Ms SAHELI C.
1ST YEAR M.Sc NURSING.
RINER

INTRODUCTION :-
 A brain tumour is an abnormal cell growth inside the
brain, skull, which encloses the brain.
 When normal cells grow old or get damaged, they die.
And new cells take their place. Sometimes these process
goes wrong and new cells grows when body does not need
them and the old/damaged cells do not die as they should
and leads to abnormal growth in the brain.
 Brain is a very rigid structure, any growth inside this
restricted place , can cause problem.
 When these tumours grow inside the brain, it increases
intracranial pressure which can cause brain damage.

 World Brain tumour day is observed on 8th of JUNE
every year since 2000 .
 This day first observed by German Brain Tumour
Association. This is a non profit organization which
raises public awareness and educates people about
brain tumour because malignant brain tumour is very
common.

DEFINITION :-
 Brain tumour is a localized,
intracranial lesion, mass ,
or abnormal cell growth
that occupies space within
the skull.
 Brain tumours can be
benign or malignant ,that
grow quickly.
 Some are primary brain
tumours, which start in the
brain. Others are
metastatic, and they start
somewhere else in the body
and move to the brain.

INCIDENCE AND PREVALENCE
 The incidence and prevalence of brain tumour is
growing in India.
 More than 500 new cases are diagnosed with brain
tumour everyday worldwide.
 More than 1 million cases per year in India, of these 20
percent are children.
 This is the most common type of cancer among
children.

CLASSIFICATION OF BRAIN TUMOUR
1. PRIMARY BRAIN TUMOUR: Primary brain tumour originates
from cells and structures within the brain. Primary brain tumour
subdivided into following categories:-
a. Intracerebral tumour : also called as gliomas. This include-
 Astrocytoma- The tumour which arises from astrocytes (star
shaped glial cell).
 Oligodendrocytoma- This rare tumour arises from cells that make
the fatty substance that covers and protects nerve, usually occurs
in the cerebrum.
 Glioblastoma multiforme- These are grade 3 and grade 4
astrocytoma.
 Ependymoma- The tumour that arises from cells that line the
ventricles or the central canal of the spinal cord. More common in
children.
 Medulloblastoma- This tumour arises in the cerebellum,
sometimes called as primitive neuroectodermal tumour.

b. Tumour arising from supporting structure : This
include the following:-
 Meningioma – This tumour arises in the meninges.
 Acoustic neuroma- Tumour that arise in the cranial nerve
VIII.
 Schwannoma- A tumour that arises from a Schwann cell of
neuron.
 Pituitary adenoma- Tumour that arises in the pituitary
gland.
 Pineal region tumour- this rare brain tumour arises in or
near the pineal gland.
 Germ cell tumour of the brain- this type of tumour arises
from a germ cell.

c. Developmental tumour : This include the following:
 Angiomas: Masses composed largely of abnormal blood vessels, are
found either in or on the surface of the brain. They occur in the
cerebellum.
 Craniopharyngioma: This type of tumour grows at the base of the
brain, near the pituitary gland.
 Dermoid tumour: It is a sac like growth that is present at birth,
contains structures such as hair, fluid, teeth and skin glands that
can be found inside the skull.
 Epidermoid tumour : This tumours occurs when the normal
developmental cells are trapped within the growing brain. It has a
thin outer layer of epithelial cells surrounding fluid, keratin and
cholesterol.
2. SECONDARY BRAIN TUMOUR: This are metastasis brain
tumour developed from structures outside the brain and migrate to
brain.

CAUSES AND RISK FACTORS:
Being male.
Race .
Age .
Family history.
Genetic risk.
Exposure to radiation , radiation to he
head.
Exposure to formaldehyde.
Exposure to vinyl chloride.
HIV infection.
Smoking .
Use of cell phones.
Use of hair dyes.

PATHOPHYSIOLOGY
OF BRAIN TUMOUR.

CLINICAL MANIFESTATION:
 Generalized symptoms:-
 Increased Intra Cranial pressure.
Vomiting ( Projectile vomiting ).
 Visual disturbances (Diplopia, Papilledema, loss of visual acuity).
Headache (Most common in the early morning and made worse by
coughing or straining ).
 Localized symptoms are-
 Hemiparesis (experiencing one sided weakness in arms, hands,
face, chest, legs or feet)
Seizures.
Mental status changes.
Alteration in cognition.
Personality changes as in case of frontal lobe tumour.
Sensory defects ( smell, hearing).
Language disturbances e.g. Aphasia (Aphasia is an inability to
comprehend and formulate language because of damage to
specific brain regions.)

Parietal tumour:
 Impaired speech.
 Inability to write.
 Memory disturbances.
 Lack of recognition.
 Seizures.
 Confusion.
 Depression.
Frontal lobe tumour:
 Behavioural and emotional changes.
 Impaired judgement.
 Memory loss.
 Hemiplegia (paralysis of one side of body).
 Vision loss.
 Papilledema ( inflammation of optic nerve).
 Reduced mental capacity.

Temporal lobe tumour:
 Asymptomatic but some times may cause memory
disturbances, auditory hallucinations, visual field
deficit.
Occipital lobe tumour:
 Visual loss in half of visual field on the opposite side of
tumour.
 Visual hallucinations.
Cerebellar area:
 Coordination, gait and balance disturbances.
 Tinnitus and vertigo.
 Numbness and tingling.
 Weakness or paralysis of face.

Brain stem tumour:
 Drowsiness.
 Difficulty in speaking and swallowing.
 Muscle weakness of one side of face.
 Uncoordinated gait.
 Hemiparesis.
 Behavioural and emotional changes.
 Hearing loss.
 Drooping eyelid.
 Respiratory depression.
 Cardio vascular instability.
 Cranial nerve dysfunction.
 Coma.

DIAGNOSTIC EVALUATION:
1. Neurological examination:

 2. CT Scan, MRI, Positron Emission Tomography

 3. Electroencephalogram . 4) Angiogram

5. Skull X-ray 6) Biopsy

SURGICAL MANAGEMENT:
 Craniotomy : craniotomy is the treatment of choice of
removal of tumour. The procedure is performed under
general anaesthesia and involves opening the skull
(cranium ). The neurosurgeon makes several holes
(called as burr holes ) into the scalp and then a bone
saw is used to join the holes together to create a flap of
bone. The bone flap is then removed to expose the
brain and to remove the tumour.

Trans sphenoidal micro-surgical
removal of tumour:
 It is an approach that gains
access to pituitary gland
through nasal cavity and
sphenoid sinuses. MRI is
used to pinpoint the
location of the tumour and
a laser is used to destroy
the tumour. This
procedure may be used
after craniotomy to remove
remaining tumour tissue.

Debulking surgery:
 Partial removal (debulking ) of the tumour can
improve quality of life by alleviating symptoms and
sometimes improve the effectiveness of radiation
therapy or chemotherapy.

Radiation therapy
Conventional therapy is 5000 -6000 centrigray of external
radiation over 5-6 weeks

Brachytherapy:
 The surgical implantation
of radiation sources for
eg. (Iodine 131 ) to deliver
high dose of radiation at a
short distance for high
grade malignant tumour,
while minimizing effects
on surrounding brain
tissue.

Stereotactic radiation therapy:
Narrow beams of radiation are directed at the tumour
from different angles. For this procedure, the patient
wears a rigid head frame. An MRI or CT Scan creates
pictures of the tumour’s exact location. The doctor
uses a computer to decide on the dose of the radiation
needed, as well as the sizes and angles of the radiation
beans. The therapy may be given during a single visit
or several visit.

Chemotherapy :
 Chemotherapy is the use of drug to kill the cancer cells.
The drugs may be given by mouth or by injection. The
drugs enters the blood stream and travels throughout the
body and destroy the cancer cell.
 Some example of this drug include-
Procarbazine.
Temozolomide.
Interferon.
Cisplastin
Carboplatin

SUPPORTIVE CARE:-
 Steroids : most patient with brain tumours need
steroids to help relieve swelling of the brain.
Eg, Dexamethasone may be used before and after
treatment to reduce cerebral edema.
 Anticonvulsant medicine:
Brain tumours can cause seizure. Anticonvulsant are
used to prevent and control seizures.
 Shunt : if fluid builds up in the brain, the surgeon
may place a shunt to drain the fluid.

Nursing management
 History collection
 Physical examination.
 Monitor ICP and cerebral perfusion pressure.
 Use strict aseptic techniques.
 Monitor and record vital signs and neurological status
continuously.
 Observe for signs of increased intracranial pressure.
 Maintaining normal respiratory pattern.
 Assess respiratory parameters and monitor ABG.
 Suction mouth and throat if needed to maintain the
airway.
 prevent the patient from injury.

 Maintain body position without flexion of head, and
reduce hip flexion.
 For patient with visual field deficits place materials in
visual field.
 Provide appropriate care and teaching for chemotherapy.
 Maintain adequate hydration and nutrition.
 Perform oral hygiene before and after meals to improve
intake.
 Monitor intake and output chart.
 Provide for total self care requirement.
 Encourage planning for each day.
 Maintain range of motion exercises for each joints.
 Supporting nursing care based on the symptoms.

Rehabilitation after treatment for
brain tumour:
 Physical therapy : it involves improving strength and
motor function.
 Speech therapy: in involves restoring the ability to
speak clearly.
 Occupational therapy: in involves restoring normal
daily functioning by the help of occupational
therapists. Therapist help patient to manage activities
of daily living such as eating, using the toilet, bathing ,
dressing, grooming etc.

ASSIGNMENT
List the 4 nursing diagnosis and
write the care plan in patients
with brain tumour ,undergone
for surgery.