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CNA Oncology Certification > Brain & CNS cancer > Flashcards

Brain & CNS cancer Flashcards

1
Q

What makes brain & CNS cancers unique

A

the location of the tumors, even if benign, can have devastating consequences & make removable impossible

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2
Q

What are the 4 types of primary brain cancers?

A
  1. Gliomas - most common; occurs in glial cells eg. GBM
  2. Meningiomas - membrane surrounding skull; higher recurrence rate
  3. nerve sheath tumors eg. shwannomas (cranial nerve sheath)
  4. pituitary tumors
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3
Q

How does brain cancer cause its symptoms?

A
  • tumor type, location, biological characteristics determine the clinical features
  • symptoms usually caused by ICP in the local area d/t the rigidity of the cranium
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4
Q

What is the triad of symptoms associated w/ increased ICP?

A
  • headache upon awakening
  • N/V
  • papilledema (optic disk swelling)
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5
Q

What are common symptoms/manifestation of brain cancer?

A
  • headache that is persistent, unusual in quality
  • mental status changes (eg. difficulty focusing, mental slowness)
  • seizures
  • focal neurological deficit d/t ICP in specific locations of CNS
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6
Q

How is brain & CNS cancer diagnosed?

A
  • history & physical exam
  • bw
  • CT for hemorrhage, hydrocephalus, structural lesion
  • MRI w/ contrast for brain abnormalities, surrounding edema & to rule out stroke
  • MRA to evaluate vasculature (ie. tumor angiogenesis)
  • MR spectroscopy (MRS) to evaluate tumor metabolism - helps grade lesons; ie. benign vs malignant
  • PET for tumor metabolism (active or treated/benign tumor)
  • fMRI for language, motor, sensory function in relation to tumor location
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7
Q

What makes metastatic brain & CNS ca different vs other types of cancers?

A
  • unlikely to be systemic & distance mets d/t lack of lympathic system in brain
  • mets normally 2cm of original site
  • mets usually occur through the CNS
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8
Q

What’s the role of surgery in brain & CNS cancers?

A
  • Diagnosis w/ surgical biopsies
  • cure (eg. benign tumors like shwammomas)
  • debulking & palliation for malignant, invasive tumors
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9
Q

How are surgical procedures selected for brain & CNS cancers?

A
  • tumor location
  • surgical goal
  • patient performance status
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10
Q

What are two common surgical procedures in brain & CNS cancers?

A
  • stereotactic biopsy - dx in deep, non-resectable tumors

- craniotomy for dx & tumor removal/debulking

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11
Q

What are the nursing considerations for brain & CNS cancer pt w/ surgeries?

A

EMPHASIS ON PT EDUCATION & PROVIDING RESOURCES

  • allowed to ask questions (a lot of information very quickly esp with sudden, unexpected dx)
  • ensure understanding of disease, treatment options
  • provide verbal & written resources
  • contact information for questions
  • ensure SW is involved for f/u
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12
Q

What is the role of RT in brain & CNS cancers?

A
  • integral to treatment of malignant brain tumors; alone or w/ chemo
  • used for recurrent or residual benign tumors
  • RT consult after stereoltactic biopsy confirms dx
  • used to treat tumor resection cavity & surrounding areas
  • 6 week, max 6000 cGY for primary brain ca, less & shorter duration treatment for met disease
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13
Q

What are nursing considerations for brain & CNS cancer pt receiving RT?

A

EDUCATION

  • if high grade tumor, pt education BEFORE surgery
  • inform of possible complications & which symptoms to report immediately (ICP triad) esp N/V
  • ensure pt & family understand treatment schedule d/t prolonged treatment requires +++ commitment
  • ensure pt is aware of s/e & complications to expect post treatment eg. alopecia, cog changes, fatigue, changes in taste & saliva

PROVIDE RESOURCES

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14
Q

What are the 3 initial treatments of newly diagnosed brain & CNS cancer patients?

A
  • dex & steroid therapy to decrease ICP
  • antacids/ histamine blockers to decrease GI SE of steroid therapy
  • prophylactic anti epileptic drugs
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15
Q

What is the role of chemotherapy in brain & CNS cancer patients?

A
  • as with RT, chemo interferes w/ cell division and inhibits tumor growth
  • chemo is used alone or combined with other modalities
  • metastatic lesions are treated w/ surgery ie. biopsies for multipole lesions, craniotomy for solitary mets followed by conventional whole brain RT or radiosurgery
  • also used when other approaches have failed or tumors that are known to be more chemo sensitive
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16
Q

What are the nursing considerations for brain & CNS cancer patients receiving chemotherapy?

A
  • manage SE even though side effects are well tolerated
  • N/V w/ vomiting = side effect, N/V w/o vomiting = Increased ICP which is treated w/ steroids
  • encourage reporting of symptoms
  • give written instructions regarding what constitutes a medical emergency, phone numbers for after hours visit
17
Q

What other treatment modalities exist for treating brain & CNS cancers?

A
  • Anti-angiogenic substances
  • gene therapy w/ anti-virals - use non-replicating viruses to modify tumor cells genetically and make them susceptible to the anti-virals
    targeted toxins
  • oncolytic viruses
18
Q

What are the nursing considerations for patients undergoing other treatment modalities for brain & CNS cancer?

A
  • obtain consent
  • ensure pt are aware that these are trials - ie. not yet shown efficacy and may have unknown toxicities
  • provide treatment schedules & 24 hr contacts for reporting adverse events
  • provide written instructions
19
Q

What are the most common disease-related complications of brain cancers?

A
  • increased ICP
  • seizures
  • mental status changes
  • focal neurologic deficits
  • DVT, PE
20
Q

What are the most common complications of treatments for brain cancers?

A 
- infection
intracranial hemorrhage
- necrosis
- steroid myopathy
- immunosuppression 
- cognitive changes
21
Q

How are spinal cord tumors classified?

A

via location

  • medullary = in spinal cord
  • dural - in the dura around the cord

eg.
- extramedullary = outside of spinal cord
- extra dural = outside of dura (most common)
- intra medullary =inside spinal cord
- intra dural = inside spinal cord

22
Q

How do you screen for spinal cord tumors?

A
  • no definitive way

- severe, consistent back pain w/ or w/o neuro deficits

23
Q

What is the similarities between brain and CNS tumors?

A
  • can be benign or malignant

- primary or mets from other sites

24
Q

How does the typical spinal cord tumor present itself?

A
  • usually extradural
  • usually met from breast, lung, prostate, myeloma and lymphoma
  • most often affects the thoracic or lumbar
25
Q

What is the main goal of treatment for spinal cord tumors?

A

pain control because 90% dural patients have pain

26
Q

Why is it important that you identify the spinal cord tumor early?

A

to avoid weakness, numbness & lack of sphincter control (difficult to reverse)

27
Q

What patient characteristics determine the type of surgical intervention for spinal cord tumors?

A
  • tumor location
  • number of met lesions
  • extent of primary lesions
  • patient clinical condition
  • responsiveness to RT (eg. lymphomas, myelomas)
28
Q

How does intradural extramedullary tumors (spinal cord tumors) present itself and how is it treated?

A
  • rarely metastatic
  • generally benign
  • usually meningiomas & schwannomas
  • surgery is preferred, esp. complete tumor resection
  • recurrence rate is dependent on completeness of resection (residual disease = 50% recurrence rate)
29
Q

How does intradural intramedullary tumors present itself and how is it treated?

A
  • glial-astrocytoma, ependymoma, oligodendroglioma
  • surgery for well-circumscribed tumors
  • complete resection difficult for infiltrative tumors
  • goal is preserving neurological function
  • MRI + RT for infiltrative tumors
30
Q

What are nursing considerations for Older Adults?

A
  • higher risk for brain tumors is between 75 - 84 years old
  • barriers to treatment: insurance & financial concerns
  • difficulty w/ adherence to medication schedules & dosing, caring for self &/or spouse at home
  • symptoms make self-care & ADL difficult eg. cognitive issues r/t tumor location or visual disturbances disrupt self care
  • risk of isolation & loss of independence d/t impaired driving caused by seizures, visual disturbances, motor function disturbances
  • decrease of mobility increase risk of complications such as DVT/PE and falls
31
Q

What are nursing interventions for Older Adults w/ brain & CNS tumors?

A
  • clear assessment
  • provide community resources
  • involve family in care
  • provide verbal AND written instructions for treatment, emergency situations, and resources
32
Q

What are nursing care considerations for increased ICP?

A
  • encourage immediate reporting of symptoms & educate pt & family when to seek medical care
  • start or increase steroid meds
  • educate on steroid SE
33
Q

What are nursing considerations for patients experiencing seizures?

A
  • instruct families on safety precautions
  • instruct as to when to seek emergency medical attention
  • provide written instructions on dosing, schedule and SE of anti epileptic drugs
34
Q

What affects the prognosis of brain & CNS tumors?

A
  • tumor type
  • age (more complications as you get older; younger patients respond better)
  • location
  • patient’s overall health

CNA Oncology Certification (5 decks)

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