Management of Patients with Oncologic or  Brain tumors are classified as primary or

Degenerative Neurologic Disorders secondary.

a. Primary brain tumors originate from cells within
bradykinesia: abnormally slow voluntary movements the brain.
and speech  In adults, most primary brain tumors originate
chorea: rapid, jerky, involuntary, purposeless from glial cells (cells that make up the structure
movements of the extremities or facial muscles, and support system of the brain and spinal cord)
including facial grimacing and are supratentorial (located above the
covering of the cerebellum).
dementia: broad term for a syndrome characterized  Primary tumors progress locally, rarely
by a general decline in higher brain functioning, such metastasize outside the CNS, and have a 5-year
as reasoning, with a pattern of eventual decline in survival rate of 33.4%.
ability to perform even basic activities of daily living,  Although many risk factors have been
such as toileting and eating investigated, exposure to ionizing radiation is the
dyskinesia: impaired ability to execute voluntary only known modifiable risk factor. Many genetic
movements factors and genetic syndromes (such as
neurofibromatosis) are associated with brain
dysphonia: voice impairment or altered voice tumor risk in families.
production neurodegenerative: deterioration of cells b. Secondary, or metastatic, brain tumors develop
or function of the nervous system from structures outside the brain and are twice as
common as primary brain tumors.
papilledema: edema of the optic nerve usually due to
 Metastatic lesions to the brain can occur from
increased intracranial pressure (ICP)
the lung, breast, lower gastrointestinal tract,
paresthesia: numbness, tingling, or a “pins and pancreas, kidney, and skin (melanomas)
needles” sensation neoplasms.
 Single or multiple metastases may occur, and
sciatica: pain and tenderness that radiates along the brain metastases may be found at any time
sciatic nerve that runs through the thigh and leg during the disease course, even at initial
spondylosis: degenerative changes occurring in a disc diagnosis of the primary disease.
and adjacent vertebral bodies; can occur in the  Patient survival rates from primary brain cancers
cervical or lumbar vertebrae are improving, however, the incidence of brain
metastases is increasing
 There is a slight male predominance in the
incidence of malignant brain tumors.
ONCOLOGIC DISORDERS OF THE BRAIN AND SPINAL
CORD
1. Brain Tumors Types of Primary Brain Tumors
A brain tumor occupies space within the skull, growing  Brain tumors may be classified into several
as a spherical mass or diffusely infiltrating tissue. The groups:
effects of brain tumors are caused by inflammation,  those arising from the coverings of the
compression, and infiltration of tissue. A variety of brain (e.g., dural meningioma),
physiologic changes result, causing any or all of the  those developing in or on the cranial
following pathophysiologic events nerves (e.g., acoustic neuroma),
 those originating within brain tissue (e.g.,
 Increased intracranial pressure (ICP) and
glioma)
cerebral edema
 metastatic lesions originating elsewhere
 Focal neurologic signs such as headache
in the body.
 Seizure activity
 Tumors of the pituitary and pineal glands and
 Hydrocephalus
of cerebral blood vessels are also types of
 Altered pituitary function
brain tumors.
 About 70% of the time tumors are benign but
even benign tumors, such as colloid cysts, can
 Neoplastic lesions in the brain ultimately cause occur in vital areas and can grow large enough
death by increasing ICP and impairing vital to have serious effect.
functions, such as respiration.
  Categorized as low or high grade (anaplastic).
Classification of Brain Tumors in Adults  Histologic distinction from astrocytomas is
difficult but important.
I. Intracerebral Tumors
A. Gliomas—infiltrate any portion of the brain;  Oligodendrogliomas are more sensitive to
most common type of brain tumor chemotherapy than astrocytomas.
1. Astrocytomas (grades I and II)
 Ependymomas:
2. Glioblastoma (astrocytoma grades III and
IV) 3.  Arise from ependymal cells (another type of glial
3. Oligodendroglioma (low and high grades) cell).
4. Ependymoma (grades I to IV)
5. Medulloblastoma  More common in children than adults.
II. Tumors Arising from Supporting Structures
A. Meningiomas
B. Neuromas (acoustic neuroma, schwannoma) Treatment of Glial Tumors:
C. Pituitary adenomas
 Combination of surgery, radiation therapy, and
III. Developmental Tumors
chemotherapy.
A. Angiomas
 Treatment depends on:
B. Dermoid, epidermoid, teratoma,
craniopharyngioma  Specific cell type.
IV. Metastatic Lesions
 Patient characteristics.

 Tumor location
I. Gliomas: Account for approximately 25% of
symptomatic primary brain tumors in adults.
 Most common type of intracerebral brain II. Meningiomas
neoplasm. Prevalence: Represent 37% of all primary brain
 Divided into various categories tumors.

 Astrocytomas: Nature: Benign, encapsulated tumors of arachnoid

cells on the meninges.
 Arise from astrocytic cells.
Growth: Slow-growing; more common in women and
 Most common type of glioma. middle-aged adults.
 Graded I to IV based on: Location: Often found near venous sinuses.
 Cellular density. Manifestations:
 Cell mitosis.  Symptoms depend on the affected area.
 Degree of differentiation from original cell  Often result from compression rather than
type. invasion of brain tissue.
 Grades III and IV are glioblastomas, which Treatment:
have little resemblance to the original cell
type.  Preferred: Surgery (complete removal or
partial dissection).
 Infiltrate surrounding neural tissue, making
total removal difficult without damaging vital  Radiation therapy: Useful in specific cases.
structures.  Metastasis: Rare.
 Oligodendroglial Tumors:  Surgical Challenges:
Difficult to remove completely without
 Arise from oligodendroglial cells (about 1.4% causing neurologic deficits if:
of gliomas).
 Located at the base of the skull.
 Occur most often in adults aged 50-60, and
are more common in men than women.  Surrounding the optic nerve.
 Rarely invasive.
 o Hypothalamic disorders (e.g., sleep,
appetite, temperature, and emotion
Association:
regulation).
 Multiple meningiomas may occur with o Increased intracranial pressure (ICP).
neurofibromatosis type 2. o Enlargement/erosion of the sella
turcica.

III. Acoustic Neuromas: Hormonal Effects

Prevalence: Account for 16% of brain tumors.  Functioning adenomas overproduce

Demographics: hormones from the anterior pituitary.
 Affects men and women equally.  Hormonal hypersecretion caused only by
 Most common in the fifth decade of life. pituitary adenomas.
Nature: Tumor of the eighth cranial nerve (responsible  Commonly overproduced hormones include:
for hearing and balance). o Prolactin (prolactinomas): Excess
Location: secretion leads to:
 Arises within the internal auditory meatus.  Women: Amenorrhea,
 Frequently expands into the cerebellopontine galactorrhea
recess. (spontaneous/excessive milk
Growth: Slow-growing, often reaching considerable flow).
size before diagnosis.  Men: Impotence,
Manifestations: hypogonadism.
 Hearing loss, tinnitus, vertigo, and staggering o Growth hormone (GH): Causes
gait. acromegaly in adults:
 Larger tumors may cause:  Enlarged hands/feet.
 Painful facial sensations (compression of the  Distorted facial features.
fifth cranial nerve).  Peripheral nerve pressure
Management: (entrapment syndromes).
 Many are benign and managed o Adrenocorticotropic hormone
conservatively. (ACTH): Results in Cushing’s disease:
 Surgical removal is possible with a good  Obesity (fat redistribution to
prognosis for growing tumors. face, supraclavicular,
 Stereotactic radiotherapy is an alternative to abdominal areas).
open craniotomy for some cases.  Hypertension, purple striae,
ecchymoses.
IV. Pituitary Adenomas: Key Notes  Osteoporosis, elevated blood
glucose.
 Prevalence: Account for ~16% of primary brain  Emotional disorders.
tumors. o Thyroid-stimulating hormone (TSH):
 Demographics: Rarely overproduced.
o Can occur at any age; more common in o Follicle-stimulating hormone
older adults. (FSH)/luteinizing hormone (LH):
o Women affected more often than men, Infrequent overproduction.
particularly during childbearing years.
 Nature: Rarely malignant; symptoms arise from Notable Associations
pressure effects or hormonal changes.
 Tumors producing both GH and prolactin are
Pressure Effects relatively common.

 May exert pressure on:

Optic nerves, optic chiasm, optic tracts.
Hypothalamus or third ventricle (if tumor Gerontologic Considerations
invades cavernous sinuses or sphenoid bone).
Brain Tumors in Older Adults: Key Notes
 Symptoms include:
o Headache.  Incidence: Increases with age.
o Visual dysfunction.
Common Symptoms: Survival Rate:

 Personality changes.  2-year survival rate for metastatic brain

 Confusion. tumors is less than 10%.
 Speech dysfunction.  Increasing prevalence due to longer cancer
 Gait disturbances. survival from improved therapies.

Challenges in Diagnosis: Neurologic Signs and Symptoms:

 Early signs can be overlooked or  Headache

misattributed to normal aging-related  Gait disturbances
cognitive and neurologic changes.  Visual impairment
 Requires careful evaluation, especially in  Personality changes
patients with a history of cancer, due to  Altered mentation (e.g., memory loss,
potential brain metastases. confusion)
 Focal weakness and paralysis.
Nursing Role:  Aphasia
 Seizures
 Provides supportive care regardless of
the patient's age or treatment decisions. Leptomeningeal Metastases:

Impact of Frailty:  Metastases to CSF and meninges.

 Symptoms include:
o Frailty significantly affects clinical o Headache.
outcomes post-brain tumor resection. o Isolated cranial nerve deficits.
o Moderately frail or frail patients:
 Higher risk for prolonged Impact: Signs and symptoms can be devastating for
hospital stays. both patients and families.
 Increased likelihood of
discharge to long-term care
facilities instead of home.
Medical Management
Clinical Manifestations
Goal:
 Neurologic Signs and Symptoms:
o Can be generalized or focal.  Palliative care to eliminate or reduce serious
symptoms.
Generalized Symptoms  Focus on improving quality of life for both
patient and family.
 Reflect increased intracranial pressure (ICP).
Prognosis:
Focal Symptoms
 Poor for untreated intracerebral metastases
 Result from interference with specific brain with limited survival time.
region functions.
 Symptoms depend on the tumor's location Therapeutic Options:
within the brain.
 Whole brain radiation therapy: Standard
Cerebral Metastases treatment for multiple metastases.
 Stereotactic radiosurgery: For up to three
 Neurologic deficits often caused by cancer metastasis sites.
metastasis to the brain, CSF, and meninges.  Surgery: Considered for a single symptomatic
 Metastatic brain tumors are more common metastasis.
than primary brain tumors.  Systemic chemotherapy:
o Often ineffective at crossing the
blood-brain barrier.
 o Chemotherapy that does cross the o Loss of bowel and bladder function.
barrier may be added.
 Intrathecal chemotherapy: Assessment and Diagnostic Findings
o Direct injection into the CSF of the
brain or spinal canal.  Neurologic examination:
o Useful for metastases in these o Focus on assessing pain.
regions. o Identifies loss of reflexes, sensation,
 Combination therapy: Usually the most or motor function.
effective approach.  Diagnostic tools:
o MRI scans: Most commonly used and
Pain Management: sensitive for detecting spinal cord
compression and metastases.
 Stepped progression in doses and types of o CT scans and biopsy may also be
analgesics. utilized.
 For severe pain:
o Morphine infusion into the epidural
or subarachnoid space.
o Administered through a spinal needle Medical Management
and catheter placed near the pain
source.  Treatment options depend on:
o Small doses given at prescribed o Tumor type and location.
intervals. o Presenting symptoms and patient’s
physical status.
Spinal Cord Tumors  Surgical intervention: Primary treatment for
most spinal cord tumors.
 Classification by Location:  Adjuvant treatments:
 Intramedullary lesions: Within the spinal cord. o Chemotherapy and radiation therapy.
 Extramedullary-intradural lesions: Within or o High-dose dexamethasone with
under the spinal dura. radiation therapy for spinal cord
 Extramedullary-extradural lesions: Outside compression from metastatic cancer.
the dural membrane.  Palliative care: Considered for some patients.

 Tumor Types:

 Primary tumors: Usually intramedullary (e.g.,

Surgical Management
astrocytoma, ependymoma).
o Meningiomas can occur as
 Goal: Remove as much tumor as possible
extramedullary-intradural lesions. while preserving spinal cord function.
 Secondary tumors:  Emergency surgery: Needed for sudden
motor, sensory, or bowel and bladder
o Far more common. function loss.
o Usually extramedullary-extradural  Prognosis influenced by:
lesions. o Neurologic status at the time of
surgery.
 Symptoms: o Speed of symptom progression.
o Pain: o Tumor origin.
 Localized or shooting pain.
 Sharp pain in areas
innervated by spinal roots
near the tumor.
Nursing Management
o Weakness.
o Loss of reflexes below tumor level.
Providing Preoperative Care
o Progressive motor function loss and
paralysis.
 Recognize neurologic changes with frequent
o Sensory deficits below the lesion
assessments.
level.
  Address pain and assist with ADLs affected by  Assess for independence at home and
motor and sensory deficits. caregiver availability.
 Assess for:  Sensory deficits:
o Weakness, muscle wasting, spasticity, o Warn about dangers of extreme
sensory changes. temperatures and heating devices.
o Bowel and bladder dysfunction. o Emphasize daily skin integrity checks.
o Respiratory problems if a cervical  Motor function impairments: Provide training
tumor is present. for ADLs and use of assistive devices.
 Evaluate for coagulation issues and  Teach:
anticoagulant use. o Pain management.
 Educate on: o Bowel and bladder management.
o Breathing exercises. o Signs and symptoms to report
o Postoperative pain management promptly.
strategies.
Continuing and Transitional Care
Postoperative Assessment and Care
 Referral to inpatient or outpatient
 Frequent assessments for neurologic changes. rehabilitation if needed.
o Sudden neurologic deficit may  Home visits to assess:
indicate spinal cord ischemia or o Neurologic function, respiratory and
infarction. nutritional status.
o Assess strength, movement, and o Pain management adequacy.
sensation of extremities.  Discuss end-of-life care preferences if
 Monitor vital signs to detect complications necessary.
early.  Consult social workers for support services.

Pain Management

 Administer prescribed pain medications

effectively.
 Use logrolling techniques for positioning to
maintain spinal alignment.
 Encourage a side-lying position with a pillow
between knees.

Monitoring for Complications

 Cervical area tumors: Watch for respiratory

compromise (e.g., asymmetric chest
movement, abnormal breath sounds).
 Urinary dysfunction:
o Palpate bladder or use a bladder scan
for retention.
o Monitor for incontinence.
 Bowel function:
o Auscultate for bowel sounds.
 CSF leakage: Monitor for staining or bulging at
the surgical site.

Promoting Home, Community-Based, and

Transitional Care

Educating Patients About Self-Care