CNS Cancers:

Brain Cancer
 What is a Brain
Cancer???
The growth of abnormal cells in the
tissues of the brain.

A brain tumor is a localized

intracranial lesion that occupies space
within the skull.
Two Main Types of Brain
Cancer

Primary brain cancer

Metastatic brain cancer

(Secondary brain tumors)
Primary brain cancer
 Metastatic brain cancer

most common
types of cancer
that spread to Melanoma
the brain Breast Cancer
Renal Cell Carcinoma
Lung Cancer
Colorectal Cancer
Etiology
 PRECIPITATING FACTORS:
PREDISPOSING FACTORS:

Pathophysiology
Idiopathic
History of cancer disease
Exposure to ionizing radiation
Growth & development
Head trauma
Hormone changes
Dietary exposure to nitrates
Age
Tumors
Sex

Genetic mutation of
cellular DNA

Abnormal cell
transformation

Cloning of cells

Proto-oncogenes (KRAS2) acts as “on switch” for cellular

growth on chromosome 12 and TP53 turn off unseeded cellular
proliferation

Abnormal proliferation of cells, ignoring growth regulating

signals in the surrounding cells

Cells acquire invasive

characteristics
 Changes in
surrounding tissues

Infiltration of cells to tissues gaining access to

lymph and blood vessels

Carrying of cells to the area

of the body

Production of destructive enzymes (proteinases),

lysosomal hydrolyses

Destruction of
surrounding tissues

Facilitation of invasion
of malignant cells

Growth of tumors at
different areas of brain

Mechanical pressure of
rapidly growing tumor
 Compression and
Signs and symptoms: infiltration of tissue Signs and symptoms:
Headache loss of hearing,
Visual dysfunction Invasion of tumor to the cavernous tinnitus,
Hypothalamic sinuses or sphenoid bone vertigo,
disorders staggering gait,
Sleep disorders painful sensations of
Appetite disorders Pressure on adjacent face
Temperature disorders structures
Emotional disorders
Increased ICP
Increased ICP

Decreased cerebral
blood flow

Signs and symptoms:

increased systolic
Cushing’s response blood pressure
(rise in arterial widened pulse
pressure pressure
cardiac slowing

Deterioration of brain’s
autoregulation
Signs and symptoms:
Bradycardia
Hypertension Cushing’s
Bradypnea triad
Herniation of brainstem and occlusion of
cerebral blood flow

Cessation of
blood flow

Cerebral ischemia

Infarction

Coma

Brain death

DEATH
Diagnostic Tests
Medical Management
Surgical Management
Gamma Knife is the leading stereotactic radiosurgery (SRS) platform, offering
unparalleled accuracy in both the localization and radiation dose delivered to targeted
brain tissue.
Nursing Management
Preoperative Nursing Care:
•Instruct patient and family about the necessity
and importance of diagnostic tests to determine
the exact location of the tumor.
•Monitor and record vital signs and neurological
status accurately q2-4h, or as ordered.
•Institute measures to prevent inadvertent
increases in intracranial pressure.
Nursing Management
• Institute seizure precautions at patient's
bedside.
• Supportive nursing care is given depending
upon the patient's symptoms and ability to
perform activities of daily living.
• Administer all doses of steroids and
antiepileptic agents on time.
Nursing Management
Post-Operative Nursing:
Meticulous nursing management and care aimed
at prevention of postoperative complications are
imperative for the patient's survival.
•Accurately monitor and record all vital signs and
neurological signs.
•Administer artificial tears (eye drops) as ordered,
to prevent corneal ulceration in the comatose
patient.
•Maintain skin integrity.
Nursing Management
• Bone flap may not have been replaced over
surgical site; turning patient to the affected side, if
the flap has been removed, can cause
irreversible damage in the first 72 hours.
• Maintain head of bed at 30ºelevation.
• Perform passive range of motion exercises to all
extremities every 2-4 hours.
• Maintain body temperature.
Nursing Management
• Institute seizure precautions at patient's bedside.
• Maintain accurate record of intake and output.
• Prevent pulmonary complications associated with
bedrest.
• Continuously talk to the patient while providing
care, reorienting him to person, place, and time.
PREVENTION
LIFESTYLE CHOICES
•Diet
•Avoid smoking
•Avoid drinking alcohol
•Proper exercise
•Sweating is powerful way to cleanse your
body from accumulated toxins
•Avoid exposure to chemicals
•Avoid or minimize exposure to radiation
 PREVENTION
STRESS MANAGEMENT AND YOUR
IMMUNE SYSTEM
• Laughter Therapy
• Change your mood
• Boost up your immune system by
taking vitamins and eating
nutritious foods
• Avoid junk foods!
Breast Cancer occurs when a mutation takes
place in the cells that line the lobules that
manufacture milk or more commonly in the
ducts that carry it to the nipple.

1. Chest Wall
2. Muscle
3. Lobules
4. Nipple
5. Areola
6. Lactiferous Ducts
7. Fat Tissues
8. Skin
The area around the center
of the breast is where most
cancers occur.

It is fairly rare for cancers to

form in the fat or non-
glandular tissues of the
breast.
 The causes of breast cancer are not
completely understood and are not set in
stone. But certain women are more
susceptible of developing one form of cancer.
 Risk Factors that cause
Breast Cancer
Factors that Cannot be Lifestyle Risks
Prevented Oral Contraceptive Use
Gender Not Having Children
Aging Hormone Replacement
Therapy
Genetic Risk Factors
(inherited) Not Breast Feeding
Family History Alcohol Use
Personal History Obesity
Race High Fat Diets
Menstrual Cycle Physical Inactivity
Estrogen Smoking
Environmental Factors

Exposure to Estrogen
Radiation
Electromagnetic Fields
Xenoestrogens
Exposure to Chemicals
 Exogenous Estrogen
• Hormonal replacement
therapy(HRT)
-30% increased risk with long term
use
• Oral Contraceptives(OC)
-risk slight
-risk returns to normal once the use
of OC’s has been discontinued
 Other Risk Factors for
Breast Cancer
• Radiation exposure
• Breast disease
-Atypical Hyperplasia
-Intraductal carcinoma in situ
-Intralobular carcinoma in situ
• Obesity
• Diet
-Fat
-Alcohol
 Genetics
BRCA-1
BRCA-2
P53, Rb-1
Her-2/neu, c-erB2,
c-myc
ONCOGENES

Onco – Cancer Gene – Genetic Material

Oncogene : Suppressor Gene Ratio

1:1
In Cancer

Oncogene > Suppressor Gene

• occurs as ducts dilate and cysts form
• most commonly in women aged 30-50 years
• estrogen appears to be a factor because cysts usually disappear
after menopause
• usually larger premenstrually and smaller postmenstrually because
of the retention of fluid in the days preceding the menstrual period
• occur singly or in multiple lumps
• usually tender, round shaped; soft or firm, mobile
• medical management: Danazol ( antiestrogenic property); used only
in severe cases due to its side effects like flushing, vaginitis and
virilization
• Nursing intervention: wear supportive bra day and night for a week;
decrease salt and caffeine intake; ibuprofen
• round, movable benign tumor of the breast
• affects women in their late teens to late 30’s
• no premenstrual changes
• firm, mobile and not fixed to breast tissue or chest wall
• fibroepithelial lesion that tends to grow rapidly
• rarely malignant and is surgically excised
• if it is malignant, mastectomy may follow
• proliferation of malignant cells
within the ducts and lobules
without invasion to the surrounding
tissue
• considered stage 0 breast cancer
• two types: ductal and lobular
carcinoma in situ
• ductal carcinoma in situ (dcis)-
more common; has the capacity
to progress to invasive cancer
• most traditional treatment is total
or simple mastectomy
• Tamoxifen for women after tx with
surgery and radiation
• lobular carcinoma in situ-
proliferation of malignant cells
within the breast lobules; rarely
associated with invasive cancer
but maybe a marker of increased
risk for the development of
invasive cancer
• Management:
1. long term surveillance
2. bilateral prophylactic mastectomy
to decrease risk
3. chemoprevention- Tamoxifen
given for 5 years
1. INFILTRATING DUCTAL
CARCINOMA- most common type of
breast cancer and accounts for 75%
of all breast cancers
• noted for its hardness on palpation
• usually metastasize to axillary nodes
• poorer prognosis than others
2. INFILTRATING LOBULAR
CARCINOMA - 5% - 10% of breast
cancers
• occur as an area of ill-defined
thickening
• several areas of thickening may occur
on one or both breasts
• metastasize to meninges
• BOTH INFILTRATING DUCTAL AND
INFILTRATING LOBULAR CARCINOMAS
USUALLY SPREAD TO THE BONE,
LUNG, LIVER OR BRAIN
3. INFLAMMATORY CARCINOMA-
rare type of breast cancer
• localized tumor is tender and painful
and the skin over it is red and dusky
• breast is abnormally firm and
enlarged
• often, edema and nipple retraction
occur
• Management:
-chemotherapy
-radiation
-surgery
 Signs and Symptoms

Signs are those that are felt by patient (subjective).

•A lump in a breast
•A pain in the armpits or breast that does not seem to be
related to the woman's menstrual period
•Pitting or redness of the skin of the breast; like the skin of
an orange
•A rash around (or on) one of the nipples
•A swelling (lump) in one of the armpits
• An area of thickened tissue in a breast
• One of the nipples has a discharge;
sometimes it may contain blood
• The nipple changes in appearance; it may
become sunken or inverted
• The size or the shape of the breast changes
• The nipple-skin or breast-skin may have
started to peel, scale or flake
Diagnostic procedures

• Breast Exam (Initial assessment)

• Mammography 2D + 3D
• X-ray
• Breast Ultrasound (solid mass vs fluid-
filled)
• Biopsy (Confirmatory procedure)
• Breast MRI (determine extent of cancer)
Breast self exam
Breast self exam
 TUMOR MARKERS are used to aid in the diagnosis of
cancer, to detect recurrence or identify regression of a
known malignancy:

CA 15-3 and CA 27-29

Specific treatment for breast cancer, these markers are

found in the blood of affected patients and are most
useful in evaluating the effectiveness of treatment for
individuals with advanced disease.
Both tests are commonly used to monitor the recurrence
in women who have been treated for breast cancer.

The CA 27-29 test may be more sensitive than CA 15-3.

Management
The TEAM
Management and the Nurse’s role

• Surgery
• Radiotherapy
• Chemotherapy
• Hormone Therapy
• Biological Treatment
 SURGERY

- Lumpectomy
- Mastectomy
- Reconstructive Surgery

Nurse’s focus:
•Post-Operative Care
•Wound Care
•Rehabilitation plan to achieve optimum
level of functioning
•Psychological care for clients towards
changes in body image
 RADIOTHERAPY

- Brachytherapy
- Linear accelerator

Nurse’s focus:
• Skin Care
• Prevent fatigue
 CHEMOTHERAPY

Nurse’s focus:
•Alleviate most common side effects:
- nausea/ vomiting,
- diarrhea/ constipation
•Prevent extravasation/ phlebitis
•Encourage adherence to treatment
plan and schedule
 Hormone Therapy
- Endocrine receptor
Some breast cancers are stimulated by
the hormone estrogen. This means that
estrogen in the body ‘helps’ the cancer to
grow. This type of breast cancer is called
estrogen receptor positive (ER+).
Hormone therapy, also called endocrine
therapy, is a treatment that blocks the
effect of estrogen on breast cancer cells.
Different hormone therapy drugs do this
in different ways.

Nurse’s focus:
•Client’s adherence to
treatment schedule and
duration
 Biological Therapy

Also known as Targeted Therapy or Immunotherapy

It uses the body's immune system or hormonal system to
fight breast cancer cells. That does less harm to healthy cells,
so the side effects aren't usually as bad as from better
known treatments like chemotherapy.

Nurse’s focus:
•Allergic reaction
•Prevent extravasation/ phlebitis
•Adherence to treatment schedule
Biological Therapy
Prevention of Breast Cancer
• Lifestyle Modification
-Alcohol consumption
-Physical Exercise
-Diet
-Postmenopausal Hormone therapy
-Bodyweight
• Breast Cancer Screening
• Breastfeeding
 Lung Cancer is the leading cause of death due to cancer among men
and
women in the U.S.
In about 70 % of patients with lung cancer, the disease quite frequently has
already spread to regional lymph nodes and other areas by the time it is
diagnosed therefore, the long-term survival rate is poor, with the 5 year
survival rate being a mere 13%

the most common cause of cancer of the lungs is usually inhaled

carcinogens, most often cigarette smoke (90%)
Carcinoma usually arises in areas of previous scarring (such as TB,
fibrosis, etc.) in the lungs
SMALL CELL LUNG NON-SMALL CELL
CANCER LUNG CANCER
 accounts for about 10- accounts for the other 85-90%
15% of tumors of tumors

 generally includes small  include squamous cell

cell carcinoma and carcinoma (more centrally
located), large cell
combined small cell carcinoma,
carcinoma adenocarcinoma and
bronchoalveolar carcinoma.
Further classification of
NSCLC is according to cell
type
Adenocarcinoma- develops peripherally as
peripheral masses or nodules and usually
metastasizes. It is the most common lung cancer in
both sexes
Bronchoalveolar carcinoma- located in the terminal
bronchi and alveoli, and for the most part is slower
growing in comparison to the other bronchogenic
carcinomas
Large Cell Carcinoma (undifferentiated carcinoma)-
a faster growing tumor that usually arises
peripherally
the stage of the tumor involves the size
of the tumor, its location, lymph nodes
involvment, and whether the cancer has
spread to other organs

staging helps clinicians better determine

prognosis and treatment direction

SCLC typically diagnosed as limited

stage (one area of chest and usually
treatable by radiation, etc.) or extensive
stage (spread to other parts of the body,
metastasized, etc.)

NSCLC typically staged as I to IV-

Stage I earliest stage, highest cure rate ;
Stage IV-metastatic spread and usually
fatal.
Number one risk factor for lung
cancer!
In the U.S. cigarette smoking is
linked to 80-90% of all lung
cancers.
People who smoke cigarettes are
15 to 30 times more likely to get
lung cancer or die from lung
cancer than those who do not
smoke.
Smoke from other people’s
cigarettes, pipes, or cigars
(secondhand smoke) also causes
lung cancer. About 7,300 people
who have never smoked die from
lung cancer each year due to
secondhand smoke.
Radon is a naturally occurring gas
that comes from rocks and dirt and
can get trapped in houses and
buildings. Radon breaks down into
radon progeny which can attach to
dust and other particles and are
then inhaled.

Levels are usually highest in

basements or crawl spaces, which
is closest to soil and rocks.
Therefore, people who spend a lot
of time in these rooms are at a
greater risk.

According to the Environmental

Protection Agency (EPA), radon
causes about 20,000 cases of lung
cancer each year, making it the
second leading cause of lung
cancer.. Nearly 1 out of 15 homes in
If you are a lung cancer
survivor, there is a risk that
you may develop another
lung cancer, especially if
you smoke!

Your risk of lung cancer

may be higher if your
parents, brothers or sisters,
or children have had lung
cancer. This could be true
because they also smoke,
or they live or work in the
same place where they are
exposed to radon and other
substances that can cause
lung cancer.
Cancer survivors who
have had radiation to
the chest are at a higher
risk for developing lung
cancer.

Examples include
people treated for
Hodgkin lymphoma or
women who get
radiation after a
mastectomy for breast
cancer.
Many work environments can harbor
potentially harmful substances known
as carcinogens. These are
substances which can cause or
increase the risk of acquiring cancer. It
is important for all workers to follow
workplace health and safety guidelines
in order to avoid potential exposure to
carcinogens.

According to the American Cancer

Society, these chemicals can include:
Tetrachlorethylene - a common dry
cleaning fluid
Asbestos - a naturally occurring
group of minerals
Benzene - a colorless and
flammable liquid which gives off a
sweet scent
Arsenic - a naturally occurring
poisonous substance
Formaldehyde - an odorless
chemical used in building materials
Cough- The MOST prominent symptom- monitor if the patient
develops any kind of change in character of chronic cough.

The cough is usually a dry, persistent hacking cough that may

become productive with sputum production if and when
infection develops

Dyspnea or difficulty breathing (especially early on in the

course of the disease)

Blood-tinged sputum (hemoptysis)

Pain –pleuritic or shoulder pain (may occur late in the course of

the disease as well if spread to the bone)

Fever- due to constant infections in the lung parenchyma

Nonspecific S/S- Weight loss and generalized weakness

If tumor metastasizes, S/S include more pronounced chest

pain and tightness, difficulty swallowing, edema of head and
neck, & possible pleural/pericardial effusion.
-Chest x-Ray- to assess density of the
lung, and to search for a single lung
nodule (or coin lesion), alveolar collapse,
or infection

-CT scan of Chest- to look for smaller

nodules that may be difficult to see on the
x-ray, or to determine lymph node
pathology

-Fiberoptic Bronchoscopy –gives an in-

detail study of the tracheobronchial tree
and allows for tissue biopsies to be
collected

-Fine-needle Aspiration- done

transthoracically and under CT guidance to
collect tissue for examination if it cannot be
collected via bronchoscopy

-PET scans, CT scans, bone scans,

abdominal scans, and ultrasounds of
various organs and other areas throughout
the body may be performed to evaluate for
Medical interventions aim to cure, treat or palliate

Interventions performed: surgical, pharmacological,

radiation
Most stage I and stage II non-small cell lung cancers are treated with
surgery to remove the tumor

Video-assisted thoracoscopic surgery (VATS) is a minimally

invasive surgical technique used to diagnose and treat problems in
your chest

 Resection of tumor, lobe: here are some types.

1. Wedge resection to remove a small section of lung that contains

the tumor along with a margin of healthy tissue

2. Segmental resection (segmentectomy) to remove a larger portion

of lung, but not an entire lobe

3. Lobectomy to remove the entire lobe of one lung

4. Pneumonectomy to remove an entire lung

Teletherapy High-powered energy Brachytherapy: (instill
beams from sources such as X-rays
and protons catheter in bronchial tube )
allow for faster and
External beam radiation therapy precise.
(EBRT): Delivers high doses of bleed and SOB relieved
radiation to lung cancer cells from
outside the body, using a variety of when high dose radiation
machine-based technologies. delivered to tumor.

Stereotactic radiosurgery (track tumor in

real time as you breath to avoid
healthy tissue)

-High dose rate (HDR) brachytherapy

(Internal Radiation): Delivers high
doses of radiation from implants
placed close to, or inside, the
tumor(s) in the body.
• Expectorants and antimicrobial agents to relieve
dyspnea and infection.

• Analgesics given ATC and PRN for breakthrough,

expect acute and chronic pain.

• Meds to manage side effects of chemo and radiation

(dry mouth)
 Chemotherapy treatment plan for lung cancer often consists of a
combination of drugs. Among the drugs most commonly used are cisplatin
(Platinol)

• carboplatin (Paraplatin) plus docetaxel (Taxotere)

• gemcitabine (Gemzar)

• paclitaxel (Taxol and others)

• vinorelbine (Navelbine and others),

• pemetrexed (Alimta).

-Chemotherapy after surgery, known as “adjuvant chemotherapy,” may

help prevent the cancer from returning.

-Chemotherapy before surgery is known as Neoadjuvant chemotherapy.

Used to shrink tumor enough to make it easier to remove with surgery or
increase effectiveness of radiation.
Targeted treatments are more specific to cancer cells. They
also attach or block targets on CA Cell surface.
Certain cancers have specific biomarkers, used to determine
eligibility and efficacy. These Biomarkers may receive
treatment with a targeted drug alone or in combination
with chemotherapy. These treatments for lung cancer
include:
• Erlotinib (Gilotrif).
• Gefitinib (Iressa)
• Bevacizumab (Avastin).
The use of one’s own immune system as treatment against cancer.

 Monoclonal antibodies are lab-generated molecules that target

specific tumor antigens

 Checkpoint inhibitors target molecules that serve as checks and

balances in the regulation of immune responses.

 Therapeutic vaccines target shared or tumor-specific antigens.

 Adoptive T-cell transfer (removed from the patient, genetically

modified or treated with chemicals to enhance their activity)
The fatigue a cancer patient
feels is an abnormal and
enduring feeling of extreme
exhaustion that does not
improve with rest. For
management of fatigue, it is
important to improve the
causes which exacerbate it,
such as pain, constipation,
or medication. Careful
balancing of rest and activity
is imperative.
Pain generates feelings of
irritability, sleeplessness,
decrease in appetite and
concentration, etc. It is helpful to
understand that pain does not
have to be a part of dying.

Signs of pain can include noisy

and labored breathing, sounds of
pain, such as groaning or moaning,
facial expressions, and body
language and movements.

Pain can be controlled and

managed. Medications for pain
range anywhere from Tylenol to
opioids such as Morphine. Other
ways to control pain include nerve
blocks, radiation treatment,
surgery, massage, application of
heat or cold, meditation, and
In the last months of life body
processes start to slow down and
the body begins to limit the nutrients
necessary to function.

Appetite loss can be caused by

changes in taste and smell, dry
mouth, changes in stomach and
bowel, shortness of breath, nausea,
vomiting, diarrhea, and constipation.

Side effects of medication, spiritual

distress, and stress are also
possible causes. Some of these can
be managed with nutritional support,
such as eating strategies and
supplements, as well as
medications that decrease nausea,
stimulate the appetite, or stimulate
peristalsis.
Shortness of breath and
labored breathing are
common in advanced cancer.

Management can include

sitting up or propping oneself
on pillows, wearing a nasal
cannula to deliver
supplemental oxygen or
increase airflow, opioid pain
and anxiolytic medications,
as well as breathing and
relaxation techniques.
 RISK FOR INFECTION Impaired Tissue Integrity:
ALOPECIA
 Teach patient to avoid those with known or
recent infections  Advise that hair loss may occur on body
parts other than the head
 Avoid shaving with a straight edge razor
 Explain that hair growth usually begins again
once therapy is completed
 Avoid heating pads, ice, adhesive tape, and hot
showers/baths.
 Guide the patient in purchasing a hair piece
or wig before hair loss
 Avoid rectal or vaginal procedures.
 Lubricate scalp with Vitamin A & D ointment
 Discuss dental procedures with PCP to decrease itching

 Avoid IM injections  Have patient wear hat or sunscreen while

exposed to the sun
 Avoid insertion of urinary catheters( but if they
are necessary, use aseptic technique)
 IMPAIRED GAS EXCAHNGE
Maintain the patient in elevated Maintain patency of chest drainage
positions in order to enhance lung system for lobectomy, segmental or
expansion
wedge resection patient.
Assess respiratory rate, rhythm,
and depth.  Avoid positioning patient with a
pneumonectomy on the operative
Assist with deep breathing side; instead, favor the “good lung
exercises and pursed-lip breathing down” position.
as appropriate.

Administer supplemental oxygen

as indicated

Monitor ABGs, Pulse oximetry,

Hbg & Hct levels.

Encourage fluid intake (2500

ml/day)
 Imbalanced Nutrition:
Less than Body Chronic Pain
Requirements
 Prevent unpleasant sights,  Offer nonpharmacologic strategies
odors and sounds during to relieve pain and discomfort.
mealtime.
 Encourage analgesics to be
 Ensure adequate fluid administered AOC rather than PRN.
hydration, before, during, and
after drug administration  Provide education about the use of
analgesics (ie; adverse effects,
 Adjust diet before and after potential complications, how to
drug administration according administer)
to patient preference and
tolerance.

 Encourage frequent oral

hygiene.

 Encourage the patient to use

guided imagery and relaxation
techniques during mealtime.
 Brain
Cancer

Thank You!!!