BOBBY ABRAHAM
MSC MEDICAL SURGICAL

ONCOLOGIC CONDITIONS OF BRAIN AND SPINAL
CORD
 Oncologic disorders in brain and spinal
cord include different types of neoplasms
because of unique anatomy and
physiology of central nervous system it is
challenging to diagnose and treat.

TUMOURS OF THE
BRAIN AND
SPINALCORD

BRAIN TUMOURS
 Itis an
abnormal
growth of
cells within
the brain or
outer parts

TYPES OF BRAIN TUMOURS
 Primary brain tumours
Orginates from the cells and structures
within the brain
 Secondary or metastatic brain tumours
develops from structures outside the brain

GLIOMAS
The most common type of brain neoplasms
Glial Cells (neuroglia) are the non-excitable
supporting cells of the nervous system. All
glial cells are much smaller but far more
numerous than the nerve cells

THE TUMOURS ARE NAMED AFTER THEIR CELL
OF ORIGIN
ASTROCYTOMA
 Astrocytomas are a type of neoplasm of
the brain. They originate in a particular kind
of glial-cells, star-shaped brain cells in the
cerebrum called astrocytes

Oligodendrogliomas
This is a type of glioma that are believed to
originate from the oligodendrocytes of the
brain. They occur primarily in adults but are
also found in children . The average age at
diagnosis is 35 years.[1]

EPENDYMONA
 It is a tumour that arises from the ependyma, a
tissue of the central nervous system
 These tumors can occur
anywhere in the brain or
spinal cord. The most
common site in the brain
is at the bottom of the
brain near the spinal cord.

MENINGIOMAS
 It is a set of tumors arising from the
meninges, the membranous layers
surrounding the central nervous system.
Meningiomas are the most common primary
brain tumour

ACOUSTIC NEUROMAS
 An acoustic neuroma is a tumour of the
eighth cranial nerve most responsible for
hearing and balance

PITUITARY ADENOMAS
 Pituitary adenomas are tumours that occur
in the pituitary gland

INCIDENCE AND RISK FACTORS
 In the united states,10,000 per year
 No known risk factors or etiological factors
possible causes may be
 Cell phone radiations
 Use of hair dyes
 Head traumas
 Hereditary by transfer from genes

PATHOPHYSIOLOGY
Due to oncological conditions
Tumour compresses the brain tissues
Causes neurological deficits,headache, and
seizures
edema or tumour formation
Increases intracranial pressure

CLINICAL MANIFESTATIONS
 Manifestations depend on the
location of tumour and effects of
edema
 Neurologic deficits includes
1. Weakness
2. Sensory changes
3. Visual field deficits
4. Gait disturbance
5. Personality changes
6. Headache

DIAGNOSTIC STUDIES
 History
 Physical examination
 MRI scan
 CT scan
 EEG for seizure activity
 Neuro endocrine tests for pituitary tumours
 Brain biopsy for histologic confirmation of
tumours
 Cerebrospinal fluid analysis for cytology
 Cerebral angiography to check vascularity of
tumours

CLINICAL MANAGEMENT
GOALS
1. Prolong life
2. Maintain the quality
of life

 Radiotherapy: the most commonly used
treatment for brain tumours, the tumour is
target at with alpha and beta rays to shrink
the tumour. The tumour is aimed at with the
rays in a circular motion to minimize damage
to the surrounding cells.

 Surgery: complete or partial resection of
the tumor with the objective of removing as
many tumor cells as possible

 Chemotherapy: is a treatment option for
cancer, however it is seldom used to treat
brain tumours as the blood and brain barrier
prevents the drugs from reaching the
cancerous cells. Chemotherapy can be
thought of as a poison that prevents the
growth and division of all cells in the body
including cancerous cells.

COMPLICATIONS
 Permanent neurologic deficits
 Recurring seizures

SPINAL CORD TUMOURS

 Spinal tumors are tumors located in the
spinal cord
 A tumour may be either benign or malignant.
Although a benign tumour can continue to
grow, the cells do not spread from the
original site. In a malignant tumour, the cells
can invade and destroy surrounding tissue
and may spread to other parts of the CNS.

TYPES OF SPINE TUMORS
 Intramedullary tumors
These are located within the nerves of the spinal
cord. There are several different types of cancer
of the spinal cord, but the most common are
astrocytomas and ependymonas|.
 Intradural extramedullary tumours
These start inside the coverings of the spinal
cord but outside the cord itself. Meningiomas|
and nerve-sheath tumours such as
schwannomas, are the most common types of
intradural extramedullary spinal tumor.

 Extradural spinal tumours
Some tumours start in the bones of the spine
(primary bone tumours). There are several
different types of primary bone tumours. Benign
tumours include chordomas and osteomas.
Malignant tumours include
osteosarcomas, chondrosarcomas and
fibrosarcomas.
 Secondary bone cancers
Some cancers can spread into the bones of the
spine (vertebrae) from elsewhere in the body.
They are known as secondary bone cancers|.
The most common primary cancers to spread to
the vertebrae include lung, breast, lymphoma
and prostate cancer. Myeloma is a cancer of the
plasma cells, which commonly affects the
vertabrae.

RISK FACTORS AND ETIOLOGY
 The cause of tumors that start in the spinal
cord or the membranes (meninges) covering
the spinal cord is unknown. Research is
being carried out into possible causes
 Most spinal cord tumors occur in adults

SIGNS AND SYMPTOMS
These depend on the position of the tumour
in the spinal cord. Spinal tumours often
cause symptoms by pressing on the spinal
nerves.
Common symptoms include
 Back and neck pain
 Numbness, and tingling
 Weakness in either the arms or legs, or
both.

 Other symptoms can include clumsiness and
difficulty in walking.
 Tumours in the lower part of the spinal cord
may cause loss of control of the bladder and
bowel (incontinence).

TESTS AND INVESTIGATIONS
 Depends on the type, position and size of the
tumour, so you may have a number of tests and
investigations.
 Health history taking
 Physical examination
 CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a
three-dimensional picture of the inside of the body.
The scan is painless and takes 10-30 minutes. CT
scans use small amounts of radiation, which will be
very unlikely to harm you or anyone you come into
contact with. You will be asked not to eat or drink

MRI (MAGNETIC RESONANCE IMAGING) SCAN
 This test is similar to a CT scan, but uses
magnetism instead of x-rays to build up a
detailed picture of areas of your body. Before
the scan you may be asked to complete and
sign a checklist. This is to make sure it's safe
for you to have an MRI scan.
 Lumbar puncture

CLINICAL MANAGEMENT
GOALS
 To control the symptoms
 Surgical removal of the tumor

 Dexamethasone to control edema of spinal
tumor
 Antispasmotics to control spasticity
 Anticholinergic to control reflex incontinence
 Chemotherapy for tumors
 Radiation therapy

 Deterioration of in neurologic function
 Immobility
 Respiratory problems
 Spinal cord compression

SPINAL CORD COMPRESSION

Spinal cord compression
 Spinal Cord Compression develops when
the spinal cord is compressed by a
tumour, abscess or other lesion. It is
regarded as a medical emergency
independent of its cause, and requires swift
diagnosis and treatment to prevent long-term
disability due to irreversible spinal cord injury

It develops when the spinal cord is
compressed
CAUSES
1. Vertebral fracture
2. Tumor
3. Abscess
4. Ruptured intervertebral disc

CLINICAL MANIFESTATIONS
 Sudden unusual pain
 back pain
 paralysis of limbs below the level of
compression
 decreased sensation below the level of
compression
 urinary and fecal incontinence and or urinary
retention

DIAGNOSTIC STUDIES
 History collection
 Physical examination
 X rays
 MRI
 CT scan

MANAGEMENT
 Patient and family education
 Dexamethasone
 Radiation therapy