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.

TypesThere 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

TypesThe 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 SymptomsMany symptoms are related to an increase inpressure 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 locationof 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 SymptomsParietal 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 ManagementSpecific 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 ProblemsDepends on the tumour location and size andwhich 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: usingfunctional independence measure and Tokuhashi scale to

optimizerehabilitation planning

V Tang*,1,2, D Harvey2,3, J Park Dorsay4, S Jiang2,5 and MP Rathbone1,21Department of Medicine, Division of Neurology, McMaster University

Hamilton, Canada; 2HamiltonNeuroRestorative 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

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