Oncologic conditions of brain and spinal cord

lecturer in critical care nursing à peoples college of nursing and research centre.bhopal
7 Aug 2012

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Oncologic conditions of brain and spinal cord

  2. 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.
  4. BRAIN TUMOURS  Itis an abnormal growth of cells within the brain or outer parts
  5. 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
  6. 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
  7. 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
  8. 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]
  9. 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.
  10. 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
  11. ACOUSTIC NEUROMAS  An acoustic neuroma is a tumour of the eighth cranial nerve most responsible for hearing and balance
  12. PITUITARY ADENOMAS  Pituitary adenomas are tumours that occur in the pituitary gland
  13. 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
  14. PATHOPHYSIOLOGY Due to oncological conditions Tumour compresses the brain tissues Causes neurological deficits,headache, and seizures edema or tumour formation Increases intracranial pressure
  15. 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
  16. 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
  17. CLINICAL MANAGEMENT GOALS 1. Prolong life 2. Maintain the quality of life
  18.  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.
  19.  Surgery: complete or partial resection of the tumor with the objective of removing as many tumor cells as possible
  20.  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.
  21. COMPLICATIONS  Permanent neurologic deficits  Recurring seizures
  23.  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.
  24. 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.
  25.  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.
  26. 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
  27. 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.
  28.  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).
  29. 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
  30. 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
  31. CLINICAL MANAGEMENT GOALS  To control the symptoms  Surgical removal of the tumor
  32.  Dexamethasone to control edema of spinal tumor  Antispasmotics to control spasticity  Anticholinergic to control reflex incontinence  Chemotherapy for tumors  Radiation therapy
  33.  Deterioration of in neurologic function  Immobility  Respiratory problems  Spinal cord compression
  35. 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
  36. It develops when the spinal cord is compressed CAUSES 1. Vertebral fracture 2. Tumor 3. Abscess 4. Ruptured intervertebral disc
  37. 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
  38. DIAGNOSTIC STUDIES  History collection  Physical examination  X rays  MRI  CT scan
  39. MANAGEMENT  Patient and family education  Dexamethasone  Radiation therapy