Brain tumors

Definition: it is defined as abnormal, autonomous, uncontrolled, uncoordinated and purposeless growth of cells within the brain. Causes of cancer: 1. Familial causes: family history of certain genetic disorders like neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, and Li-Fraumeni syndrome. Neurofibromatosis: formerly known as von Recklinghausen disease is a human genetic disorder. It is possibly the most common inherited disorder caused by a single gene.it is caused by a mutation of a gene on the long arm of chromosome 17 which encodes a protein known as neurofibromin (not to be confused with the disorder itself) which plays a role in cell signaling.( Cell signaling is part of a complex system of communication that governs basic cellular activities and coordinates cell actions. The ability of cells to perceive and correctly respond to their microenvironment is the basis of development, tissue repair, and immunity as well as normal tissue homeostasis. Errors in cellular information processing are responsible for diseases such as cancer, autoimmunity, and diabetes.) tuberous sclerosis: Tuberous sclerosis or tuberous sclerosis complex (TSC) is a rare multi-system genetic disease that causes non-malignant tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. TSC is caused by a mutation of either of two genes, TSC1 and TSC2, which code for the proteins hamartin and tuberin respectively. These proteins act as tumor growth suppressors, agents that regulate cell proliferation and differentiation. Von HippelLindau (VHL) is a rare, autosomal dominant genetic condition, VHL results from a mutation in the von HippelLindau tumor suppressor gene on chromosome. Li-Fraumeni syndrome is an extremely rare autosomal dominant hereditary disorder. The syndrome is linked to germline mutations of the p53 tumor suppressor gene,[2] which normally helps control cell growth

2. Chemicals/Environment Asbestos Exposure and Cancer Risk Agricultural Hair Dyes and Cancer Risk Tobacco

Formaldehyde - Pathologists and embalmers who work with formaldehyde have an increased risk of developing brain cancer. Scientists have not found an increased risk of brain cancer among other types of workers exposed to formaldehyde. Vinyl chloride - Workers who make plastics may be exposed to vinyl chloride. This chemical may increase the risk of brain tumors. Acrylonitrile - People who make textiles and plastics may be exposed to acrylonitrile. This exposure may increase the risk of brain cancer.

3. Food

Acrylamide in Food and Cancer Risk Artificial Sweeteners and Cancer Fluoridated Water Chemicals in Meat Cooked at High Temperatures and Cancer Risk

4. Hormones

Women & Cancer: Pregnancy, Contraceptives, and Post-menopausal Hormone Use Diethylstilbestrol (DES) and Cancer

5. Infectious Agents

HIV Infection and Cancer Risk HPV and Cancer

6. Radiation

Cell Phones Magnetic Field Exposure Accidents at Nuclear Power Plants Radioactive I-131 from Fallout Radiation Risks and Pediatric Computed Tomography (CT) Sunlight

7. Metastasis: secondary brain tumors occur due to metastasis from other distant organs. 8. Others: Chronic scarring of brain tissue Head injury
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Chronic and recurrent infections. Viral infections

Types: it include 2 types, benign tumors and malignant tumors. Benign tumors: Usually, benign tumors can be removed, and they seldom grow back. The border or edge of a benign brain tumor can be clearly seen. Cells from benign tumors do not invade tissues around them or spread to other parts of the body. However, benign tumors can press on sensitive areas of the brain and cause serious health problems. Unlike benign tumors in most other parts of the body, benign brain tumors are sometimes life threatening. Very rarely, a benign brain tumor may become malignant. Malignant brain tumors: Malignant brain tumors are generally more serious and often life threatening. They are likely to grow rapidly and crowd or invade the surrounding healthy brain tissue. Very rarely, cancer cells may break away from a malignant brain tumor and spread to other parts of the brain, to the spinal cord, or even to other parts of the body. The spread of cancer is called metastasis. Sometimes, a malignant tumor does not extend into healthy tissue. The tumor may be contained within a layer of tissue. Or the bones of the skull or another structure in the head may confine it. This kind of tumor is called encapsulated. Benign tumors Malignant tumors Pituitary adenoma Acuostic neuroma meningioma Craniopharyngioma Medulloblastoma Anaplastic astrocytoma and Glioblastoma Apendymoma Brain stem glioma

Pliocytic Astrocytoma and low grade astrocytoma Oligodendrioma Optic nerve glioma

Pituitary Tumors (Benign)

The pituitary gland produces hormones that affect growth and the functions of other glands in the body. Certain pituitary tumors secrete abnormally high amounts of their respective hormones and cause related symptoms. Other pituitary tumors do not secrete hormones, but grow and compress brain tissue, causing other symptoms. Tumors which exceed 10 mm in size are defined as macroadenomas, and those smaller than 10 mm are referred to as microadenomas. Characteristics

Named for its location on or near the pituitary gland, located at the center of the brain behind and above the nose Can range from low grade to high grade May cause excessive secretion of hormones Common among men and women in their 50s-80s Accounts for about 13 percent of all brain tumors

Clinical manifestations: occurs due to hormonal overproduction and compression of brain structures. Gigantism is a condition occurs due to increased secretion of growth hormone. It is manifested as increase size of hands and feet, acromegaly. Spleenomegaly, hepatomegaly etc. Elevation of blood glucose Increase TSH leads to hyperthyroidism which is manifested as increased BMR, increase body temperature and increase catecholamines, catecholamines leads to increase heart rate and blood pressure. Increase level of gonadotrophins leads to impotence and decreased libido in males and menstrual abnormalities in females. Gallactorrhea due to increased prolactin level. Increase ACTH leads to increase level of glucocorticoids which increase breakdown of proteins and increase glucose production. It also depress the immune system of body which accounts for further uninterrupted growth of tumor. Posterior pituitary tumor leads to increase production of ADH which leads to oliguria, sodium and water retention, edema and increased blood pressure. Oxytocin causes dysmenorrheal, abortion and galactorrhea. Others:Headache, Depression. Nausea or vomiting, Behavioral and cognitive changes, Hair growth in women Vision loss due to compression of optic nerve.

Acoustic Neuroma (Benign)

An acoustic neuroma is also known as vestibular schwannoma, or neurilemmoma.it is a benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (CN VIII). The term "vestibular schwannoma" involves the vestibular portion of the 8th cranial nerve and arises from Schwann cells, which are responsible for the myelin sheath in the peripheral nervous system. Characteristics

Arises from cells that form a protective sheath around nerve fibers Typically grows around the eighth cranial nerve, but can be found around other cranial or spinal nerves Symptoms: Tinnitus Ear ache Vertigo Balance and coordination problems Headache Hearing loss

Meningioma (Benign)
These tumors grow from the meninges, the layers of tissue covering the brain and spinal cord. As they grow, meningiomas compress adjacent brain tissue. Symptoms are often related to this compression of brain tissue, which can also affect cranial nerves and blood vessels. In some cases, meningioma growth can also extend into the bones of the head and face, which may produce visible changes. Most meningiomas are considered nonmalignant or low grade tumors. However, unlike nonmalignant tumors elsewhere in the body, some of these brain tumors can cause disability and may sometimes be life threatening. In many cases, meningiomas grow slowly. Other meningiomas grow more rapidly or have sudden growth spurts. There is no way to predict the rate of growth of a meningioma or to know for certain how long a specific tumor was growing before diagnosis. Meningiomas are graded from low to high. The lower the grade, the lower the risk of recurrence and aggressive growth. The WHO classification divides meningiomas into three grades: Grade I: Benign Meningioma Grade II: Atypical Meningioma
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Grade III: Malignant (Anaplastic) Meningioma Characteristics

May arise after previous treatment from ionizing radiation or excessive x-ray exposure Common among women and men in their 40s-50s, but can occur at any age Twice as common in women as in men Accounts for 34 percent of all primary brain tumors In very rare cases, can invade the skull or metastasize to the skin or lungs Women with meningiomas can experience tumor growth during pregnancy In rare cases, multiple meningiomas can develop at the same time in different parts of the brain and/or spinal cord

Clinical manifestations results from compression of brain structures.

Craniopharyngioma (Benign):
A craniopharyngioma is a benign tumor that develops near the pituitary gland Characteristics

Most common in the parasellar region, an area at the base of the brain and near the optic nerves Also grows in the regions of the optic nerves and the hypothalamus, near the pituitary gland Tends to be low grade Often accompanied by a cyst Originates in cells left over from early fetal development Occurs in children and men and women in their 50s and 60s

Symptoms Due to compression of optic nerve: Cloudy or haloed vision Nausea or headaches Light sensitivity (photophobia) Excessive blinking (blepharospasm) Crossed or out-turned eyes (strabismus) Excessive tearing (epiphora) Decreased vision (amblyopia)
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Diplopia Vision loss

Due to pituitary gland compression: it leads to decresed pituitary gland activity. Symptoms will be Dwarfism is a condition occurs due to decreased secretion of growth hormone. It is manifested as decrease size of hands and feetand growth retardation decrease TSH leads to hypothyroidism which is manifested as slowing of metabolic rate, obesity,dull skin, dry hair,slow movements, arthalgia,decreased libido, intolerance to cold. Decrease level of gonadotrophins leads to impotence and decreased libido in males and menstrual abnormalities in females. Decrease ACTH leads to adrenal insufficiency i.e. Addisons disease, symptoms are weight loss, hyperpigmantation of face, fatigue, decrease muscle size and tone. Posterior pituitary tumor leads to decrease production of ADH which leads to dieresis sodium and water loss,and dehydration. Others:Headache, Depression. Nausea or vomiting, Behavioral and cognitive changes, decreased hair in women.

Mixed Glioma (Benign)

Gliomasinclude tumors of glial cells i.e. astrocytoma, ependymoma, oligodendroglioma, optic nerve glioma. A mixed glioma is often a combination of an astrocytoma and an oligodendroglioma (see oligodendroglioma for more). Characteristics

Composed of two or more types of glioma cells Graded according to the most aggressive type of tumor cells Common among men and women in their 20s-50s Accounts for one percent of all brain tumors

Oligodendroglioma (Benign)
This tumor type develops from glial cells called oligodendrocytes.

Characteristics

Occurs frequently in the frontal or temporal lobes Can be classified as low grade or high grade Common among men and women in their 20s-40s, but can occur in children More common in men than women Accounts for two percent of all brain tumors May be associated with 1p or 19q chromosomal losses

Symptoms: occurs due to Compression and involvement of frontal lobe: Unable to form words Poor muscle contraction of opposite side of affected area Poor intellect, poor judgment and decision making, and behavioral changes. Compression and involvement of temporal lobe: Inability to recognize voice Speech problems Effect on neurons: Oligodendrocytes help in myelination of neurons, due to hyperplasia of these cells , they cause hyperactivity of neurons which is manifested as Seizures Tremors Excitability Over activity Headache Insomnia Jerky movements Poor muscle coordinations

Optic Nerve Glioma (Benign)

Characteristics

Named for its location on or near the nerve pathways between the eyes and the brain Can range from low grade to high grade Occurs most often in infants and children, but can occur in adults
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Symptoms:

Cloudy or haloed vision Nausea or headaches Light sensitivity (photophobia) Excessive blinking (blepharospasm) Crossed or out-turned eyes (strabismus) Excessive tearing (epiphora) Decreased vision (amblyopia) Diplopia Vision loss

Medulloblastoma (Malignant)
Characteristics

Often located in the cerebellum or near the brain stem Can spread to the spinal cord through the cerebrospinal fluid (CSF) May obstruct the fourth ventricle, causing hydrocephalus (water on the brain) Occurs most often in children under the age of ten, but may occur in adults Slightly more common in males than females

Symptoms occurs due to Compression and involvement of brain stem Compression and involvement of cerebellum Symptoms due to hydrocephalus

Due to involvement of brain stem: Medulary tumors: Disturbances in cardiovascular centre casuses Bradycardia or tachycardia, palpitations, hypertension, dysrythmias, cardiac arrest, complete heart block, ECG changes, widen pulse pressure. Medullary rythmicity area of respiratory centre disturbances cause tachypnea, impaied vomiting, coughing, sneezing, swallowing and hiccupping reflexes further leads to aspiration of food content, infections, allergies, projectile vomiting. Impaired touch, vibration and proprioception sensations. cranial nerves invovement: Vestibulocochlear VIII:Tinnitus, hearing loss, balance and coordination problems Glossopharyngeal IX: impaired taste sensation Vagus X: dysphagia (swallowing problems),velopharyngeal insufficiency.
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Accessory XI : inability to shrug, weak head movement Hypoglossal XII: impaired tongue movements and speech articulation. Damage to medulla cause cranial nerve alterations at the same side and paralysis in opposite side.

Tumors near Pons Causes respiratory symptoms such as dyspnea, tachypnea, chienne stroke respiration. Nerve involvement: Trigeminal V : intense pain in lips, nose teeth, gums and forehead, dysphagia, diminished or loss of corneal reflex, impaired mastication. Abducens VI : ptosis and blurred vision, papillary edema Facial VII : masklike face, decresed facial expression Vestibulocochlear VIII:

Mid brain tumors:

visual changes Inability in tracking moving objects and scanning stationary objects Startle reflex absent Impaired function of substantia nigra which release dopamine and also responsible for subconscious muscle activities, so the client may experience parkinsons disease.

Due to involvement of cerebellum

Inability to perform skilled skeletal muscle movements, such as inability to write, typing, playing music instrument, cutting vegetables, eating food with spoon, dialing numbers etc. Posture and balance disturbances such as unsteady gait, giddiness, posture changes, unable to stand on one leg. Difficulty in walking straight, riding bicycle, dancing etc. Changes in cognition and language processing, impaired learning,

Symptoms of increased ICP and hydrocephalus: Giddiness Dizziness and drowsiness Headache Nausea and vominting Papilledema Elevated ICP Cerebellar herniation Irritability Seizures
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Others: increasing the pressure on the brain (intracranial pressure) dizziness, drowsiness pain fainting or giddiness altered level of consciousness weakness and fatigue

Pilocytic Astrocytoma (Benign)

Also called Juvenile Pilocytic Astrocytoma (JPA) Characteristics

Slow growing, with relatively well-defined borders Grows in the cerebrum, optic nerve pathways, brain stem and cerebellum Occurs most often in children and teens Accounts for two percent of all brain tumors

Symptoms: are due to involvement of cerebrum, optic nerve pathways, brain stem and cerebellum Due to involvement of cerebrum: Cognitive impairment causes delayed learning, loss of judgment, reasoning, lack of concenteration. Sensory impairment: leads to visual, auditory, olfactory, touch sensation and taste alterations. Motor disturbances like jerky movements or bradykinesia, paralysis, hemiparasis.

Low-Grade Astrocytoma (Benign)

An astrocytoma is a type of glioma that develops from star-shaped cells (astrocytes) that support nerve cells. The WHO classifies a low-grade astrocytoma as a grade II tumor. Characteristics

Slow growing Rarely spreads to other parts of the CNS Borders not well defined

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Anaplastic Astrocytoma (Malignant)

An astrocytoma is a glioma that develops from star-shaped glial cells (astrocytes) that support nerve cells. An anaplastic astrocytoma is classified as a grade III tumor. Characteristics

Grows faster and more aggressively than grade II astrocytomas Tumor cells are not uniform in appearance Invades neighboring tissue Common among men and women in their 30s-50s More common in men than women Accounts for two percent of all brain tumors

Glioblastoma Multiforme (GBM) (Malignant)

An astrocytoma is a glioma that develops from star-shaped glial cells (astrocytes) that support nerve cells. A glioblastoma multiforme is classified as a grade IV astrocytoma. It is also referred to as a glioblastoma or GBM. Characteristics

Most invasive type of glial tumor Commonly spreads to nearby tissue Grows rapidly Includes distinct genetic subtypes May be composed of several different kinds of cells (i.e., astrocytes, oligodendrocytes) May have evolved from a low-grade astrocytoma or an oligodendroglioma Common among men and women in their 50s-70s More common in men than women Accounts for 17 percent of all primary brain tumors

Ependymoma (Malignant)
Ependymal tumors begin in the ependyma, cells that line the passageways in the brain where cerebrospinal fluid (CSF) is produced and stored. Ependymomas are classified as either supratentorial (in the cerebral hemispheres) or infratentorial (in the back of the brain). Variations of this tumor type include subependymoma, subependymal giant-cell astrocytoma, and malignant ependymoma. Ependymoblastoma, which occurs in infants and children under three years, is no

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longer considered a subtype of ependymoma. For ependymoblastoma, see primitive neuroectodermal tumor (PNET) in the Non-glial Tumors section. Characteristics

Usually localized to one area of the brain Develops from cells that line the hollow cavities at the bottom of the brain and the canal containing the spinal cord Can be slow growing or fast growing May be located in the ventricles (cavities in the center of the brain) May block the ventricles, causing hydrocephalus (water on the brain) Sometimes extends to the spinal cord Common in children, and among men and women in their 40s and 50s Occurrence peaks at age five and again at age 34 Accounts for two percent of all brain tumors

Symptoms: are related to increased production of CSF, hydocepahlus and compression of brain structure.

Brain Stem Glioma (Malignant)

Characteristics

Named for its location at the base of the brain Can range from low grade to high grade Occurs most often in children between three and ten years of age, but can occur in adults

Symptoms: are related to involvement of brain stem and compression of cranial nerves.

Clinical manifestations of brain tumors:

Motor disturbances Sensory disturbances Intellectual and emotional disturbances

Diagnostic evaluations: 1. A neurological examination is a series of tests to measure the function of the patient s nervous system and physical and mental alertness. If responses to the exam are not normal, the doctor may order a brain scan or refer the patient to a neurologist or neurosurgeon, who will then order a brain scan.
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2. A brain scan is a picture of the internal structures in the brain. A specialized machine takes a scan in much the same way a digital camera takes a photograph. Using computer technology, a scan compiles an image of the brain by photographing it from various angles. 3. Some types of scans use a contrast agent (or contrast dye), which helps the doctor see the difference between normal and abnormal brain tissue. The contrast agent is injected into a vein and flows into brain tissue. Abnormal or diseased brain tissue absorbs more dye than normal healthy tissue. The most common scans used for diagnosis are as follows: 4. MRI (Magnetic Resonance Imaging) is a scanning device that uses magnetic fields and computers to capture images of the brain on film. It does not use x-rays. It provides pictures from various planes, which permit doctors to create a three-dimensional image of the tumor. The MRI detects signals emitted from normal and abnormal tissue, providing clear images of most tumors. 5. CT or CAT Scan (Computed Tomography) combines sophisticated x-ray and computer technology. CT can show a combination of soft tissue, bone, and blood vessels. CT images can determine some types of tumors, as well as help detect swelling, bleeding, and bone and tissue calcification. Usually, iodine is the contrast agent used during a CT scan. 6. PET Scan (Positron Emission Tomography) provides a picture of the brain s activity, rather than its structure, by measuring the rate at which a tumor absorbs glucose (a sugar). The patient is injected with deoxyglucose that has been labeled with radioactive markers. The PET scan measures the brain s activity and sends this information to a computer, which creates a live image. Doctors use PET scans to see the difference between scar tissue, recurring tumor cells, and necrosis (cells destroyed by radiation treatment). 7. A biopsy is a surgical procedure in which a sample of tissue is taken from the tumor site and examined under a microscope. The biopsy will provide information on types of abnormal cells present in the tumor. The purpose of a biopsy is to discover the type and grade of a tumor. A biopsy is the most accurate method of obtaining a diagnosis. 8. An open biopsy is done during a craniotomy. A craniotomy involves removing a piece of the skull in order to get access to the brain. After the tumor is resected (completely removed) or debulked (partially removed), the bone is usually put back into place. A closed biopsy (also called a stereotactic or needle biopsy) may be performed when the tumor is in an area of the brain that is difficult to reach. In a closed biopsy, the neurosurgeon drills a small hole into the skull and passes a narrow hollow needle into the tumor to remove a sample of tissue. 9. Once a sample is obtained, a pathologist examines the tissue under a microscope and writes a pathology report containing an analysis of the brain tissue. Sometimes the pathologist may not be able to make an exact diagnosis. This may be because more than one grade of tumor
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cells exists within the same tumor. In some cases, the tissue may be sent to another institution for additional analysis.

Management of brain tumors: Brain Cancer Surgery

Most people with a brain tumor undergo surgery.

Craniotomy: it involves opening the cranium and resection of tumor cells. Stereotactic radiosurgery is a newer "knifeless" technique that destroys a brain tumor without opening the skull. A CT or MRI scan is used to pinpoint the exact location of the tumor in the brain. High-energy radiation beams are trained on the tumor from different angles. The radiation destroys the tumor. There are various types of stereotactic radiosurgery. Brain decompression: relieving the pressure within the cranial vault. This may be done surgically by opening the cranium, or medically by administering hypertonic solutions of slowly metabolized materials, such as mannitol, intravenously. Temporal lobectomy: temporal lobectomy is the complete removal of the anterior portion of thetemporal lobe of the brain Hypophysectomy: removal of pituitary gland. Shunt procedure: it is a pathway to redirect the CSF from one area to another using a tube or implanted device. Eg. Venticuloperitoneal shunt. Tumor lysis: it involves restricting blood supply to the tumor cells so that these cells die automatically. This approach is used by ligating or resecting the respective vessels.

Radiation Therapy for Brain Cancer

Radiation therapy may be used for people who cannot undergo surgery. In other cases, it is used after surgery to kill any tumor calls that may remain. Radiation (also called x-rays, gamma rays, or photons) either kills tumor cells directly or interferes with their ability to grow. Radiation affects both normal cells and tumor cells. However, following standard doses of radiation, healthy cells repair themselves more quickly and completely than tumor cells. As the radiation treatments continue, an increasing number of tumor cells die. The tumor shrinks as the dead cells are broken down and disposed of by the immune system. Radiation can be given in either of two ways.

External radiation uses a high-energy beam of radiation targeted at the tumor. The beam travels through the skin, the skull, healthy brain tissue, and other tissues to get to the tumor. The
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treatments are usually given five days a week for certain amount of time. Each treatment takes only a few minutes. Three-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fi elds to deliver precise doses of radiation to the brain. Tailoring each of the radiation beams to the patients tumor allows coverage of the diseased cells while keeping radiation away from nearby organs, such as the eyes. Intensity modulated radiation therapy (IMRT) is the most recent advance in the delivery of radiation. IMRT diff ers from 3D-CRT by modifying the intensity of the radiation within each of the radiation beams. Stereotactic radiotherapy, sometimes called radiosurgery, is a type of external beam radiation therapy that pinpoints high doses directly on the tumor, in some cases in only one treatment. At some centers, stereotactic radiotherapy is called by the name of the company that makes the equipment.

Internal or implant radiation uses a tiny radioactive capsule that is placed inside the tumor itself. The radiation emitted from the capsule destroys the tumor. The radioactivity of the capsule decreases a little bit each day; the amount of radioactivity of the capsule is carefully calculated to run out when the optimal dose has been given. You need to stay in the hospital for several days while receiving this treatment. Gamma radiation: Chemotherapy for Brain Cancer Chemotherapy uses drugs to kill or alter cancer cells. Chemotherapy is not an effective initial treatment for low-grade brain tumors, mostly because standard drugs have a hard time passing into the brain because of how the brain protects itself (the blood-brain barrier). In addition, not all types of brain tumors respond to chemotherapy. In general, chemotherapy for brain tumors is usually administered following surgery or radiation therapy. Interstitial chemotherapy uses disc-shaped polymer wafers (known as Gliadel wafers) soaked with carmustine, the standard chemotherapeutic drug for brain cancer. The surgeon implants the wafer directly into the surgical cavity after a tumor is removed. Intrathecal chemotherapy delivers chemotherapeutic drugs directly into the spinal fluid. Intra-arterial chemotherapy delivers high-dose chemotherapy into arteries in the brain using tiny catheters. Convection-enhanced delivery (CED) involves placing catheters into the brain tumor or nearby brain tissue to deliver slowly and continuously a cancer drug over several days. Temozolomide (Temodar) . Temozolomide is approved for adult patients with anaplastic astrocytoma that did not respond to other treatments. It is also approved for use during and after radiation therapy for patients newly diagnosed with glioblastoma multiforme. The current firstline treatment for patients with glioblastoma is combined radiotherapy and temozolomide,
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followed by monthly doses of temozolomide after radiation treatment ends. The drug may work best for patients with a specific genotype. Temozolomide's side effects are relatively minor, but may include constipation, nausea and vomiting, fatigue, and headache. The drug is taken by mouth as a pill. Carmustine (BCNU, BiCNU). Carmustine is used to treat many types of brain tumors, including glioblastoma, medulloblastoma, and astrocytoma. Carmustine is usually administered into the vein by IV. It can also be delivered through a wafer implant (Gliadel), which is surgically placed into the brain cavity after tumor removal. If carmustine is administered intravenously, side effects may include nausea and vomiting, fatigue, respiratory problems, and lung scarring (pulmonary fibrosis). Intravenous carmustine may cause bone marrow impairment, which results in decreased production of blood cells (a condition called myelosuppression). If carmustine is delivered through a wafer, side effects may include seizures, brain swelling, and infection within the brain cavity. PCV Drug Regimen . PCV is an abbreviation for a chemotherapy regimen that combines procarbazine (Matulane), lomustine (CCNU), and vincristine (Oncovin). PCV is commonly used to treat oligodendrogliomas and mixed oligoastrocytomas. The drugs may also be used alone or in other combinations. Procarbazine and lomustine are taken by mouth. Vincristine is given by either injection or IV. These drugs can cause significant side effects, including a drop in blood cell counts, nausea and vomiting, constipation, fatigue, and mouth sores. Procarbazine can cause high blood pressure when taken with foods high in tyramine. Patients should avoid foods such as beer, red wine, cheese, chocolate, processed meat, yogurt, and certain fruits and vegetables. Platinum-Based Drugs . Cisplatin (Platinol) and carboplatin (Paraplatin) are standard cancer drugs that are sometimes used to treat glioma, medulloblastoma, and other types of brain tumors. These drugs are delivered by IV. In addition to nausea and vomiting, carboplatin can cause hair loss, and cisplatin can cause muscle weakness. Other Chemotherapy Drugs . Researchers are investigating whether drugs used to treat other types of cancer may have benefits for brain tumors. These drugs include: Tamoxifen (Nolvadex) and paclitaxel (Taxol), which are used to treat breast cancer Topotecan (Hycamtin), which is used to treat ovarian and lung cancers Vorinostat (Zolinza), which is approved for treatment of cutaneous T-cell lymphoma Irinotecan (Campath) is another cancer drug that is being studied in combination treatment. BIOLOGIC DRUGS (TARGETED THERAPY) Traditional chemotherapy drugs can be effective, but because they do not distinguish between healthy and cancerous cells their generalized toxicity can cause severe side effects. Targeted biologic therapies work on a molecular level by blocking specific mechanisms associated with cancer cell growth and division. Because they selectively target cancerous cells, these biologic drugs may induce less severe side effects. In addition, these drugs hold the promise of creating options for more individualized cancer treatment based on a patient's genotype.

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Bevacizumab (Avastin). Bevacizumab (Avastin) is a biologic drug that blocks the growth of blood vessels that feed tumors (a process called angiogenesis). In 2009, the FDA approved bevacizumab for the treatment of glioblastoma in patients whose brain cancer has continued to progress after prior treatment with chemotherapy and radiation. Bevacizumab is the first targeted therapy approved for brain tumors, and the first new treatment for glioblastoma in more than a decade. Investigational Targeted Therapies . Targeted therapies being tested in clinical trials include: Vaccines are among the most promising immunotherapies being tested for slowing the progression of glioblastoma multiforme. Unlike conventional vaccines that are used to prevent disease, these vaccines are used as a cancer treatment. CDX-110 and. DCVax-Brain are two such vaccines. Tyrosine kinase inhibitor drugs block proteins involved in tumor cell growth and production. Tyrosine kinase inhibitors that target EGFR, (such as erlotinib [Tarceva], imatinib [Gleevac], and gefitinib [Iressa]) are being studied for their effects on brain tumors MTOR inhibitors target other enzymes involved in cell growth and replication. Everolimus (RAD-001) is being studied for glioblastoma multiforme and astrocytoma. Everolimus is related to rapamycin (Siroliumus) and tacrolimus (Prograf), which are also being investigated for brain tumor treatment. These drugs are commonly used to suppress the immune system to prevent rejection after organ transplantation. New Brain Cancer Treatments Stem cell therapy: use of stem cells to treat cancer is new advancement only aplolied in developed countries yet. Neural stem cells are being considered for the treatment of brain cancers, and in view of recent developments in stem cell biology that cancer may be a stem cell disease; researchers are revisiting the origin of brain tumors and attempting to isolate and characterize brain tumor stem cells (BTSCs). Genetic cloning: it involves changing the chromosomal make up of person. The affected genes are modified and cancer is prevented.

Nursing management: Nursing assessment: Client data: name, age, sex, religion, ethnicity, marital status, education, occupation, blood type, address, etc.. Medical history: o Main Complaints o Medical history Now o Previous Health History
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o Family Health History Physical Examination o Nerves: seizures, bizarre behavior, disorientation, aphasia, decreased / loss of memory, inappropriate affect, hissing o Vision: decreased field of vision, blurred vision o Hearing: tinnitus, hearing loss, hallucinations o Cardiac: bradycardia, hypertension o Respiratory system: respiratory rhythm increased, dyspnea, potential airway obstruction, neuromuscular dysfunction o Hormonal System: amenorrhoea, hair loss, diabetes mellitus o Motor: hyperextension, joints weakness Nursing diagnosis: Chronic pain related to compression of brain tissues secondary to growth of cancer cells as evidenced by patients verbalization and behavioral changes. Ineffective cerebral tissue perfusion related to decreased arterial blood flow and cerebral edema as evidenced by cerebral perfusion pressure< 60 mm of Hg, changes in motor and behavioral pattern. Decreased intracranial adaptive capacity related to sustain increase in intracranial pressure secondary to compression of brain tissue by tumor cells as evidenced by elevated systolic blood pressure bradicardia and widened pulse pressure. Impaired sensory perception related to cranial nerves involvement as evidenced by diplopia, blurred vision, hearing loss. Ineffective coping related to loss of control over body function and alter life style secondary to chemotherapy as evidenced by verbalization, expression of anger, negative feeling and refuse to participate in social activities.

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