BRAIN CANCER

Primary brain cancer develops from cells within the brain. Part of the central
nervous system (CNS), the brain is the control center for vital functions of the body,
including speech, movement, thoughts, feelings, memory, vision, hearing and more.

Primary brain tumors are classified by the type of cell or tissue the tumor affects,
and the location and grade of the tumor. Tumor cells may travel short distances within
the brain, but generally won't travel outside of the brain itself. When cancer develops
elsewhere in the body and spreads (metastasizes) to the brain, its called a secondary
brain tumor, or metastatic brain cancer. Metastatic brain tumors are more common than
primary brain tumors. Some cancers that commonly spread to the brain include lung,
colon, kidney and breast cancers.

Types of Brain Cancer:

PRIMARY BRAIN CANCER

- may spread to other parts of the brain or to the spine, but rarely to other organs.

Types of PBC

A. Gliomas
-Malignant gliomas are the most common and deadly brain cancers

-they originate in the glial cells of the central nervous system (CNS)

1. Astrocytoma tumor arises from star-shaped glial cells called astrocyte

Grade I or II astrocytoma a low-grade glioma

Grade III astrocytoma a h igh-grade or an anaplastic astrocytoma

Grade IV astrocytoma a glioblastoma or malignant astrocytic glioma

2. Meningioma The tumor arises in the meninges

1
 3. Oligodendroglioma The tumor arises from cells that make the fatty
substance that covers and protects nerves. It is most common in middle-aged adults

B.Nongliomas
- tumors that do not arise from glial cells

1. Medulloblastoma - The tumor usually arises in the cerebellum. And

sometimes called a primitive neuroectodermal tumor

2. Grade I or II astrocytoma - In children, this low grade tumor occurs anywhere

in the brain. It is most common astrocytoma among children is juvenile
pilocytic astrocytoma

3.Ependymoma - The tumor arises from cells that line the ventricles or the
central canal of the spinal cord

4. Brain stem glioma - Tumor occurs in the lowest part of the brain. It is most
common type is diffuse intrinsic pontine glioma.

GRADING

Grade I: tissue is benign, cells look nearly like normal and they grow
slowly
Grade II: tissue is malignant, cells look less like normal than the cells in a
Grade I
Grade III: malignant tissue has cells that look very different from normal ,
the abnormal cells are actively growing (anaplastic)

Grade IV: tissue has cells that look most abnormal and tend to grow
quickly.

SECONDARY BRAIN CANCER

- Malignant tumors grow and spread aggressively, invading and spreading into
areas of healthy tissue, and then overpowering them by taking their space, blood, and
nutrients

2
 -Malignant brain tumors usually cause such problems more aggressively and quickly
than do primary brain cancer

Incidence

Malignant and non-malignant brain tumors are reported in 14.8 per 100 000
individual per year. There are approximately 44, 000 new cases of primary brain tumors
(originating within the brain) in U.S each year. Of these, 18 500 are high grade
malignant tumors. Approximately 13, 000 deaths from malignant brain tumors were
reported in the U.S in 2005. Brain tumors account for 1.4 of all cancers, incidence of
brain tumor is higher in men.

I. Etiology

a. Gender In general, men are more likely than women to develop a brain tumor.
However, some specific types of brain tumors, such as meningioma, are more
common in women (according to American Society of Clinical Oncology).

There is no general rule that covers all brain cancers. Certain cancers, like
meningiomas, are twice as likely to develop in women. Medulloblastomas are
more frequently found in males. (Cancer Treatment Center of America)

b. Age In general, the frequency of brain cancer increases with age, with more
occurrences in individuals age 65 and older. The age factor varies depending on
the cell type and location of the tumor. Adults have a very low risk of developing
medulloblastomas, while gliomas are most common in adults. The incidence of
meningiomas and craniopharyngiomas are far more frequent in adults over age
50, but these tumors may occur at any age.
c. Family History and Genetic Conditions About 5% of brain tumors may be
linked to hereditary genetic factors or conditions, including Li-Fraumeni
syndrome, Neurofibromatosis, Nevoid basal cell carcinoma syndrome, Tuberous
sclerosis, Turcot syndrome, and Von Hippel-Lindau disease. Scientists have also
found clusters of brain tumors within some families without a link to these

3
 known hereditary conditions. Studies are underway to try to find a cause for
these clusters.
d. Exposure to Radiation It is the only definite risk factor in developing Brain
tumor. Exposure to high levels of ionizing radiation in the head area, such as
radiation treatments for other cancers, is known to increase the risk of brain
cancer. Especially those who have had treatments and scans for childhood
cancers.
e. Chemical Exposure Exposure to solvents, pesticides, oil products, rubber, or
vinyl chloride may increase the risk of developing a brain tumor. However, there
is not yet scientific evidence that supports this possible link.
f. Exposure to infections, viruses, and allergens Infection with the Epstein-
Barr virus (EBV) increases the risk of CNS lymphoma. EBV is more commonly
known as the virus that causes mononucleosis or mono. In other research, high
levels of a common virus called cytomegalovirus (CMV) have been found in brain
tumor tissue. The meaning of this finding is being researched. Several types of
other viruses have been shown to cause brain tumors in research on animals.
More data are needed to find out if exposure to infections, other viruses, or
allergens increase the risk of a brain tumor in people. Of note, studies have
shown that patients with a history of allergies or skin conditions have a lower risk
of glioma.
g. Previous Cancer People who have had cancer as a child have a higher risk of
developing a brain tumor later in life. People who have had leukemia, non
Hodgkin lymphoma or a glioma brain tumor as an adult also have an increased
risk.
There is an increased risk of brain tumors in adults who have had other
types of cancer that will develop in to Secondary or Metastatic Brain Tumor.
These types of cancers includes: Breast cancer, Colon cancer, Kidney cancer,
Lung cancer, and Melanoma
The increase in brain tumor risk might be due to the treatment for the
previous cancer, such as radiotherapy to the head.

4
 Having the chemotherapy drug methotrexate into the cerebrospinal fluid
around the spinal cord (intrathecal methotrexate) has been shown to increase the
risk of brain tumours.

II. Manifestations

a. Increased ICP According to the modified Monro- Kellie hypothesis, if any one
of these skull components increases in volume, ICP increases unless one of the
other components decreases in volume. Consequently, any change in volume
occupied by the brain (as occurs wth disorders such as brain tumor or cerebral
edema) produces signs and symptoms of increased ICP.
Symptoms of increased ICP results from a gradual compression of the
brain by the enlarging tumor. The effect is a disruption of the equilibrium that
exist between the brain, the CSF, and the cerebral blood, all located within the
skull. As the tumor grows, compensatory adjustment may occur through
compression of intracranial veins, reduction of CNS volume (by increased
absorption or decreased production), a modest decrease of cerebral blood flow,
and reduction of intracellular and extracellular brain tissue mass. When these
compensatory mechanism fail, the patient develops signs and symptoms of
increased ICP. The three most common signs of increased ICP are headache,
nausea and vomiting, and a sixth-nerve palsy. Personality changes and variety of
focal deficits, including motor, sensory, and cranial nerve dysfunction, are also
common.

b. Headache- Although not always present, is most common in the early morning
and is made worse by coughing, straining, or sudden movement. It is thought to
be caused by tumor invading, compressing, or distorting the pain-sensitive
structures or by edema that accompanies the tumor. Headache are usually
described as expanding or as dull but unrelenting. Frontal tumors usually
produce a bilateral frontal headache; pituitary gland tumors produce pain

5
 radiating between two temples (bitemporal): in cerebellar tumors, the headache
may be located in the suboccipital region at the back of the head.
c. Vomiting- seldom related to food intake, is usually due to irritation of the vagal
centers in the medulla. If the vomiting is the forceful type, it is described as
projectile vomiting.
d. Visual Disturbance- Papilledema (edema of the optic nerve is present in 70% to
75% of patient and is associated with visual disturbances such as decreased
visual acuity, diplopia (double vision), and visual field deficits.

Localized Symptoms

Although some tumors are not easily localized because they lie in so-called silent
ares of the brain (areas in which functions are not definitely determined), many tumors
can be localized by correlating the signs and symptoms to known areas of the brain, as
follows:

A motor cortex tumor produces seizure-like movements localized on one side of

the body, called Jacksonian seizures.
An occipital lobe tumor produces visual manifestations: contralateral
homonymous hemianopia (visual loss in half of the visual field on the opposite
side of the tumor) and visual hallucination.
A cerebellar tumor causes dizziness, an ataxic or staggering gait with a
tendency to fall toward the side of the lesion, marked muscle incoordination, and
nystagmus (involuntary rhythmic eye movements), usually in the horizontal
direction.
A frontal lobe tumor frequently produces personality disorder, changes in
emotional state or behavior, and an uninterested mental attitude. The patient
often becomes extremely untidy and careless and may use obscene language.
A cerebellopontine angle tumor usually originated in the sheath of acoustic
nerve and gives rise to a characteristic sequence of symptoms. Tinnitus and
vertigo appears first, soon followed by progressive nerve deafness (eight cranial
nerve dysfunction). Numbness and tingling of the face and the tongue occur
(due to the involvement of the fifth cranial nerve). Later, weakness or paralysis

6
 of the face develops (seven cranial nerve involvement). Finally because the
enlarging tumor presses on the cerebellum, abnormalities in motor function may
be present.

III. Diagnostic Procedures

a. Neurological, vision, and hearing tests. These tests help determine if a tumor
is affecting how the brain functions. An eye examination can detect changes to
the optic nerve, as well as changes to a persons field of vision.

b. Neurocognitive assessment. This consists of a detailed assessment of all

major functions of the brain, such as storage and retrieval of memory, expressive
and receptive language abilities, calculation, dexterity, and the overall well-being
of the patient.

c. MRI. It uses magnetic fields, not x-rays, to produce detailed images of the body.
It is used to measure the tumors size. A special dye called a contrast medium is
given before the scan to create a clearer picture. It is the preferred way to
diagnose a brain tumor. The MRI may be of the brain, spinal cord, or both,
depending on the type of tumor suspected and the likelihood that it will spread in
the CNS. There are different types of MRI.

o Intravenous (IV) gadolinium-enhanced MRI is typically used to help create

a clearer picture of a brain tumor. The gadolinium collects around the cancer
cells so they show up brighter in the picture. This is when a patient first has a
regular MRI, and afterwards is given a special type of contrast medium called
gadolinium through an IV.

o A spinal MRI may be used to diagnose a tumor on or near the spine.

o A functional MRI (fMRI) provides information about the location of specific

areas of the brain that are responsible for muscle movement and speech.
During the fMRI examination, the patient is asked to do certain tasks that
cause changes in the brain and can be seen on the fMRI image. This test is

7
 used to help plan surgery, so the surgeon can avoid damaging the functional
parts of the brain while removing the tumor.

d. Magnetic resonance spectroscopy (MRS) is a test using MRI that provides

information on the chemical composition of the brain. It can help tell the
difference between dead tissue caused by previous radiation treatments and new
tumor cells in the brain.

e. Serum tumor marker test : sample of blood is examined to measure the

amounts of certain substances released into the blood by organs, tissues, or
tumor cells in the body. Certain substances are linked to specific types of cancer
when found in increased levels in the blood. These are called tumor markers.

f. Tissue sampling/biopsy/surgical removal of a tumor. A sample of the tumors

tissue is usually needed for the final diagnosis. A biopsy is the removal of a small
amount of tissue for examination and is the only definitive way a brain tumor can
be diagnosed.

g. CT scan. Creates a 3-dimensional picture of the inside of the body using x-rays
taken from different angles. A CT scan can help find bleeding and enlargement of
the fluid-filled spaces in the brain, called ventricles. Changes to bone in the skull
can also be seen on a CT scan, and it can be used to measure a tumors size. A
CT scan may also be used if the patient cannot have an MRI, such as if the
person has a pacemaker for his or her heart. Sometimes, a contrast medium is
given before the scan to provide better detail on the image.

h. Positron emission tomography (PET) or PET-CT scan. A PET scan is used at

first to find out more about a tumor while a patient is receiving treatment. It may
also be used if the tumor comes back after treatment. A PET scan is usually
combined with a CT scan, called a PET-CT scan. A PET scan is a way to create
pictures of organs and tissues inside the body. A small amount of a radioactive
sugar substance is injected into the patients body. This sugar substance is taken
up by cells that use the most energy. Because tumor cells tends to use energy

8
 actively, it absorbs more of the radioactive substance. A scanner then detects
this substance to produce images of the inside of the body.

i. Cerebral arteriogram/ cerebral angiogram. A cerebral arteriogram is an x-ray,

or series of x-rays, of the head that shows the arteries in the brain. X-rays are
taken after a contrast medium is injected into the main arteries of the patients
head.

j. Lumbar puncture or spinal tap. A lumbar puncture is a procedure in which a

doctor uses a needle to take a sample of cerebrospinal fluid (CSF) to look for
tumor cells, blood, or tumor markers.

k. Myelogram. to find out if the tumor has spread to the spinal fluid, other parts of
the brain, or the spinal cord. A myelogram uses a dye injected into the CSF that
surrounds the spinal cord. The dye shows up on an x-ray and can outline the
spinal cord to help the doctor look for a tumor. This is rarely done; a lumbar
puncture is more common.

l. Molecular testing of the tumor. to identify specific genes, proteins, and other
factors, such as tumor markers, unique to the tumor. Researchers are examining
biomarkers to find ways to diagnose a brain tumor before symptoms begin.
Ultimately, results of these tests may help decide whether your treatment options
include a type of treatment called targeted therapy. The markers most commonly
looked at for brain tumors include:

o For oligodendrogliomaIt is linked to more successful treatment, particularly

with chemotherapy, and can be used to help plan treatment, especially for
anaplastic oligodendroglioma.

o Mutations in the isocitrate dehydrogenase (IDH) gene which is found in

about 70% to 80% of low-grade gliomas in adults. Higher-grade tumors can
also have IDH gene mutations. This mutation is linked with a better prognosis
in both low-grade and high-grade tumors.

9
 o In glioblastoma, whether a gene called methyl guanine methyl
transferase (MGMT) is changed can help the doctor understand a patients
prognosis and how well treatment will work. Its role in determining the benefit
of treatment is being tested in clinical trials.

m. Electroencephalography (EEG). An EEG is a non-invasive test in which

electrodes are attached to the outside of a person's head to measure electrical
activity of the brain. It is used to monitor for possible seizures .

n. Evoked potentials. Evoked potentials involve the use of electrodes to measure

the electrical activity of nerves and can often detect acoustic schwannoma, a
noncancerous brain tumor. This test can be used as a guide when removing a
tumor that is growing around important nerves.

IV. Medical Managements

a. Palliative treatments- vary widely and often include medication, nutritional

changes, relaxation techniques, emotional support, and other therapies.

o Corticosteroids used to lower swelling in the brain, which can lessen pain
from the swelling without the need for prescription pain medications. These
drugs may also help improve neurological symptoms by decreasing the
pressure from the tumor and swelling in the healthy brain tissue.
o Antiseizure medication to help control seizures.

b. Surgery- It is usually the first treatment used for a brain tumor and is often the
only treatment needed for a low-grade brain tumor. Removing the tumor can
improve neurological symptoms, provide tissue for diagnosis, help make other
brain tumor treatments more effective, and, in many instances, improve the
prognosis of a person with a brain tumor.

c. Cortical mapping- This technique allows doctors to identify certain areas of the
brain that control the senses, language, and motor skills. In addition, enhanced

10
 imaging devices give surgeons more tools to plan and perform surgery. For
example, computer-based techniques, such as Image Guided Surgery (IGS),
help surgeons map out the location of the tumor very accurately.
For a tumor that is near the brains speech center, it is increasingly common
to perform the operation when the patient is awake for part of the surgery.
Typically, the patient is awakened once the surface of the brain is exposed.
Then, special electrical stimulation techniques are used to locate the specific part
of the brain that controls speech. This approach can avoid causing damage while
removing the tumor.
For some tumor types, the results of the biopsy can help determine if
chemotherapy or radiation therapy will be useful. For a cancerous tumor, even if
it cannot be cured, removing it can relieve symptoms from the tumor pressing on
the brain.
Sometimes, surgery cannot be performed because the tumor is located in a
place the surgeon cannot reach or is near a vital structure; these tumors are
called inoperable. If the tumor is inoperable, the doctor will recommend other
treatment options.

d. Radiation therapy- is the use of high-energy x-rays or other particles to destroy

tumor cells. Doctors may use radiation therapy to slow or stop the growth of the
tumor. It is typically given after surgery and possibly along with chemotherapy.

o External-beam radiation therapy- The most common type of radiation

treatment, which is radiation given from a machine outside the body.
o Internal radiation therapy or brachytherapy- using implants.

External-beam radiation therapy can be directed at the tumor in the

following ways:

Conventional radiation therapy. The treatment location is determined

based on anatomic landmarks and x-rays. In certain situations, such as
whole brain radiation therapy for brain metastases, this technique is

11
 appropriate. The amount of radiation given depends on the tumors
grade.

3-dimensional conformal radiation therapy (3D-CRT). Using images

from CT and MRI scans, a 3D model of the tumor and healthy tissue
surrounding the tumor is created on a computer. This model can be
used to aim the radiation beams directly at the tumor, sparing the
healthy tissue from high doses of radiation therapy.

Intensity modulated radiation therapy (IMRT). A type of 3D-CRT

that can more directly target a tumor. It can deliver higher doses of
radiation to the tumor while giving less to the surrounding healthy
tissue. In IMRT, the radiation beams are broken up into smaller beams
and the intensity of each of these smaller beams can be changed. This
means that the beams giving more radiation, can be directed only at the
tumor.

Fractionated stereotactic radiation therapy. Radiation therapy is

delivered with stereotactic precision but divided into small daily doses
called fractions given over several weeks, in contrast to the 1-day
radiosurgery. This technique is used for tumors located close to
sensitive structures, such as the optic nerves or brain stem.

Stereotactic radiosurgery. The use of a single, high dose of radiation

given directly to the tumor and not healthy tissue. It works best for a
tumor that is only in 1 area of the brain and certain noncancerous
tumors. It can also be used when a person has more than 1 metastatic
brain tumor. There are many different types of stereotactic radiosurgery
equipment, including:

The CyberKnife- delivers multiple beams of x-rays using a robotic

arm. It is image-guided so can adjust to the natural movements of
the organs and work anywhere in the body or where other treatment
options may compromise other vital organs. Typically brain cancer

12
 treatments are completed within five days. For most patients the
CyberKnife treatment is a completely pain-free experience.

The Gamma Knife- delivers gamma rays to a highly-defined target

within the brain. It utilizes a lightweight frame to hold the head in
place and provide a reference point for targeted radiosurgery.
Imaging is performed prior to radiation treatment to ensure that the
Gamma Knifes beams are focused on the tumour site. Working
together, neurosurgeons and radiation oncologists identify the target
and develop a plan to deliver an extremely accurate dose of
radiation while reducing exposure to sensitive healthy tissue.
Treatment sessions can last from a few minutes to an hour.

Proton beam therapy- which targets tumours with great precision

and where the radiation dose can be significantly and safely
increased to help eradicate the cancer. Protons are positively
charged particles found in the nucleus of every atom. Protons are
made available in this therapy by stripping away electrons from
hydrogen atoms. As protons move through the body they slow
down, causing greater damage to surrounding cells. Due to this
unique property, Proton Therapy causes minimal damage to healthy
tissue as it enters the body and almost no damage to tissue as it
exits the body. As a result, the radiation oncologist can increase the
dose to the tumour while reducing the dose to surrounding normal
tissues. Proton beam therapy is typically used for tumors when less
radiation is needed because of the location. This includes tumors
that have grown into nearby bone, such as the base of skull, and
those near the optic nerve.

Short-term side effects from radiation therapy may include fatigue, mild
skin reactions, hair loss, upset stomach, and neurologic symptoms. Most side
effects go away soon after treatment is finished. Also, radiation therapy is usually

13
 not recommended for children younger than 5 because of the high risk of
damage to their developing brains.

Longer term side effects of radiation depend on how much healthy

tissue received radiation therapy and include memory and hormonal problems
and cognitive (thought process) changes, such as difficulty understanding and
performing complex tasks.

e. Chemotherapy- use of drugs to destroy tumor cells, usually by stopping the

cancer cells ability to grow and divide.
Systemic chemotherapy gets into the bloodstream to reach tumor cells
throughout the body. Common ways to give chemotherapy include a pill or
capsule that is swallowed (orally) or by intravenous (IV) injection placed into a
vein using a needle. It may also be given through a catheter or port, which are
used to make IV injections easier.
A chemotherapy regimen (schedule) usually consists of a specific number
of cycles given over a set period of time. A patient may receive 1 drug at a time
or combinations of different drugs at the same time. Some drugs are better at
going through the blood-brain barrier. These are the drugs often used for a brain
tumor.

o Gliadel wafers are one way to give the drug carmustine. These wafers are
placed in the area where the tumor was removed during surgery.

o For people with glioblastoma and high-grade glioma, the latest standard of
care is radiation therapy with daily low-dose temozolomide (Temodar). This
is followed by monthly doses of temozolomide after radiation therapy for 6
months to 1 year.

o A combination of 3 drugs, lomustine (Gleostine), procarbazine (Matulane),

and vincristine (Vincasar), have been used along with radiation therapy.
This approach has helped lengthen the lives of patients with grade III
oligodendroglioma when given either before or right after radiation therapy. It
has also been shown to lengthen lives of patients after radiation therapy for a

14
 low-grade tumor that could not be completely removed with surgery. Clinical
trials on the use of chemotherapy to delay radiation therapy in patients with
low-grade glioma are also ongoing.

Patients are monitored with a brain MRI every 2 to 3 months while receiving
active treatment. The side effects of chemotherapy depend on the individual and
the dose used, but they can include fatigue, risk of infection, nausea and
vomiting, hair loss, loss of appetite and diarrhea. These side effects usually go
away once treatment is finished. Rarely, certain drugs may cause some hearing
loss. Others may cause kidney damage. Patients may be given extra fluid by IV
to protect their kidneys.

f. Targeted therapy- In addition to standard chemotherapy, targeted therapy is a

treatment that targets the tumors specific genes, proteins, or the tissue
environment that contributes to a tumors growth and survival.
This type of treatment blocks the growth and spread of tumor cells while
limiting the damage to healthy cells.
For a brain tumor, anti-angiogenesis therapy is a type of targeted therapy
used, and others are being researched. It is focused on stopping angiogenesis,
which is the process of making new blood vessels. Because a tumor needs the
nutrients delivered by blood vessels to grow and spread, the goal of anti-
angiogenesis therapies is to starve the tumor. Bevacizumab (Avastin) is an
anti-angiogenesis therapy used to treat glioblastoma multiforme when prior
treatment has not worked.

o Alternating electric field therapy (tumor treating fields)- This type of

treatment uses a noninvasive portable device that interferes with parts of a cell
that are needed for the tumor cells to grow and spread. It is given by placing
electrodes that produce an electric field on the outside of a persons head. The
available device is called Optune.In addition, they had fewer side effects. This
treatment approach is now considered a recommended option for
glioblastoma.

15
o Immunotherapy offers promising options for treating brain cancer, which is
traditionally treated with chemotherapy, radiation, and surgery. Bevacizumab
(Avastin), a targeted antibody that disrupts tumor blood vessel formation, is
currently approved for patients with recurrent glioblastoma, while the targeted
antibody dinutuximab (UNITUXIN) is approved for children with
neuroblastoma, a cancer of the nervous system.

Current immunotherapies for brain cancer fall into six broad categories:

1. Cancer vaccines are designed to elicit an immune response against

tumor-specific or tumor-associated antigens, encouraging the immune
system to attack cancer cells bearing these antigens.
2. A promising avenue of clinical research in brain cancer is the use of
immune checkpoint inhibitors. These treatments work by targeting
molecules that serve as checks and balances on immune responses. By
blocking these inhibitory molecules, these treatments are designed to
unleash or enhance pre-existing anti-cancer immune responses.
3. Oncolytic virus therapy uses a modified virus that can cause tumor cells
to self-destruct and generate a greater immune response against the
cancer.
4. Adoptive cell therapy. In this approach, immune cells are removed from
a patient, genetically modified or treated with chemicals to enhance their
activity, and then re-introduced into the patient with the goal of improving
the immune systems anti-cancer response.
5. Adjuvants are substances that boost the immune response. They can be
used alone or combined with other immunotherapies.
6. Monoclonal antibodies are molecules, generated in the lab, that target
specific antigens on tumors.

16
Safety for the patient and family

Having radiation therapy slightly increases the risk of developing a second

cancer. However, for many people, radiation therapy eliminates the existing cancer.
This benefit is greater than the small risk that the treatment could cause a new cancer.

However, internal radiation therapy causes the patient to give off radiation. As a
result, visitors should follow these safety measures:

Dont visit the patient if pregnant or younger than 18.

Stay at least 6 feet from the patients bed.
Limit stay to 30 minutes or less each day.

Permanent implants remain radioactive after the patient leaves the hospital.
Because of this, the patient should not have close or more than 5 minutes of contact
with children or pregnant women for 2 months.

Similarly, patients who have had systemic radiation therapy should use safety
precautions. For the first few days after treatment, take these precautions:

Wash hands thoroughly after using the toilet.

Use separate utensils and towels.
Drink plenty of fluids to flush the remaining radioactive material from the body.
Avoid sexual contact.
Minimize contact with infants, children, and pregnant women.

V. Nursing Care Plan

1. Acute Pain

Nursing Diagnosis

Acute pain related to presence of abnormal cell growth in the brain secondary
to increase intracranial pressure as manifested by headache with a pain scale of 6
out of 10 and grimacing face.

17
 Nursing Inference

Brain tumor occur because of proliferation of abnormal cell growth, rapidly

spread in areas of central nervous system. These cell will continue to evolve the
healthy brain tissue, causing now to experience neurologic changes such as
increase in intracranial pressure, thus patient may felt pain.

Nursing Goal

After 30 minutes of imparting nursing intervention, the client will be able to

reduced pain with a manifestation of feeling relaxed with a pain scale of 2 out of 10
and no grimacing face.

Nursing Intervention Rationale

Assess the location, and duration of Sudden changes or severe pain may
headache. indicate increased ICT and should be
reported to the doctor
Set giving analgesics / narcotics. Giving narcotic, sedative effect.
Give comfort to the patient. Eliminating discomfort and anxiety

Give a lot of time resting and less visitors Can reduce physical and emotional
as desired patient. discomfort.

Collaboration with physicians in drug To assist in the healing of patients

delivery.
Provide additional comfort measures: Improves circulation, reduces muscle

Back-rub, heat or cold applications. tension and anxiety associated with pain.
Enhances sense of well-being.
Encourage use of relaxation Relieves muscle and emotional tension
techniques: deep-breathing exercises, Enhances sense of control and may
guided imagery, visualization, music. improve coping abilities.
Nursing Evaluation

18
 After 30 minutes of imparting nursing intervention, the client was able to
reduced pain with a manifestation of feeling relaxed with a pain scale of 2 out of 10
and no grimacing face.

2. Nausea

Nursing Diagnosis

Nausea related to stimulation of medulla oblongata secondary to presence of

abnormal growth cell as manifested by reports of being nauseous.

Nursing Inference

Medulla oblongata plays a role in regulating muscle tone and movement, it

houses nerves that carry sensory information from the internal organs to the brain it
also responsible in initiating reflexes, so if it is stimulated nausea may experience.

Nursing Goal

After 5-10 minutes of imparting therapeutic nursing intervention, the client will
be able to free from nausea as manifested by feeling relaxed.

Nursing Intervention Rationale

Encourage to eat small portion of food but To prevent nausea and vomiting
should be often
Advise patient to try dry foods such as To prevent nausea and vomiting
toast, crackers, dry cereals before arising
when nausea occurs in the morning or
throughout the day as appropriate
Encouraged patient to drink liquids before To prevent nausea and vomiting
or after meal instead with meals
Provide diet and snacks with substitutions To improve nutrient intake
of preferred foods when available such as
including of gelatin or bland beverages
and instruct to avoid overly sweet, fried

19
and fatty foods.
Encourage deep, slow breathing To promote relaxation
Provide clean, pleasant smelling, quiet To prevent nausea and vomiting
environment and instruct to avoid
offending odors such as smoke and
perfume
Advise patient to suck on ice chips or To provide some nutrient
hard candies
Encourage to use distraction method To limit dwelling on unpleasant sensation
such as listening to music or watching
movies
Administer antiemetic as prescribe by the To prevent nausea and vomiting
physician
Nursing Evaluation

After 5-10 minutes of imparting therapeutic nursing intervention, the client

was able to free from nausea as manifested by feeling relaxed.

3. Anxiety

Nursing Diagnosis

Anxiety related to the diagnosis, poor prognosis of brain cancer,

chemotherapy and possible side effects of it as manifested by deep sadness and
anticipation of death.

Nursing Inference

Anxiety is a normal reaction to cancer due to undergoing of cancer screening

test, waiting for test result, receiving a diagnosis of cancer or anticipation of death
cause by cancer.

20
 Nursing Goal

After 30 minutes to 1 hour of rendering therapeutic nursing interventions, the

client will be able to decrease anxiety as evident by feeling relax and verbalization of
understanding of the dying process.

Nursing Interventions Rationale

Develop therapeutic nurse-client relationship, Promotes sense of trust, allowing
providing consistent caregiver. individual to discuss feelings openly.
Encourage expression of feelings and make Acknowledges reality of feelings and
time to listen to concerns. that they are okay. Help individual sort
out thinking and begin to develop
understanding of situation and look at
other alternatives.
Give real information you know about the Knowledge about what I expected to
disease, treatment and prognosis. decrease anxiety.
Help client identify more appropriate solutions To lessen sense of anxiety and
like exercise associated physical manifestations
Involve family in planning To improve understanding and support.
Use presence, touch (with permission),
verbalization, and demeanor to remind clients
that she is not alone and to encourage
expression or clarification of needs, concerns,
unknowns, and questions.
Accept clients defenses do not dare, argue, Anxiety is a highly individualized,
or debate. normal physical and psychological
response to internal or external life
events.
Lessen sensory stimuli by keeping a quiet and Anxiety may intensify to a panic sstate
peaceful environment keep threatening with excessive conversation, noise,
equipment out of sight. and equipment around the client.
Increasing anxiety may become

21
 frightening to the client and others.
Help client determine precipitants of anxiety Obtaining insight allows the client to
that may indicate interventions. reevaluate the threat or identify new
ways to deal with it.
Allow client to talk about anxious feelings and Talking about anxiety-producing
examine anxiety-provoking situations if they situations and anxious feeling can help
are identifiable. the client perceive the situation
realistically and recognize factors
leading to the anxious feelings.
Encourage the client to consider positive self- Cognitive therapies focus on changing
talk like Anxiety wont kill me, I can do this behaviors and feelings by changing
one step at a time, Right now I need to thoughts. Replacing negative self-
breathe and stretch, I dont have to be statements with positive self-
perfect. statements aids to reduce anxiety.
Avoid unnecessary reassurance; this may Reassurance is not helpful for the
increase undue worry. anxious individual.
Assist the client in developing new anxiety- Discovering new coping methods
reducing skills like relaxation, deep breathing, provides the client with a variety of
positive visualization, and reassuring self- ways to manage anxiety.
statements.
Provide massage and backrubs for client to This aids in reduction in anxiety.
reduce anxiety.
Provide clients with a means to listen to music Music is a simple, inexpensive,
of their choice. aesthetically pleasing means of
alleviating anxiety.
Teach client to visualize or fantasize about the Use of guided imagery has been useful
absence of anxiety or pain, successful for reducing anxiety.
experience of the situation, resolution of
conflict, or outcome of procedure.

22
Nursing Evaluation

After 30 minutes to 1 hour of rendering therapeutic nursing interventions, the

client was able to decrease anxiety as evident by feeling relax and verbalization of
understanding of the dying process.

23
 Reference

Doenges, et al (2013) Nurses Pocket Guide 13th Edition. Philiadelpia, PA: F.A. Davis Company

Hinkle & Cheever (2014). Medical-Surgical Nursing 13th Edition. Philippines: Lippincott Williams
& Wilkins

http://www.curebraincancer.org.au/page/12/ brain-tumours

http://www.emedicinehealth.com/brain_cancer/pageem.htm

https://www.cancerresearch.org/patients/patients/cancer-types/brain-cancer

http://www.cancer.net/cancer-types/brain-tumor/risk-factors

http://www.mayoclinic.org/diseases-conditions/brain-tumor/symptoms-causes/dxc-
20117134

http://www.cancerresearchuk.org/about-cancer/brain-tumours/risks-causes

http://www.cancercenter.com/brain-cancer/learning/

24