Neurological Oncological Conditions

1. Neurological Oncological Conditions Kerry McIntyre

2. Definition • Neuro-oncology refers to all cancers that affect the brain and central nervous system.

3. 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).

4. Pathophysiology

5. 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

6. 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.

7. 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.

8. 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

9. 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

10. 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

11. Causes and Risk Factors • Genetic abnormalitiesgenes that control mitosis are mutated • exposure to certain chemicals • Exposure to excessive radiationx-rays and cell phones • HIV infection • Genetic conditions

12. 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.

13. 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.

14. 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.

15. 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.

16. 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

17. Signs and Symptoms Cerebellum: • Lack of co-ordination which affects walking • Speech difficulties • Unsteadiness • Nystagmus • Vomiting • Neck stiffness.

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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/Typesofbraintumours/Typesofbraintumours.aspx • http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Symptomsdiagnosis/Symptoms.aspx • http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbraintumours/Whatiscancer.aspx • http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbraintumours/Causes.aspx • http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Brain/Aboutbraintumours/Types.aspx • http://www.braintumor.org/patients-family-friends/about-brain-tumors/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/