Brain Tumors

adults children

-more frequent in ___ -more malignant in ___

malignant normal

A tumor in an adult is also graded or staged according to: -how ___ it is -how rapidly it is growing and how likely it is to invade other tissues -how closely its cells resemble ___ cells. (The more abnormal a tumor cell looks, the faster it is likely to grow)

cause compensate

Balance Multifactoral Root ___ and treat there May ___ with equipment

CNS CNS systemic

Brain Tumor Classification: Primary Versus Secondary Tumors -Primary Tumors originate in the ___ -Secondary Tumors Spread to the ___ from ___ cancer sites

MoCa strategies environment

Cognition -___ best test -Can present as memory, attention, awareness Memory-___ Attention-___ Awareness-safety

steroid fatigue cognitive

Considerations for Physical therapy: -Complications from surgery -Radiation side effects -Chemotherapy side effects-thrombocytopenia platelet levels below 150,000 cells/μL compression garments, BP cuffs??, straining below 50,000 cells/μL-Moderate Below 20,000 cells/ μL-ADL -___ side effects -Anticonvulsant side effects -Increased risk of venous thrombic embolism -Cancer related ___ -___ changes

children adolescents CSF benign

Ependymoma: -9% of all gliomas, and 5% of all intracranial tumors. Most common in ___ and ___ -begin in the very thin membranes that help form ___ and line the brain cavities (ventricles) that contain it. -usually ___ -well-differentiated borders -Cells look very much like normal cells -grow very slowly. -The cells of anaplastic (malignant) ependymomas look abnormal and grow more rapidly than the cells of benign tumors.

astrocytomas

GLIOMAS -Arise from the supportive tissue in the cerebrum -Several types of gliomas: ___ (most common) Oligodendrogliomas Ependymomas

HA nausea vomiting visual seizures LOB

General signs and symptoms -___-presenting symptom in 65% of cases -___ and ___ 10% -___ Disturbance 30% -___-presenting symptom in 25% -AMS—presenting symptom in 15—20% of cases -Papilledema-less common but present with slow growing tumors -___ associated with HA

100 0 smaller

Karnofsky Performance Scale: ___ is normal ___ is dead -is a little more sensitive to ___ changes in function

AIDS behavioral hemiparesis

Lymphoma-non-hodgkins: -Small percentage of brain tumors -Can occur in immunocompetent or immunocompromised individuals. -Very common in patients with ___ -Problems with this tumor range from ___ problems to ___ depending on the size and location of the tumor

fast malignant cerebellum children coordination

Medulloblastoma: -___-growing, ___ tumors -originate in embryonic cells not normally present in the body after birth. -Tumors always in the ___ -most common in ___( boys >girls). -Only 30% of MDL tumors occur in adults. -usually originate in the cerebellum, and are often carried to other parts of the brain by cerebrospinal fluid. -Rarely metastasize beyond the brain and spinal cord. -pt will present with ___ issues

benign women recover slow

Meningioma: -Represent more than 20% of all primary brain tumors -originate in the membranes that enclose the brain and spinal cord (meninges). -These tumors are usually ___ and most often occur in ___ aged 30-50 years old. -may be hard to ___ bc of ___ onset

glioblastoma

Most malignant and most common - ___

rare slowly spread

OLIGODENDROGLIOMA: -____ -found anywhere within the cerebral hemisphere of the brain, although the frontal and temporal lobes are the most common sites -middle-aged adults -grow ___ -do not usually ___ -Originates in Cerebrum in the glial cells-produce myelin -Usually grades II and III

yup

Other types of primary tumors-non glial brain tumors Medulloblastomas Meningiomas Pituitary adenomas Schwannomas Lymphoma

estim

Pain Neuropathic pain - ___ helps Strategies for HA, Pressure reliefs etc NSAIDS??? Caution

benign hormones

Pituitary adenoma: -___ epithelial tumors originating from the pituitary gland. -Can lead to hypo or hypo secretion of ___ -Prognosis depends on size and call type of the tumor

40 70 blood vessel

Positive prognostic factors for patients with astrocytomas -less than ___ years of age -a preoperative and postoperative functional level of ___% or more on the Karnofsky Performance Status Scale -tumor location -greater extent of surgical removal -uniform ___ ___ size in the histological specimen.

fatigue

SCALES: FIM Karnofsky Brief ___ Inventory Eastern Cooperative Oncology Group Cancer Rehabilitation Evaluation System- self report Other appropriate BS, Activity or participation OM's

hearing balance face walking swallowing eye taste deadly

Schwannoma (Acoustic Neuroma): -originate in the Schwann cells- myelin-hearing. -2x women>men -ages 30-60. -Slow growing -___ and ___ loss -As the tumor progresses, it can press on the nerves that control movement and feeling in the ___, and cause headaches and facial numbness or tingling. -The patient may have trouble w, s, or controlling ___ movements, and the sense of ___ can be affected. -can grow large enough to press on the brainstem-___.

radio

Stereotactic ___surgery-good for tumors <3cm in size. Uses a gamma knife to deliver a high dose of radiation to a specific site.

low mod 30 5 3 2

Strengthening and CV conditioning: -Depending on the stage of the cancer may do restorative or compensatory strengthening and CV- usually ___ to ___ intensity for both -___ min per day ___ days per week is recommended (___ days CV, ___ days strength) -Steroid Myopathy -Research does show it can improve fatigue, nausea -Pools/water exercise in generally avoided

hematoma hydrocephalus

Surgery-goal is to remove as much tumor as can safely remove Complications = h, h, infection, infarction

originates grows cells

The name of a brain tumor describes where it ___, how it ___, and what kind of ___ it contains.

patches

Vision -Can be double vision, hemianopsia, visual processing -Prisms, ___ (alternate eyes), scanning, environmental adaptations

cerebellum

___ Ataxia Ipsilateral dysmetria Dysdiadochokinesia Intention tremmor

brainstem

___ Gait disturbances Diplopia Focal weakness Altered consciousness/attention

temporal

___ Lobe Auditory and perceptual changes Memory and learning Impairments Aphasia ( wernicke's)

occipital

___ Lobe Homonymous Hemianopsia Impaired extraocular Muscle movement

frontal

___ Lobe Primary movements Personality changes Cognitive impairments Delayed initiation Language problems (broca's)

parietal

___ Lobe Somatosensory changes Impaired spatial relations Homonymous visual deficits Agnosia Language comprehension problems

radiation

___ Therapy-can be used alone or in combination of surgery and/or chemotherapy-main complication is the possibility of radiation necrosis

cerebellopontine

___ angle Hearing loss, ataxia Tinnitus Dizziness Facial palsy

chemo

___-can be used independently if too dangerous to operate or in conjunction with surgery-main complication is destruction of normal cells

CNS frontal glioblastoma malforma

astrocytoma: -within the ___ -Grade I and II usually occur in the third or fourth decade of life -They are most often located in the ___ lobe of the brain, but may also be found in the basal ganglia and temporal, parietal, or occipital lobes. -Grade IV astrocytoma: It may be called a ___ ___ or malignant astrocytic glioma.-Most common Primary brain tumor

excise borders malignant

benign brain tumors do not contain cancer cells: -easier to ___ usually -more defined ___ -doesn't spread as quickly -damage depends on tumor encroachment -can turn ___

PET SPECT MRS (Spectroscopy)

dx: dynamic tests -___ - grading tumors -___ - grading and differentiating btwn recurring tumors and radiation necrosis -___ - produces images that show function rather than shape. This technique can show patterns of activity that may be helpful in diagnosing specific tumors and conditions. may also be used to determine how advanced a tumor is. -Biopsy

MRI CT

dx: static tests - -

0 5

eastern cooperative oncology group (ECOG): another measure for prognosis ___ = fully active ___ = dead

exercise

fatigue: ___ is best (5 P's)

least normal slowly

grade 1: The tissue is the ___ malignant. The cells look nearly like ____ brain cells, and they grow ___

slow nearby

grade 2: These tumors are ___-growing and look slightly abnormal under a microscope. Some can spread into ___ normal tissue and recur, sometimes as a higher-grade tumor.

malignant II abnormal

grade 3: These tumors are, by definition, ___ although there is not always a big difference between grade ___ and grade III tumors. The cells of a grade III tumor are actively reproducing ___ cells, which grow into nearby normal brain tissue. These tumors tend to recur, often as a grade IV.

rapidly dead

grade 4: These are the most malignant tumors. They reproduce ___, can have a bizarre appearance when viewed under the microscope, and easily grow into nearby normal brain tissue. These tumors form new blood vessels so they can maintain their rapid growth. They also have areas of ___ cells in their centers.

highest

grading a tumor: -Brain tumor can contain several different types of cells. -The tumor's grade is determined by the ___-grade (most malignant) cell detected under a microscope, even if most of the cells in the tumor are less malignant. -An infiltrating tumor is a tumor of any grade that grows into surrounding tissue.

slow defined encapsulated brain

low grade: I and II -rate of growth: ___ -borders: ___ or ___: make it easy to remove -spread: may spread but stays in ___

brain cancer shorter CNS

malignant tumors (also called ___ ___): -generally more serious -grow quickly so ___ lifespan -more common to spread within ___

faster other parts of the body

medium or high grade: III and IV -rate of growth: ___ -borders: not well-defined - difficult to remove entire tumor -spread: may metastasize to ___

good

prognosis: -Astrocytoma-5 years 66%; 11 years 11% -Glioblastoma Multiforma=12-18 months after diagnosis -Meningiomas=good if age less than 60, no increased ICP, complete resection, absence of atypical histological featers -Schwannomas ( acoustic Neuromas)=___ prognosis if complete excision -Metastatic brain CA= difficult to treat with prognosis favorable if patient is less than 50 YO, no uncontrolled systemic disease, complete resection of the tumor, no increased ICP and the primary source of CA is identified and treated

preventative restorative supportive palliative

rehab: 4 phases of care p r s (maintenance) p

frontal lung behavior lability judgment impulsivity

secondary tumors: -___ lobe most common location for secondary tumor from a systemic cancer including lung, breast, or kidney cancer. -20-40% of people with systemic cancer develop metastatic brain tumors -50% with ___ CA -15-20% with breast CA -will present with ___ issues (l, j, i)