema resulting from brain tumors

4. Phenytoin (Dilantin) may be used to prevent or treat seizure activity

5. Histamine blockers such as ranitidine hydrochloride (Zantac, Apo-Ranitidine) or proton pump inhibitors such as pantoprazole (Protonix) are given to decrease gastric acid secretion and prevent the development of stress ulcers

6. Metoclopramide (Reglan) and other antiemetics are used to treat nausea and vomiting