What is a Brain Tumor?

The most common solid tumors in children.

Approximately 1,500 children in the US are diagnosed
with a brain tumor each year. It is either malignant or
benign, they are tumors that originates in the cells of the
brain.
Brain tumors are localized
intracranial neoplasm that
produce effects of a spaceoccupying lesion.

A benign tumor does not contain cancer cells and usually, once
removed, does not recur. Most benign brain tumors have clear
borders, meaning they do not invade surrounding tissue. These
tumors can, however, cause symptoms similar to cancerous
tumors because of their size and location in the brain.
Malignant brain tumors contain cancer cells. It is usually fast
growing and invade surrounding tissue. And very rarely to
spread to other areas of the body, but may recur after treatment.
Brain tumors that are not cancer are called malignant because
of their size and location, and the damage they can do to the
vital functions of the brain.

Anatomy of the Brain

The central nervous system (CNS) consists of the brain and

spinal cord. The brain is an important organ that controls
thought, memory, emotion, touch, motor skills, vision, respiration,
temperature, hunger and every process that regulates our body.
The brain can be divided into the cerebrum, the brainstem and
cerebellum.
cerebrum (supratentorial or front of brain) composed of
the right and left hemispheres. Functions include: initiation of
movement, coordination of movement, temperature, touch,
vision, hearing, judgment, reasoning, problem solving, emotions
and learning.

Brainstem (midline or middle of brain) includes

the midbrain, the pons, and medulla. Functions include:
movement of the eyes and mouth, relaying sensory
messages, hunger, respirations, consciousness, cardiac
function, body temperature, involuntary muscle
movements, sneezing, coughing, vomiting and
swallowing.
Cerebellum (infratentorial or back of brain)
located at the back of the head, its functions is to
coordinate voluntary muscle movements and to
maintain posture, balance and equilibrium.

What causes Brain Tumor?

The majority of brain tumors have abnormalities of
genes involved in cell cycle control, causing uncontrolled
cell growth. Caused by alterations directly in the genes,
or by chromosomes rearrangements which change the
function of a gene.
certain genetic conditions (neurofibromatosis,

von Hippel-Lindau disease, Li-Fraumeni syndrome,

and retinoblastoma) also have an increased risk to
develop tumors of the central nervous system.

What causes Brain Tumor?

Research has been investigating parents of children
with brain tumors and their past exposure to certain
chemicals. Some chemicals may change the structure of
a gene that protects the body from diseases and cancer.
Workers in oil refining, rubber manufacturing, and
chemists have a higher incidence of certain types of
tumors.
children who have received radiation therapy to the
head as part of prior treatment for other malignancies
also at an increased risk for new brain tumors.

What are the different types of

Gliomas most Brain
common Tumor?
type of brain tumor. Gliomas
begin from glial cells, which are the supportive tissue of
the brain. There are several types of gliomas,
categorized by where are found, and the type of cells that
originated the tumor. The following are the different
types of gliomas:
1. Astrocytomas are glial cell tumors that are derived from
connective tissue cells called astrocytes. These cells can be
found anywhere in the brain or spinal cord. The most
common type of childhood brain tumor. Generally subdivided
into high grade or low grade tumors..

What are the different types of

Brain are
Tumor?
High grade astrocytomas
the most malignant of all
brain tumors. Its is further classified for presenting signs,
symptoms, treatment and prognosis, based on the
location of the tumor. The most common location of these
tumors is in the cerebellum where they are called
cerebellar astrocytomas.
These person usually have symptoms of increased
intracranial pressure, headache and vomiting. There
can also be problems with walking and coordination,
as well as double vision.

What are the different types of

Brain Tumor?
2. Brain Stem Gliomas - are tumors found in the brain
stem. Most brain stem tumors cannot be surgically
removed because of the remote location and delicate
and complex function this are controls. Occur almost
exclusively in children; the group most often affected is
the school age child. The child usually does not have
increased intracranial pressure, but may have
problems with double vision, movement of the face or
one side of the body or difficulty with walking and
coordination.

What are the different types of

Tumor?
3. EpendymomasBrain
are also
glial cell tumors. They
usually develop in the lining of the ventricles or in the
spinal cord. The most common place they are found in
children is near the cerebellum. The tumor often blocks
the flow of the CSF (cerebral spinal fluid) causing
increased intracranial pressure. This type of tumor
mostly occurs in children younger than 10 years of
age. It can be slow growing, compared to other brain
tumors, but may recur after treatment is completed.
Recurrence result in a more invasive tumor with more
resistance to treatment.

What are the different types of

Brain
Tumor?
4. Optic Nerve Gliomas
are
found in or around the
nerves that send messages from the eye to the brain.
They are frequently found in persons who have
neurofibromatosis, a condition a child is born with that
makes him/her more likely to develop tumors in the
brain. Persons usually experienced loss of vision, as
well As hormone problems, since these tumors are
usually located at the base of the brain where
hormonal control is located. These are typically difficult
to treat due to the surrounding sensitive brain
structures.

What are the different types of

Brain Tumor?
Primitive Neuroectodermal Tumors (PNET) can
occur anywhere in the brain of a child, although the
most common place is in the back of the brain near the
cerebellum. When they occur here, they are called
medulloblastomas. The symptoms depends on their
location in the brain, but typically the child experience
increased intracranial pressure. These tumors are fast
growing and often malignant, with occasional
spreading throughout the brain or spinal cord.

What are the different types of

Brain
1. Medulloblastomas
areTumor?
one type of PNET that are
found near the midline of the cerebellum. This tumor is
rapidly growing and often blocks drainage of the CSF
(cerebral spinal fluid), causing symptoms associated
with increased ICP. Medulloblastomas cells can spread
(metastasize) to other areas of the central nervous
system, especially around the spinal cord. A
combination of surgery, radiation and chemotherapy is
usually needed to control these tumors.

What are the different types of

Brain
Craniopharyngioma
areTumor?
benign tumors that occur at
the base of the brain near the nerves from the eyes to
the brain, and the hormones centers. Most persons
with this type of brain tumor develop symptoms before
the age of 20. Symptoms include headaches, as well
as problems with vision. Hormonal imbalances are
common, including poor growth and short stature.
Symptoms of increased intracranial pressure may also
seen. Although these tumors are benign, they are hard
to remove due to the sensitive brain structures that
surround them.

What are the different types of

Brain Tumor?

Pineal region tumors - many different tumors can rise near

the pineal gland, a gland which helps control sleep and wake
cycles. Gliomas are common in this region, as are pineal
blastomas (PNET). In addition, germ cell tumors, another from
of malignant tumor, can be found in this area. Tumors in this
region are common in children than adults, and make up to 3 to
8 % Of pediatric brain tumors. Benign pineal gland cysts are
also seen in this location, which makes the diagnosis difficult
between what is malignant and what is benign. Biopsy or
removal of the tumor is frequently necessary to tell the different
types of tumors part.

What are the symptoms of a Brain

Increased Intracranialtumor?
Pressure (ICP) - caused by extra

tissue or fluid in the brain. Pressure may increase because one

or more of the ventricles that drain cerebrospinal fluid has been
blocked, causing the fluid to be trapped in the brain. Increased
ICP can cause the following:
Vomiting (usually in the morning)
Decreased cardiac and respiratory function and eventually
coma
Personality change and irritability
Drowsiness, headache, nausea
depression

What are the symptoms of a Brain

symptoms vary depending
upon which part of the brain the
tumor?
tumor is found. Symptoms of brain tumors in the cerebrum
(front of the brain) may include:
Seizures
Visual changes
Slurred speech
Paralysis or weakness on half of the body or face
Increased ICP
Drowsiness and/or confusion
Personality changes

What are the symptoms of a Brain

symptoms of the brain tumors
in the brainstem (middle
tumor?
brain) may include:
Seizures
Endocrine problems (diabetes and/or hormone regulation)
Visual changes or double vision
headaches
Paralysis of the nerves/muscles of the face or half of the
body
Respiratory changes
Increased intracranial pressure

What are the symptoms of a Brain

tumor?
symptoms of the brain tumors
in the cerebellum (back of
the brain) may include:
Increased intracranial pressure
Vomiting (usually occurs in the morning without nausea)
headaches
Uncoordinated muscle movements
Problems walking (ataxia)

How is brain tumor diagnosed?

Neurological Exam your childs physician tests reflexes,
muscle strength, eye and mouth movement, coordination and
alertness.
Computerized Tomography Scan (CT or CAT Scan) - a

diagnostic imaging procedure that uses a combination

of x-rays and computer technology to produce crosssectional images often called slices), both horizontally
and vertically, of the body. A CT scan shows detailed
images of any part of the body, including the bones,
muscles, fat and organs. CT scans are more detailed
than general x-rays.

How is brain tumor diagnosed?

Bone Scan - pictures or x-rays taken of the bone after a dye
has been injected that is absorbed by bone tissue. These are
used to detect tumors and bone abnormalities.
Magnetic Resonance Imaging (MRI) a diagnostic

procedure that used a combination of large magnets,

radio frequencies and a computer to produce detailed
images of organs and structures within the body. A MRI
of the brain usually shows more details of the brain than
a CT scan and is the diagnostic test of choice in brain
tumors.

How is brain tumor diagnosed?

Myelogram - an x-ray of the spine, similar to an

angiogram
Lumbar Puncture/Spinal Tap a special needle is
placed into the lower back, into, into the spinal canal.
This is the area around the spinal cord. A small amount
of cerebral spinal fluid (CSF) can be removed and sent
for testing. CSF is the fluid which bathes The brain and
spinal cord. There may be situation in which a lumbar
puncture would be contraindicated in brain tumors.

Collaborative Management
Surgical Intervention
1. Surgery is performed to determine the type of the
tumor and the extent of invasiveness and to excise as
much of the lesion as possible.
2. Corticosteroids may be used as adjunct therapy to
reduce cerebral swelling.
3. A ventriculoperitoneal shunt is often necessary for
children who develop hydrocephalus.

Collaborative Management
Therapeutic and Pharmacological Interventions
1. Radiation therapy is usually initiated as soon as the
diagnosis is established and the surgical wound is healed.
2. Chemotherapy is used in children younger than age 4 with
medulloblastoma (to avoid early radiation) and in children with
ependymomas.
3. Steroid to treat and prevent seizures with intracranial
pressure
4. Anti-seizure medication to treat and prevent seizures
associated with intracranial pressure

Nursing Diagnosis
Acute Pain
Disturbed Body Image
Fear
Imbalanced Nutrition Less than body requirements
Impaired physical mobility
Risk for infection
Risk for injury

Nursing Intervention
Monitoring
1. Monitor vital signs, level of consciousness and pupillary
reaction frequently
2. Observe for signs of brain stem herniation (a neurosurgical
emergency)
a. Attacks of opisthotonos
b. Tilting of the head; neck stiffness
c. Poorly reactive pupils
d. Increased BP; widened pulse pressure
e. Change in respiratory rate and nature of respiration

Nursing Intervention
Monitoring
f. Irregularity of pulse or lowered pulse rate
g. Alterations of body temperature
3. Monitor temperature closely after surgery
a. A marked rise in temperature may be attributable to trauma,
disturbance of the heat-regulating center, or to intracranial
edema.
b. If hyperthermia occurs, administer antipyretics and sponge
baths as ordered. Temperature should not be reduced rapidly

Nursing Intervention
Monitoring
4. Observe for signs of shock, increased ICP and altered level of
consciousness
Supportive Care
1. Prepare the parents for the postoperative appearance of their
child; advise that the child might be comatose immediately
after surgery
2. Prepare the child for surgery; explain procedures at the
appropriate developmental level.
3. Prepare the child for postoperative expectations

Nursing Intervention
Supportive Care
4. Administer opiods as ordered in the immediate postoperative
period; assess the childs level of consciousness before
administration
5. Position the child according to surgeons request, usually on
unaffected side with head level. Raising the foot of the bed
may increase ICP and bleeding.
6. Change the childs position frequently and provide meticulous
skin care to prevent hypostatic pneumonia and pressure
sores.

Nursing Intervention
Supportive Care
7. move the child carefully and slowly, being certain to move the
head in line with the body.
8. Support paralyzed or spastic extremities with pillows, towel
rolls or other means.
9. Initiate feeding for the child when the child is fully alert.
Refeed the child after he vomits.
10. If the child is unable to eat, provide tube feedings. A
gastrostomy tube may be inserted.
11. Maintain IV hydration or hyperalimentation and intralipids if
indicated.

Nursing Intervention

Supportive Care

12. Check the surgical dressing for bleeding and for CSF
drainage.
13. Assess the child for edema of the head, face, and neck.
14. Carefully regulate fluid administration to prevent increased
cerebral edema.
15. Have equipment readily available for CPR, respiratory
assistance, oxygen inhalation, blood transfusion, ventricular
tap, and other potential emergency situations.
16. If the child is receiving chemotherapy or radiation, instruct
the parents to report fever over 101F (38.4C), nausea,
vomiting.

Nursing Intervention
Supportive Care
17. Encourage the child to express feelings regarding the
changes in body image (hair loss)
18. Reassure the child that he will be able to wear a wig or a hat
after recovery; hair will grow back following surgery, but
does not grow back at radiation site.
19. Help the parents to see the childs increasing capabilities
and encourage them to foster independence.

Education and Health Maintenance

1. Provide parents with written information regarding the childs

needs-medications, activity, care of the incision, and follow up
appointments.
2. Teach the parents about radiation or chemotherapy
treatments and their adverse effects. Corticosteroids may
cause cushingoid changes (moon face, weight gain, edema)
if used for long period
3. If a child has a ventriculoperitoneal shunt, teach parents to
recognize and report fever, nausea, vomiting, irritability or bulging
anterior fontanel.
4.Initiate a referral to a community health nurse to reinforced
teaching and to maintain therapeutic support for the family.

Education and Health Maintenance

5. For additional resources, refer family to agencies such as
American Brain Tumor Association.

MRI Appearance of Primary Brian

Tumors (Gliomas, high grade glioblastoma
and low grade gliomas.)

A grade 3 glioma (sometimes called

anaplastic astrocytoma) will have less
necrosis in the center (compared to a grade 4
or glioblastoma) but still look more abnormal
(more enhancement) than a low grade (grade
1 or grade 2) .