Cancer — Nervous System — Precision Clinical Education

Pathophysiology

Gliomas: Derived from glial (supporting) cells. Often highly malignant and fast-growing. Most common primary type
Meningiomas: Arise from meninges. Usually slow-growing and benign but dangerous due to pressure effects in the rigid skull
Schwannomas: Arise from Schwann cells in the peripheral nervous system
Neuroblastoma: Malignant tumor of immature nerve cells. Most common in infants
Even histologically benign brain tumors can be fatal by increasing intracranial pressure within the fixed skull volume
Chemotherapy effectiveness is limited by the blood-brain barrier

New headache pattern or frequency. Worse in the morning. Worsened by coughing or bending (increased intracranial pressure)
Seizures (very common initial symptom, especially near motor cortex)
Facial droop, vacant/dazed expression, unequal pupils (cranial nerve involvement)
Ataxia, broad-based gait, loss of balance (cerebellar involvement)
Widespread numbness or tingling. Loss of proprioception (sensory tract damage)
Sudden weakness, loss of limb strength, pronator drift (UMN lesion)
The 5 Ds: Dizziness, Diplopia, Dysarthria, Dysphagia, Drop Attacks (vertebrobasilar/brainstem involvement)

"Worst headache ever experienced" or sudden confusion: Emergency evaluation required
Headaches worse in the morning, worsened by coughing/bending, new in pattern: Red flags for intracranial tumor
New seizures in an adult: Require immediate neurological investigation
Positive Babinski sign: Definitive indicator of CNS damage/UMN disease
The 5 Ds: Indicate vertebrobasilar or brainstem involvement
Unequal pupils or facial droop: Cranial nerve involvement — urgent neurological referral

Goal: Primarily palliative care to alleviate pain, anxiety, depression, and improve sleep
Local contraindications: Strictly contraindicated over undiagnosed lumps, active tumor sites, or recent radiation sites
Neurological monitoring: Watch for new or worsening neurological signs during treatment
Medical equipment: Adjust for shunts, catheters, and ports
Lymphedema risk: Cervical lymph node removal causes lifelong risk of fluid accumulation in face/neck
Treatment sequelae: Chemotherapy and radiation cause "brain fog," anemia, and hair loss, impacting body image
Emergency trigger: "Worst headache ever," sudden confusion, or new seizures — report immediately

Headaches worse in the morning, worsened by coughing/bending, new in pattern = red flags for intracranial tumor
Seizures are a very common initial symptom of brain tumors
The 5 Ds indicate vertebrobasilar/brainstem involvement
Positive Babinski sign is a definitive indicator of CNS damage
Even "benign" brain tumors can be fatal due to increased intracranial pressure
Metastatic brain tumors are more common than primary brain tumors

Metastatic brain tumors (from lungs, breasts, melanoma) are more common than primary brain tumors
Even benign brain tumors can be fatal by increasing intracranial pressure within the rigid skull
Seizures are a common initial symptom. Morning headaches worsened by coughing or bending are key red flags
The 5 Ds and positive Babinski sign are critical neurological screening findings
"Worst headache ever experienced" or sudden confusion requires immediate emergency referral