Download Neurological Oncological Conditions

Neurological Oncological
Conditions
Kerry McIntyre
Definition
• Neuro-oncology refers to all cancers that
affect the brain and central nervous system.
Definition
• Cancerous tumours consist of cells
multiplying at an abnormal rate crowding
out and destroying the normal tissue.
• Tumours can either originate in the brain
or come from another part of the body and
travel to the brain (metastasize).
• Brain tumours may be classified as either
benign (non-cancerous) or malignant
(cancerous).
Pathophysiology
Trigger
Uncontrolled mitosis
Forms a mass or tumour
Benign Tumours
• A benign tumor does not contain cancer cells.
• Most benign brain tumors have clear borders,
and therefore do not invade the surrounding
brain tissue.
• Benign tumors can cause symptoms very
similar to cancerous tumors because they still
grow and therefore can compress brain tissue
inhibiting functioning
Malignant Tumours
• Malignant brain tumors contain cancer cells.
• Malignant brain tumors are usually fast
growing and invade surrounding tissue.
• Sometimes, brain tumors that are not cancer
are called malignant because of their size and
location, and the damage they can do to vital
functions of the brain.
Metastatic Brain Tumours
• Metastatic brain tumors are tumors that
initially grow in another part of the body
and then spread to the brain through the
bloodstream.
• Common types of cancer that can travel
to the brain include lung cancer, breast
cancer, and colon cancer.
Types
There are many different types of brain tumors.
They are either categorized by:
the type of cell that forms the tumour
or
the area of the brain where they occur
Types
The most common types of brain tumours include:
• gliomas
• astrocytomas
• brain stem gliomas
• ependymomas
• optic nerve gliomas
• oligodendrogliomas
• metastatic tumours
• meningiomas
• Schwannomas
• pituitary tumours
• primitive neuroectodermal tumors (PNET)
• medulloblastomas
• craniopharyngioma
• pineal region tumours
Grading
• Grade IV: Highly malignant.
• Grade III: Also malignant, but not as
aggressive as grade IV.
• Grade II: Invasive but less aggressive than
grade III. Sometimes considered benign, but
probably best considered as being borderline
malignant.
• Grade I: Tumours that are usually slow
growing and less invasive
Causes and Risk Factors
• Genetic abnormalities genes that control mitosis are mutated
• exposure to certain chemicals
• Exposure to excessive radiation x-rays and cell phones
• HIV infection
• Genetic conditions
neurofibromatosis
Von Hippel-Lindau
Disease
Li-Fraumeni
Syndrome
Retinoblastoma
Signs and Symptoms
Many symptoms are related to an increase in
pressure in or around the brain.
• headache
• vomiting
• nausea
• personality changes
• irritability
• drowsiness
• depression
• decreased cardiac and respiratory function
Symptoms vary depending on the size and location
of tumour.
Signs and Symptoms
Frontal lobe tumours:
• Changes in personality and intellect.
• Uncoordinated walking
• weakness of one side of the body
• loss of smell
• occasional speech difficulties.
Signs and Symptoms
Parietal lobe:
• Difficulty speaking or understanding words.
• Problems with writing, reading or doing simple
calculations.
• Difficulty in co-ordinating certain movements
• Disorientation.
• Numbness or weakness on one side of the body.
Signs and Symptoms
Occipital lobe:
• Loss of vision on one side.
• The person may not notice this at first and it
may sometimes be discovered during routine
eye tests.
Signs and Symptoms
Temporal lobe:
• Fits, which may cause strange sensations: a
feeling of fear or intense familiarity (déjà vu)
• strange smells or blackouts.
• Speech difficulties
• Memory problems
Signs and Symptoms
Cerebellum:
• Lack of co-ordination which affects walking
• Speech difficulties
• Unsteadiness
• Nystagmus
• Vomiting
• Neck stiffness.
Signs and Symptoms
Brain stem:
• Unsteadiness
• Unco-ordinated walk
• Facial weakness, a one-sided smile or
drooping eyelid
• Double vision
• Vomiting or headache just after waking
• Difficulty speaking and swallowing
Medical Management
Specific treatment will be determined based on:
• age
• general health
• medical history
• type, location, and size of the tumour
• extent of the condition
• tolerance for specific medications, procedures, or
therapies
• expected progression and prognosis
Medical Management
•
•
•
•
•
•
•
•
•
•
surgery
chemotherapy
radiation therapy
steroids (to treat and prevent inflammation)
anti-seizure medication
placement of a ventriculoperitoneal shunt
bone marrow transplantation
supportive care
antibiotics
continuous follow-up care very important for ensuring
remission remains
Medical Management
Prognosis:
•
•
•
•
•
•
type of tumour
extent of the disease
size and location of the tumour
presence or absence of metastasis
the tumour’s response to therapy
age, general health and medical history
Physiotherapy Problems
Depends on the tumour location and size and
which areas of the brain it is affecting
• tone
• tone
• balance
• proprioception
• sensation
• Difficulties with motor planning
• co-ordination
• Neurological symptoms
• Muscle strength
Physiotherapeutic Management
• Rehabilitation
• Tone normalizing techniques such as
compressions
• Balance and proprioception exercises
• Advice regarding limbs with decreased or
increased sensation
• Maintenance of ROM and muscle lengths
• Improve muscle strength
• Frenkel’s exercises for co-ordination
• Activities relating to motor planning ie.
breaking movement up into components
Article
Prognostic indicators in metastatic spinal cord compression: using
functional independence measure and Tokuhashi scale to optimize
rehabilitation planning
V Tang*,1,2, D Harvey2,3, J Park Dorsay4, S Jiang2,5 and MP Rathbone1,2
1Department of Medicine, Division of Neurology, McMaster University Hamilton,
Canada; 2Hamilton
NeuroRestorative Group, Hamilton, Canada; 3Department of Medicine, Division of
Physical Medicine and Rehabilitation, McMaster University Hamilton, Canada;
4Rehabilitation and Orthopedic Program, Hamilton Health Sciences,
Henderson General Hospital, Hamilton, Canada; 5Department of Surgery,
Division of Neurosurgery, McMaster University, Hamilton, Canada
References
•
•
•
•
•
•
•
•
•
•
•
•
•
http://www.emedicinehealth.com/brain_cancer/page3_em.htm
http://www.emedicinehealth.com/brain_cancer/page2_em.htm
http://www.emedicinehealth.com/brain_cancer/article_em.htm
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Typesofb
raintumours/Typesofbraintumours.aspx
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Sympto
msdiagnosis/Symptoms.aspx
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbr
aintumours/Whatiscancer.aspx
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbr
aintumours/Causes.aspx
http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbr
aintumours/Types.aspx
http://www.braintumor.org/patients-family-friends/about-braintumors/tumor-types/
http://www.cancer.med.umich.edu/cancertreat/brain/symptoms.shtml
http://www.cancer.med.umich.edu/cancertreat/brain/brain_tumor.shtml
http://www.columbianeurosurgery.org/conditions/brain-tumors/
http://www.columbianeurosurgery.org/conditions/neuro-oncology/