Tumors of the brain

Incidence of primary brain tumors(benign or malignant) 12.8/100,00010%–15% of cancer patients developbrain metastases

Primary – unknownGenetic – hereditaryMetastatic35% - lung20% - breast10% - kidney5% - gastrointestinal tract

Often unknown Under investigation: Genetic changes Heredity Errors in fetal development Ionizing radiation Electromagnetic fields (including cellular phones) Environmental hazards (including diet) Viruses Injury or immunosuppression

Tissue of origin Location Primary or secondary (metastatic) Grading

Microscopic appearance Growth rate Different for other types of CA For CNS, per WHO: GX Grade cannot be assessed (Undetermined) G1 Well-differentiated (Low grade) G2 Moderately differentiated (Intermediate grade) G3 Poorly differentiated (High grade) G4 Undifferentiated (High grade)


Depends on location, size, and type of tumor Neurological deficit 68% 45% motor weakness Mental status changes HA 54% Seizures 26%

General Cerebral edema Increased intracranial pressure Focal neurologic deficits Obstruction of flow of CSF Pituitary dysfunction Papilledema (if swelling around optic disk)


Cerebral Tumors Headache Vomiting unrelated to food intake Changes in visual fields and acuity Hemiparesis or hemiplegia Hypokinesia Decreased tactile discrimination Seizures Changes in personality or behavior



Brainstem tumors Hearing loss (acoustic neuroma) Facial pain and weakness Dysphagia, decreased gag reflex Nystagmus Hoarseness Ataxia (loss of muscle coordination) and dysarthria (speech muscle disorder) (cerebellar tumors)


Cerebellar tumors Disturbances in coordination and equilibrium Pituitary tumors Endocrine dysfunction Visual deficits Headache


Frontal Lobe Inappropriate behavior Personality changes Inability to concentrate Impaired judgment Memory loss Headache Expressive aphasia Motor dysfunctions


Parietal lobeSensory deficitsParesthesiaLoss of 2 pt discriminationVisual field deficitsTemporal lobePsychomotor seizures – temporal lobe-judgment, behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousnessOccipital lobeVisual disturbances

Gliomas Astrocytoma (Grades I & II) Anaplastic Astrocytoma Glioblastoma Multiforme Oligodendroglioma Ependymomas Medulloblastoma CNS Lymphoma

Grade I Non-infiltrating

Grade II Infiltrating Slow growing

Grade III Infiltrating Aggressive

Grade IV Highly infiltrative Rapidly growing Areas of necrosis


Grades II-IV Mixed astro/glio

Slow growing Benign HCP/ICP Surgery, RT, Chemo

Small cell embryonal neoplasms Malignant HCP/ICP

Primary CNS lymphoma B lymphocytes Increased ICP Brain destruction

Meningioma Metastatic Acoustic neuromas (Schwannoma) Pituitary adenoma Neurofibroma

Usually benign Slow growing Well circumscribed Easily excisable

Peritumoral edema Necrotic center

Benign Schwannoma cells CN VIII

Benign Anterior pituitary Endocrine dysfxn

Cystic tumor Hypothalamic-pituitary axis dysfunction

Radiological Imaging Computed Tomography scan (CT scan) with/without contrast Magnetic Resonance Imaging (MRI) with/without contrast Plain films Myelography Positron Emission Tomography scan (PET scan) LP/CSF analysis Pathology

Resection Craniotomy Stereotaxis Surgery Biopsy Transsphenoidal

Drug therapy – Palliative Done for symptom treatment and to prevent complicationsNSAIDsAnalgesics – Steroids (Decadron, medrols, prednisone)Anti-seizure medications (phenytoin) Dilantin & CerebyxHistamine blockersAnti-emetics Muscle relaxers (for spasms)Mannitol for ICP –New Hypertonic saline

Increased ICP Hematoma Hypovolemic shock Hydrocephalus Atelectasis Pulmonary edema Meningitis Fluid and electrolyte imbalances (ADH)
Wound infection Seizures CSF leak Edema

Follow-up appointments and procedures Medications Exercise Diet Patient may need referral to dietician to help with diet planning while undergoing chemotherapy Seizures Are a risk for 1 or more years following surgery If expecting long term changes, coordinate discharge planning with appropriate members of health care team

Damages DNA of rapidly dividing cells4000–6000 Gy total doseDuration of 4–8 weeksBrachytherapyStereotactic radiosurgery

Slows cell growth Cytotoxic drugs CCNU, BCNU, PCV, Cisplatin, Etoposide, Vincristine, Temozolomide (Temodar)