Saturday, 25 February 2012

Thank You for Nurses and Doctors

I thought it would be a nice idea to give the staff at the hospital a gift  that everyone could use yet still be a little special so I came up with a bouquet of pens.

What to bring with you to hospital as an in patient or out patient

Despite being a qualified nurse (a long time ago) I've been on a steep learning curve when it comes to organising a person to be admitted to a hospital AND for visiting a hospital ( long time waiting around for doctors appointments).  So........

What to bring with you to hospital as a in patient

Bring your appointment card or admission letter with you when you go into hospital if you have one. If you are staying in hospital you may also need the following:

  • two nightdresses or pairs of pyjamas (depending on the length of your stay)
  • day clothes (you may not need to wear your night clothes for your entire stay in hospital. Hospital wards are often kept warm, so bear this in mind when choosing clothes.)
  • clean underwear
  • a dressing gown and slippers
  • a small hand towel
  • toiletries, including soap, a toothbrush, toothpaste, shampoo and conditioner
  • sanitary towels or tampons
  • a razor and shaving materials
  • a comb or hairbrush
  • things to occupy you, such as books, magazines or puzzle books
  • a small amount of money to buy things such as newspapers, phone calls and anything you may want from the hospital shop or ward trolley
  • any medicines you normally take, including nicotine replacement treatment, eye drops, inhalers and creams
  • a notebook and pen to write down any questions you have when the doctor is not available
  • if you wish, you can bring healthy snacks to eat between meals
  • your address book and important phone numbers, including your GP’s name, address and telephone number
  • proof that you do not have to pay prescription charges, if applicable (inpatients don't normally have to pay for the medication they are sent home with)
Limit clutter and gifts. Keeping your bed area free from clutter makes cleaning easier. Where possible, it is advisable to mark all items of personal property with your name

Sean found his MP3 Player invaluable and his mobile phone (fully charged  with plenty of credit) for texting the children and for family prayers morning and night ( we put his calls on speaker phone and sang Let Us Gather in a Circle, had a prayer and gave our love and greetings which set everyone up for the day and for a good night sleep.  (mobile can only be used in certain places check with staff where your allowed to use it)


What to bring with you to hospital as an out patient

Note Pad and Pen with Questions on it
Out patient appointment letter/card
Flask with ice water and cup
Packed lunch/ something to eat
book/magazine/ kindle/MP3 Player
List of medicines and when you take it & other doctor appointments times/names

Change for vending machines/parking charges
Small Toiletry bag with deodorant, spritz spray, lip balm, eye drops, wipes, tissues, paracetamol,(I particularly value this item I even have a small sewing project in it to divert my thoughts)

Thursday, 23 February 2012

Seans Back Home

Seans back home.  The children were excited to see him however the girls asked dad to put a hat on because they were a bit squeemish about seeing dads scare and staples however Adam was quite curious.

Its not to bad considering.

Wednesday, 22 February 2012

This Scarcrow has a Brain

Ok I'm smiling now get on with it

Sean being ackward

I HAVE A BRAIN!

and an appatite

and some  extremely cool white stockings!
Sean less that 12 hours after biopsy doing well and giving the nurses a hard time with his constant chatter and wanting to move around.

Tuesday, 21 February 2012

Sean was Admitted to Ward 64 Southern General Hospital

This morning we had a chat with our Surgeon Mr Mathison and we have decided the best way forward  for sean was to have a Stereotactic Brain Biopsy and then have Chemotherapy and Radiotherapy.


The children visiting dad and seeing him for the first time as a patient

Saying bye was hard we just wanted to kidnap him home

Sean waving madly from the third floor


PATIENT GUIDE TO STEREOTACTIC BRAIN BIOPSIES

WHAT IS A STEREOTACTIC BRAIN BIOPSY?
A stereotactic brain biopsy is a surgical procedure. Its purpose is to obtain a small specimen from a specific part of the brain so we can tell you what condition you have. If the concern is that you may have a growth, the biopsy is intended to determine if it is a benign or aggressive tumor, and if it started in the brain or spread there from another part of the body. This in turn determines what treatment would be appropriate for it.

PREPARATION FOR THE BIOPSY
You should eat nothing after midnight on the evening before the procedure. Otherwise, there is no special preparation.

THE BIOPSY
You come into the admitting area of the hospital early on the day prior to the biopsy. You will fill out some paperwork, and then be transported to either the MRI or CT scan area. An intravenous line will be started. Then a metal frame called a "Leksell head frame" or "BRW frame" is attached to you by Dr. .

The frame is difficult to describe. It is a metal device (see picture) that weighs about three pounds that you can easily see through. It attaches to the head with posts that are advanced through the frame to put pressure on the scalp and head. Two posts are in the front (in the forehead), and two are in the back of the head. You have this frame on for several hours, and any discomfort from the posts will be relieved with Novocaine.

A CT scan or MRI scan is then obtained. This takes about 20 minutes. You will then be transported to the operating room while dr analyze the scan and make calculations as to how the biopsy will be taken. In the operating room, you will lie on the operating table, and the frame will be secured to it. An area about the size of a postage stamp is shaved and cleansed with soap solution to prevent infection.

After these preparations, the biopsy itself begins. We numb a small area of the skin with Novocaine. A small nick is made in the scalp, and using a very small drill, a hole about the diameter of a piece of spaghetti is made in the skull. A biopsy probe is advanced through this to a pre-determined spot in the brain. We take a small specimen about the size of the kernel of rice. This is  processed and looked at under the microscope by the pathologist.We will give the results in about a week.

The pathologist will tell us one of three things: (1) they know immediately what the diagnosis is, (2) they will almost certainly know in a few days what the diagnosis is, (3) they would like us to obtain more biopsies. The usually tell us (2).

If the pathologist tells us we need to take more biopsies, we will do so. Otherwise, the procedure is over. The biopsy probe is removed, and a single stitch is placed in the skin that will dissolve on its own. The frame is removed and you return to your room. From the time you enter the operating room to the time you leave is usually 45 minutes.
AFTER THE BIOPSY
On returning to your room, you should feel largely back to normal. Some people have a mild to moderate headache on the evening of the procedure.

The nurses will watch you for several hours. If all is well, we will obtain a CT scan to determine if there has been any internal bleeding or new swelling at the biopsy site. If all seems well, you are free to leave at your convenience that same day. We will arrange a time to review the biopsy results.

REMOVING THE STITCH
You can shower and wash your hair as you normally would the day of the biopsy. The stitch will dissolve over about 2 weeks and does not need to be removed.

Sunday, 19 February 2012

Finding Incredible: What Cancer—and Trials—Can Teach Us

I read this story from the LDS Newnews room and was so touched and encouraged by thier faith that it really has motivated me to try to keep strong.  thought I would share....

Finding Incredible: What Cancer—and Trials—Can Teach Us




In September 2011, Daniel Hedlund, a seminary teacher in Layton, Utah, USA, wrote the above words and submitted them to an online competition called “In Search of Incredible.”
Singer and filmmaker Jason Mraz was in search of incredible stories from around the world, and he invited people to share theirs. And in December, people from around the world voted.
They chose Daniel’s story, which was made into a short film and presented at the largest independent cinema festival in the United States—the Sundance Film Festival in Park City, Utah, USA—on January 19, 2012.
Daniel’s experience is incredible, but he is quick to point out that he doesn’t think his story is much different from that of anyone else who has been through something difficult.
“I think the lesson to be learned is that our Heavenly Father loves us, and He wants what’s best for us, like any father would,” Daniel said. “If we can trust that simple fact . . . then all of a sudden there’s this paradigm shift because we look at our trials and challenges and obstacles as a means to an end. It all of a sudden became for me something that would grow me as a person, would grow my testimony, would grow my faith in the Savior, would help me to rely on somebody other than my own capabilities.”
Since he was diagnosed with osteosarcoma (bone cancer) four years ago, Daniel has undergone 20 rounds of chemotherapy and 10 surgeries. The cancer has returned twice, but Daniel is currently in remission. Through these experiences, he said, his understanding of the Atonement has deepened.
“[Christ’s] ability to be there for us when we need Him, His ability to give us the peace and comfort that we seek when we most need it, and the reality of His atoning sacrifice and how far-reaching that is. . . . To me, that’s incredible,” Daniel said. “It is an infinite Atonement. And its effects are much more far-reaching than my living room.”

Living with Cancer

The Friday morning leading up to a new scan is one of the most difficult for Daniel and his wife, Melanie. It’s January, and it’s been three months since Daniel has been scanned for any new cancer growth. The last two scans, taken at three-month intervals, have come up clean.
The time between when Daniel is scanned and when he receives the results the following Monday is “nerve-wracking,” he said. “Luckily, one of those days is Sunday, so we get to go to church and receive that spiritual charge.”
This time, the scan comes up clean for the third time in a row. As the Hedlunds leave, they stop at the desk and set the next appointment for three months from now.
Daniel’s first scan occurred in December 2007. Newlywed in November 2007, Daniel and Melanie, 23 and 20 years old respectively, were eager to begin their life together.
But three weeks after their wedding, during a checkup for a sore leg, doctors saw that something on the x-ray didn’t look quite right and recommended an MRI immediately.
In the waiting room of the imaging center, Melanie wrote out wedding thank-you notes as they waited for a phone call that would tell them the results. Finally, it came. Daniel said he remembers everything about that phone call.
“I remember how the doctor sounded. I remember the words he said. But most of all I think I remember how it felt to hear those words, ‘You have cancer,’ for the first time,” he said. “He told me . . . I would have to do chemotherapy, and I might lose my leg.”
He dropped his head and began to cry. As he hung up and turned around, he realized Melanie hadn’t heard any of it, but could tell from his expression something was very wrong.
“I had to sit next to her and tell my bride of three weeks that her new husband had cancer,” Daniel recalled.
Osteosarcoma is generally a pediatric cancer that occurs in younger patients and teenagers. Daniel had no history of cancer in his family, and he said the unknown was terrifying.
In his case, the cancer had metastasized, or spread, to his lungs, making it a stage-four cancer with a 20–50 percent survival rate.
Rounds of chemotherapy involved Daniel being administered a series of drugs in various cycles. Some treatments required that he return to the hospital every day for several days, while others required that he stay at the hospital for an extended period of time.
Chemotherapy often left him feeling nauseous and exhausted. Within two months of his diagnosis Daniel had lost 30 pounds and his hair had begun falling out.
Because of his faith in the plan of salvation, Daniel said he was never afraid to die, but he did fear not being able to experience much of what life has to offer—having children, playing with grandchildren, serving missions with his wife.
“I was afraid, especially at the beginning, that I was failing at being a husband,” he said. “I felt like it was my job to prevent things like this from happening, and here I was the cause of this happening.”
Since his initial diagnosis and during each recurrence of cancer in his lungs—for five months in February 2010 and for another five months in February 2011—Daniel said he and Melanie have learned specific lessons that have application to any trial or challenge life may present.

After the Rain Comes the Rainbow

When Daniel was diagnosed with cancer the first time, he said he believed Heavenly Father wanted him to learn something before he could move on. When he was declared in remission the first time, he thought he had “passed the test.”
But then it came back again, and then again. For a long time, Daniel said, he wondered if there was something he wasn’t learning that God wanted him to. It was during the cancer’s second recurrence that he reached a turning point.
He was reading in the New Testament:
“And there arose a great storm of wind, and the waves beat into the ship, so that it was now full.
“And [Christ] was in the hinder part of the ship, asleep on a pillow: and they awake him, and say unto him, Master, carest thou not that we perish?” (Mark 4:37–38).
“I thought to myself, ‘That is exactly the way I feel right now,’” Daniel said. “’Master, carest thou not that I perish? Carest thou not, Heavenly Father, that I have cancer? Carest thou not that my wife and I want to start a family? Carest thou not that I’m tired of doing this? Carest thou not that we want to continue our lives?’”
When Daniel continued reading, he said, he found the answer to all of his questions.
“The Savior’s response to His disciples was, ‘O ye of little faith,’ and He stretched forth His hand and He calmed the tempest,” Daniel said, quoting Matthew 8:26. “I had to ask myself in that moment, ‘Do I believe that this actually happened? Do I believe that Christ calmed the waters that day?’ And I do. And because I believe that, I know that He can calm the tempest going on inside my body. . . . And it’s not my job to ask why or to wonder why this is happening to me again. My job is just to have the faith that Heavenly Father is in charge and that He knows what’s best for me.”
On March 25, 2008, just three months after Daniel’s initial diagnosis, Melanie wrote on their CaringBridge blog, “Although I don’t believe God GAVE Daniel cancer, I do believe He ALLOWED the cancer to come into our lives at this time for a purpose that we do not yet know. But I know there is a purpose that He has in mind.”
Melanie said she continues to learn what that purpose is.
“I hope I never fully figure it out, because trying to figure out the purpose behind Daniel’s illness helps me to learn what I think my Heavenly Father would want me to learn,” she said.
When, on March 11, 2011, doctors found cancer in Daniel’s lungs for a third time, he wrote that he knew that not only had he and his wife been blessed during the previous three years, but that they had come out ahead of where they would have otherwise been.
The past four years have helped Daniel and Melanie to be more aware of the blessings of family and friends, they said. In 2008, during Daniel’s first bout with cancer, supporters put on a benefit concert themed “After the Rain Comes the Rainbow,” alluding to the story of Noah.
Funds went to help with the Hedlunds’ medical costs—costs for treating for this type of cancer can run from $500,000 to $800,000 USD.
Over the past four years, the Hedlunds have spent more than 100 days in the hospital. Regular visits from friends and family, coupled with the support of compassionate doctors and nurses, were a great source of comfort and support to them during those hospital stays, the couple said. Daniel’s mother even moved to Utah for four months to be near her son and to allow Melanie to continue to attend school.
Daniel and Melanie also found a greater appreciation for temple covenants because of their trials.
“The doctors can give me a 30 percent chance to live, but I have a 100 percent chance to be with my wife forever,” Daniel said. “And that knowledge keeps us sane and gives us peace and gives us comfort in those otherwise stressful times in our lives.”
Perhaps most importantly, the past four years have taught Daniel and Melanie that the gospel is the ultimate source of comfort and hope.
“I wanted that newlywed life—and not only that, I wanted a full life with my husband. And all of those things were up in the air and questionable,” she said. “And I learned that the gospel . . . is the only thing that can help you overcome that sorrow of that loss. And it’s because we’ve been promised all of those things that are most important. We’ve been promised eternal life if we’re faithful. We’ve been promised eternal families if we keep our covenants.”
Daniel recalled how prayer comforted him during late nights when chemotherapy treatments kept him up and he felt alone.
“Those were the times that the Atonement was most real to me because it was almost as if the Savior were there in the room with me and telling me, ‘It’s OK. I know what you’re going through because I’ve gone through it, because I’ve been there,’” he said. “That was the single source of comfort on so many occasions for me—knowing that I had a Savior who loved me enough to suffer what I was suffering.”

Conclusion

As of January 2012, Daniel Hedlund is cancer-free. The eight-inch donor bone that replaced the cancerous part of his femur has yet to incorporate fully, so he continues to walk with the aid of a cane. Every three months for the rest of his life, Daniel will undergo scanning to check for new cancer growth throughout his body.
Daniel continues to hold the same perspective he’s developed through his experience with cancer, which he wrote about last March when he was diagnosed with cancer for a third time:

I’m looking forward to seeing what the Lord has in store for me. . . . What lessons He’ll teach me. How He’ll stretch me and school me. And most of all, what He will turn me into. Where I see myself going and who I see myself becoming are very different from where God sees me going and who He sees me becoming. But each step of the way, I can see that where He has taken me is a much better place than I ever thought of for myself.

Tuesday, 14 February 2012

HEART ATTACKS!

For the children we made rolo dynamite we got the idea from HERE
and for the next 12 days we will give the children one of  these wee cards in thier lunch to remind them about Love

Hanna & Sean got busy and creative in the kitchen

making a very big MESS and some Lovely Valentine Treats



 Traditional we deliver secret Valentines for people we love and appreciate  This year we gave out 8 to pink pressies to members of the church.
and 8 to other people we wish to share our love with  We attached a balloon to wee parcels of sweets and hearts with messages on them We based the idea from HERE
We decided to put the goodies at the end of the string to use as a weight .  we were going to deliver by knocking the doors and running.

NOTE: 1. DO NOT HAVE A DOZEN BALLOONS ON RIBBON WITH PARCELS AT THE END AND PUT IN THE BOOT OF THE CAR = SPAGETTI JUNCTION WHICH RESULTS IN SERIOUS SURGERY AND FRAID (mum and dads) TEMPER.

Its fun not getting caught....

 and even more when we DO get caught
However it was eventually all worth it...

Monday, 13 February 2012

What is Valentines Day

Valentine's Day

From Wikipedia, the free encyclopedia

Saint Valentine's Day, commonly shortened to Valentine's Day, is a holiday observed on February 14 honoring one or more early Christian martyrs named Saint Valentine. It was first established by Pope Gelasius I in 496 AD, and was later deleted from the General Roman Calendar of saints in 1969 by Pope Paul VI.

The day first became associated with romantic love in the circle of Geoffrey Chaucer in the High Middle Ages, when the tradition of courtly love flourished. By the 15th century, it had evolved into an occasion in which lovers expressed their love for each other by presenting flowers, offering confectionery, and sending greeting cards (known as "valentines")

Modern Valentine's Day symbols include the heart-shaped outline, doves, and the figure of the winged Cupid. Since the 19th century, handwritten valentines have given way to mass-produced greeting cards
For more info click here

Fresh Start for Scripture Study

This year I decided to really consentrate on my scripture study so I made a consious effort to abandon my expensive copys of the scriptures which I have marked over the last 10 years and got a new set of cheap soft cover scriptures.  I protected the covers with laminated drawings I did (used adult colouring in sheets using a Paisley Pattern - I come from Paisley Stake) and decided on a scripture marking theme.  I'm using a marking system from The Red Headed Hostess.  She has a really good journal system as well which I am using.  I mark things which are very pertainant to our situation now and I have found the scriptures to be a true shining light in dark times.

Introducing Two New Family Members......

Mikey the Monkey and Daisy the Cow

We have been trying to prepare the children for dad being away from home and having a hospital stay.  We  asked the children what would bring them comfort and came up with the idea of a cuddly toy however we felt it would be best for the children to have their own cuddly toys to give THEM comfort when dads not there, so we all went shopping and found Mikey and Daisy.

 Mikey is a hot water bottle cover for mum to keep her warm and bring her comfort when dads not there and Daisy (Named after a local cow) is a pajama holder in which we can put love letters and pictures to chear dad up when he gets lonely or scared and to bring comfort with a big squish cuddle.

Friday, 10 February 2012

Thallium Test Results

We had a call from our surgeon today, apparently the thallium spect results didn't come through in time for the multi disciplinary meeting last Wednesday so it had to be cancelled.   Dr Mathison has now got the results and has rescheduled the multi disciplinary team meeting for next Wednesday.  He says the test showed "No Increased uptake" so he thinks its a low grade Glioma however to find out exactly will require a biopsy and he's going to push for one when he meets with the other team members with a look to getting it in 2-3 weeks time.

Gliomas           
Most tumours develop from the supporting cells of the brain known as the glial cells. They may be named after the type of cell that they are made up of, or after the part of the brain in which they are found, such as a brain stem glioma. More than half of all primary brain tumours are gliomas.

Grading of gliomas

Grading is a term that refers to how the tumour cells look under the microscope. A pathologist will examine the cells and look at whether there are signs they are dividing, how abnormal they look and if there are any abnormal blood vessels.
The grade gives an idea of how quickly the tumour may develop. There are four grades: grade 1 tumours are benign and grow very slowly, whereas grade 4 tumours are malignant (cancerous) and grow faster. Sometimes grade 1 and 2 gliomas are called low-grade gliomas and grades 3 and 4 are called high-grade gliomas. Knowing the type and grade of your tumour will help your doctors plan the best treatment.

Biopsy

In some cases, if a diagnosis cannot be made clearly from the scans, a biopsy may be performed to determine what type of tumour is present. Biopsy is a procedure to remove a small amount of tumour to be examined by a pathologist under a microscope. A biopsy can be taken as part of an open surgical procedure to remove the tumour or as a separate diagnostic procedure, known as a needle biopsy via a small hole drilled in the skull . A hollow needle is guided into the tumour and a tissue sample is removed ). A stereotactic biopsy is like a needle biopsy but is performed with the use of a stereotactic head frame and a computer to precisely locate the tumour and direct the needle. This more complex procedure is used for deep tumours in critical locations.
 During a needle biopsy, a hollow cannula is inserted into the tumour.
Small biting instruments remove bits of tumour for the pathologist
to examine and determine the exact tumour cell type.

Information leaflet for patients having a brain biopsy (this is not from our hospital its the only information that I can find that will tell us about being in hospital for a biopsy.

That's it.  All there is to report, we are carrying on with life as normal as we can, Sean goes to work and winds up the patients and workmates and I do alot of cleaning (OK so that's not normal)  The children go to school and clubs and we pray every night and Thank our Heavenly Father for the blessings we have so abundantly in our lives.

Some things that have been helping me through this week are :







             

Thursday, 2 February 2012

SPECT Scan


On Wed 1st of Feb Sean went for a Thalliun 201 SPECT Scan at the Southern General Hospital, Glasgow.



 

Overview

A Single Photon Emission Computed Tomography (SPECT) scan is a type of nuclear imaging test that shows how blood flows to tissues and organs.

How does a SPECT scan work?

A SPECT scan integrates two technologies to view your body: computed tomography (CT) and a radioactive material (tracer). The tracer is what allows doctors to see how blood flows to tissues and organs.Before the SPECT scan, you are injected with a chemical that is radiolabled, meaning it emits gamma rays that can be detected by the scanner. The computer collects the information emitted by the gamma rays and translates them into two-dimensional cross-sections. These cross-sections can be added back together to form a 3D image of your brain. The radioisotopes typically used in SPECT to label tracers are iodine-123, technetium-99m, xenon-133, thallium-201, and fluorine-18. These radioactive forms of natural elements will pass safely through your body and be detected by the scanner. Various drugs and other chemicals can be labeled with these isotopes.The type of tracer used depends on what your doctor wants to measure. For example, if your doctor is looking at a tumour, he or she might use radiolabled glucose (FDG) and watch how it is metabolized by the tumour.The test differs from a PET scan in that the tracer stays in your blood stream rather than being absorbed by surrounding tissues, thereby limiting the images to areas where blood flows. SPECT scans are cheaper and more readily available than higher resolution PET scans.

What does a SPECT scan show?

A SPECT scan is primarily used to view how blood flows through arteries and veins in the brain. Tests have shown that it might be more sensitive to brain injury than either MRI or CT scanning because it can detect reduced blood flow to injured sites.SPECT scanning is also useful for presurgical evaluation of medically uncontrolled seizures (Fig. 1). The test can be performed between seizures (interictal) or during a seizure (ictal) to determine blood flow to areas where the seizures originate.
Figure 1. A SPECT scan of a patient with uncontrolled complex partial seizures. The temporal lobe on the left side of the brain shows less blood flow than the right, confirming for the surgeon the nonfunctioning area of the brain causing seizures.
This type of scanning is also useful in diagnosing stress fractures in the spine (spondylolysis), blood deprived (ischemic) areas of brain following a stroke, and tumours.

Who performs the test?

A specially trained nuclear medicine technologist will perform the test in the Nuclear Medicine department of the hospital, or at an outpatient imaging centre.

How should I prepare for the test?

Wear comfortable clothing and be prepared to stay for 1 to 2 hours.

What happens during the test?

First, you will receive an injection of a small amount of radioactive tracer. You'll be asked to rest for about 10-20 minutes until the tracer reaches your brain. Next, you'll lie comfortably on a scanner table while a special camera rotates around your head. Be sure to remain as still as possible so that the machine can take accurate pictures.Once the scan is complete, you can leave. Be sure to drink plenty of fluids to flush out any tracer left in your body.

What are the risks?

The amount of radiation your body is exposed to is less than you receive during a chest X-ray or CT scan. Women who are pregnant or nursing should not undergo a SPECT scan.

How do I get the test results?

The nuclear medicine doctor will promptly review your images and communicate directly with your referring doctor, who in turn will discuss the results with you.

Glossary

gamma rays: electromagnetic radiation emitted during radioactive decay and having an extremely short wavelength.
positron emission tomography (PET): a nuclear medicine test in which tissue function can be imaged. Damaged tissues have reduced metabolic activity; therefore, gamma radiation from these areas is reduced or absent.
photon: a particle that travels at the speed of light.
positron: an electrically charged particle that has the opposite charge as an electron. It reacts with an electron to produce gamma rays.
radiolabel: the technique of attaching, or "tagging", a radioactive molecule to another molecule (such as a protein) so that it can be identified in the body. The radiolabeled substance emits positrons that can be picked up by a special scanner.
tomography: the technique of using rotating X-rays to capture an image at a particular depth in the body, bringing those structures into sharp focus while blurring structures at other depths.
tracer: a substance, usually radioactively labelled, which is injected into your body and can be followed to gain information about metabolic processes.

Introduction to Brain Tumors

We found this information on a website and found it quite useful in understanding what Sean was going through.

Overview

A tumour (also called a neoplasm or lesion) is abnormal tissue that grows by uncontrolled cell division. Normal cells grow in a controlled manner as new cells replace old or damaged ones. For reasons not fully understood, tumour cells reproduce uncontrollably.

Brain tumours are named after the cell type from which they grow. They may be primary (starting in the brain) or secondary (spreading to the brain from another area). Treatment options vary depending on the tumour type, size and location; whether the tumour has spread; and the age and medical health of the person. Treatment options may be curative or focus on relieving symptoms. Of the more than 120 types of brain tumour's, many can be successfully treated. New therapies are improving the life span and quality of life for many people.

What is a brain tumour?

A primary brain tumour is an abnormal growth that starts in the brain and usually does not spread to other parts of the body. Primary brain tumour's may be benign or malignant.
A benign brain tumour grows slowly, has distinct boundaries, and rarely spreads. Although its cells are not malignant, this tumour composed of benign cells and located in vital areas can be considered life-threatening.

A malignant brain tumour grows quickly, has irregular boundaries, and spreads to nearby brain areas. Although they are sometimes called brain cancer, malignant brain tumour's do not fit the definition of cancer because they do not spread to organs outside the brain and spinal cord.
Metastatic (secondary) brain tumour's begin as cancer elsewhere in the body and spread to the brain. They form when cancer cells are carried in the blood stream to the brain. The most common cancers that spread to the brain are lung and breast.Whether a brain tumour is benign, malignant, or metastatic, all are potentially life-threatening. Enclosed within the bony skull, the brain cannot expand to make room for a growing mass. As a result, the tumour compresses and displaces normal brain tissue (Fig. 1). Some brain tumour's cause a blockage of cerebrospinal fluid (CSF) that flows around and through the brain. This blockage increases intracranial pressure and can enlarge the ventricles (hydrocephalus). Some brain tumours cause swelling (oedema). Size, pressure, and swelling all create "mass effect," which cause many of the symptoms.
tumor mass effect
Figure 1. Brain tumour's compress and displace normal brain tissue.
Increasing size, pressure and swelling cause neurologic symptoms.

Types of brain tumour's

There are over 120 different types of brain tumours. Common brain tumours include:Gliomas
  • Astrocytoma
  • Pilocytic Astrocytoma (grade I)
  • Diffuse Astrocytoma (grade II)
  • Anaplastic Astrocytoma (grade III)
  • Glioblastoma Multiforme (grade IV)
  • Oligodendroglioma (grade II)
  • Anaplastic Oligodendroglioma (grade III)
  • Ependymoma (grade II)
  • Anaplastic Ependymoma (grade III)
Craniopharyngioma
Epidermoid
Lymphoma
Meningioma
Schwannoma (neuroma)
Pituitary adenoma
Pinealoma (pineocytoma, pineoblastoma)
Medulloblastoma
The World Health Organization (WHO) developed a classification and grading system to standardise communication, treatment planning, and predict outcomes for brain tumour's. Tumours are classified by their cell type and grade by viewing the cells, usually taken during a biopsy, under a microscope.
Cell type. Refers to the cell of origin of the tumour. For example, nerve cells (neurons) and support cells (glial and schwann cells) give rise to tumour's. About half of all primary brain tumour's grow from glial cells (gliomas). There are many types of gliomas because there are different kinds of glial cells.Grade. Refers to the way tumour cells look under the microscope and is an indication of aggressiveness (e.g., low grade means least aggressive and high grade means most aggressive) (Table 1). Tumour's often have a mix of cell grades and can change as they grow. Differentiated and anaplastic are terms used to describe how similar or abnormal the tumour cells appear compared to normal cells.Table 1. Glioma Grading Scale
Grade
Characteristics
I
Slow growing cells
Almost normal appearance
Least malignant
Usually associated with long-term survival
II
Relatively slow growing cells
Slightly abnormal appearance
Can invade nearby tissue
Sometimes recur as a higher grade
III
Actively reproducing abnormal cells
Abnormal appearance
Infiltrate normal tissue
Tend to recur, often as a higher grade
IV
Rapidly reproducing abnormal cells
Very abnormal appearance
Area of dead cells (necrosis) in centre
Form new blood vessels to maintain growth

What causes brain tumour's?

Medical science neither knows what causes brain tumours nor how to prevent primary tumours that start in the brain. People most at risk for brain tumours include those who have:
  • cancer elsewhere in the body
  • prolonged exposure to pesticides, industrial solvents, and other chemicals
  • inherited diseases, such as neurofibromatosis

What are the symptoms?

Tumours can affect the brain by destroying normal tissue, compressing normal tissue, or increasing intracranial pressure. Symptoms vary depending on the tumor’s type, size, and location in the brain (Fig. 2). General symptoms include:
  • headaches that tend to worsen in the morning
  • seizures
  • stumbling, dizziness, difficulty walking
  • speech problems (e.g., difficulty finding the right word)
  • vision problems, abnormal eye movements
  • weakness on one side of the body
  • increased intracranial pressure, which causes drowsiness, headaches, nausea and vomiting, sluggish responses
Figure 2. Brain tumour symptoms are related to the functional areas of the brain, giving doctors clues as to the tumour location.
Specific symptoms include:
  • Frontal lobe tumours may cause behavioral and emotional changes, impaired judgment, impaired sense of smell, memory loss, paralysis on one side of the body, reduced mental abilities, and vision loss.
  • tumours may cause impaired speech, inability to write, lack of recognition, and spatial disorders.
  • Occipital lobe tumours may cause vision loss in one or both eyes.
  • Temporal lobe tumours may cause impaired speech and memory difficulty.
  • Brainstem tumours may cause behavioral and emotional changes, difficulty speaking and swallowing, drowsiness, hearing loss, muscle weakness on one side of the face (e.g., head tilt, crooked smile), muscle weakness on one side of the body, uncoordinated gait, drooping eyelid or double vision, and vomiting.
  • Pituitary gland tumours may cause increased secretion of hormones (Cushing’s Disease, acromegaly), a stop in menstruation, abnormal secretion of milk, and decreased libido.

Who is affected?

The American Brain Tumour Association estimates that about 40,900 people will be diagnosed with a primary brain tumour in the US this year (rate of 14 per 100,000 people). Metastatic (secondary) brain tumours are more common than primary brain tumours by at least 10 to 1, and they occur in 20% to 40% of cancer patients. The exact number of brain metastases is unknown, but it has been estimated that 98,000 to 170,000 new cases are diagnosed in the US each year. Unfortunately, each year about 12,690 people die of brain tumours in the US. Although brain tumours can occur at any age, they are most common in children 3 to 12 years old and in adults 40 to 70 years old.

How is a diagnosis made?

First, the doctor will obtain your personal and family medical history and perform a complete physical examination. In addition to checking your general health, the doctor performs a neurological exam to check mental status and memory, cranial nerve function (sight, hearing, smell, tongue and facial movement), muscle strength, coordination, reflexes, and response to pain. Additional tests may include:
  • Audiometry, a hearing test performed by an audiologist, detects hearing loss due to tumors near the cochlear nerve (e.g., acoustic neuroma).
  • An endocrine evaluation measures hormone levels in your blood or urine to detect abnormal levels caused by pituitary tumours (e.g., Cushing’s Disease).
  • A visual field acuity test is performed by a neuro-ophthalmologist to detect vision loss and missing areas in your field of view.
  • A lumbar puncture (spinal tap) may be performed to examine cerebrospinal fluid for tumour cells, proteins, infection, and blood.

Imaging tests

  • Computed Tomography (CT) scan is a safe, noninvasive test that uses an X-ray beam and a computer to make 2-dimensional images of the brain. Similar to an MRI, it views the brain in slices, layer-by-layer, taking a picture of each slice. A dye (contrast agent) may be injected into your bloodstream. CT is especially useful for viewing changes in bony structures.
  • Magnetic Resonance Imaging (MRI) scan is a noninvasive test that uses a magnetic field and radiofrequency waves to give a detailed view of the soft tissues of the brain. It views the brain 3-dimensionally in slices that can be taken from the side or from the top as a cross-section. A dye (contrast agent) may be injected into your bloodstream. MRI is very useful to evaluate brain lesions and their effects on surrounding brain (Fig. 3).
Figure 3. MRI scans of a benign and malignant brain tumour. Benign tumours have well defined edges and are more easily removed surgically. Malignant tumours have an irregular border that invades normal tissue with finger-like projections making surgical removal more difficult.

Biopsy

In some cases, if a diagnosis cannot be made clearly from the scans, a biopsy may be performed to determine what type of tumour is present. Biopsy is a procedure to remove a small amount of tumour to be examined by a pathologist under a microscope. A biopsy can be taken as part of an open surgical procedure to remove the tumour or as a separate diagnostic procedure, known as a needle biopsy via a small hole drilled in the skull . A hollow needle is guided into the tumour and a tissue sample is removed (Fig. 4). A stereotactic biopsy is like a needle biopsy but is performed with the use of a stereotactic head frame and a computer to precisely locate the tumour and direct the needle. This more complex procedure is used for deep tumours in critical locations.
Figure 4. During a needle biopsy, a hollow cannula is inserted into the tumour.
Small biting instruments remove bits of tumour for the pathologist
to examine and determine the exact tumour cell type.

Who treats brain tumours?

Because there are so many kinds of brain tumours and some are complex to treat, many doctors may be involved in your care. Your team may include a neurosurgeon, oncologist, radiation oncologist, radiologist, neurologist, and neuro-ophthalmologist.

What treatments are available?

Treatment options vary depending on the type, grade, size and location of the tumour; whether it has spread; and your age and general health. The goal of treatment may be curative or focus on relieving symptoms (palliative care). Treatments are often used in combination with one another. The goal is to remove all or as much of the tumour as possible through surgery to minimise the chance of recurrence. Radiation therapy and chemotherapy are used to treat tumours that cannot be removed by surgery alone. For example, surgery may remove the bulk of the tumour and a small amount of residual tumour near a critical structure can later be treated with radiation. ObservationSometimes the best treatment is observation. For example, benign, slow growing tumours that are small and have few symptoms may be observed with routine MRI scans every year until their growth or symptoms necessitate surgery. Observation may be the best option for older patients with other health conditions.MedicationMedications are used to control some of the common side effects of brain tumours.
  • Corticosteroid medications, such as dexamethasone (Decadron), are prescribed to reduce swelling and inflammation around the tumor. Because steroid medications can cause stomach ulcers and gastric reflux, famotidine (Pepcid) or pantoprazole (Protonix) are prescribed to reduce the amount of acid produced in the stomach.
  • Furosemide (Lasix) or mannitol (Osmitrol) may be used to control oedema and intracranial pressure.
  • Anticonvulsant medications are used to prevent or control seizures. The most common ones include phenytoin (Dilantin), valproic acid (Depakote), carbamazepine (Tegretol), and levetiracetam (Keppra).
SurgerySurgery is the treatment of choice for brain tumours that can be reached without causing significant injury to vital parts of the brain (eloquent tissue). Surgery can help to refine the diagnosis, remove as much of the tumour as possible, and release pressure within the skull caused by the tumour. A neurosurgeon performs a craniotomy to open the skull and remove the tumour. Sometimes only part of the tumour is removed if it is near critical areas of the brain. A partial removal can still relieve symptoms. Radiation or chemotherapy may be used on the remaining tumour cells.Improvements in techniques, particularly image-guided surgery, intraoperative MRI/CT, and functional brain mapping have improved the surgeon’s ability to precisely locate the tumour, define the tumor’s borders, avoid injury to vital brain areas, and confirm the amount of tumour removal while in the operating room.RadiationRadiation therapy uses controlled high-energy rays to treat brain tumours. Radiation works by damaging the DNA inside cells making them unable to divide and reproduce. The goal of radiation therapy is to maximise the dose to abnormal cells and minimise exposure to normal cells (Fig. 5). The benefits of radiation are not immediate but occur over time. Aggressive tumours, whose cells divide rapidly, typically respond more quickly to radiation. There are two ways to deliver radiation, external and internal beams.
radiation
Figure 5. The radiation beam is shaped to match the tumour and minimise exposure to normal brain tissue. The coloured rings represent the radiation dose level.
External beam radiation is delivered from outside the body by a machine that aims high-energy rays (x-rays, gamma rays) at the tumour.
  • Stereotactic radiosurgery (SRS) delivers a high dose of radiation during a single session. Although it is called surgery, no incision is made.
  • Fractionated stereotactic radiotherapy (FSR) delivers lower doses of radiation over many visits. Patients return daily over several weeks to receive the complete radiation dose.
  • Whole brain radiotherapy (WBRT) delivers the radiation dose to the entire brain. It is often used to treat multiple brain tumors and metastases.
Internal radiation (brachytherapy) is delivered from inside the body by surgically placing radioactive material (sealed in catheters, seeds, or balloons) directly into the tumour. After the patient undergoes a craniotomy to remove the tumour, the radioactive material is placed inside the tumour cavity. The radiation dose is delivered to the first few millimetres of tissue that surrounded the tumour cavity where malignant cells may still remain. Patients have no risk of radiation injury to other parts of their own body or to others around them because the radiation dose is precisely delivered and short lived. ChemotherapyChemotherapy drugs work by interrupting cell division. However, it affects not only tumour cells but normal cells, thus causing side effects, especially in fast growing cells (e.g., hair, digestive, blood). Treatment is delivered in cycles with rest periods in between to allow the body to rebuild healthy cells. Chemotherapy drugs can be administered orally as a pill, intravenously (IV), or as a wafer placed surgically into the tumour. The drugs most commonly used to treat brain tumours are carmustine (BCNU), lomustine (CCNU), and temozolomide (Temodar). Chemotherapy is also used as a radio-sensitizing agent that increases tumour cell death during radiation therapy. Agents that often work in high-grade gliomas include procarbazine, platinum analogs (cisplatin, carboplatin), the nitrosureas (BCNU, CCNU), and alkylating agents (temozolomide, vincristine). BCNU has been proven effective when applied locally to the tumour bed after the tumour has been removed. By applying it directly to the diseased area of the brain, side effects are limited and the drug has a more beneficial effect. Chemotherapy is not routinely used for benign tumours. Adjunct therapies
  • Immunotherapy or biotherapy activates the immune system (T-cells and antibodies) to destroy cancer cells. Experimental research is exploring ways to prevent or treat cancer through vaccines.
  • Gene therapy uses viruses or other vectors to introduce new genetic material into tumour cells. This experimental therapy can cause tumour cells to die or increase their susceptibility to other cancer therapies.
  • Hyperbaric oxygen uses oxygen at higher than normal levels to promote wound healing and help fight infection. It may also improve the tumor’s responsiveness to radiation and is being studied experimentally. Currently it is being used to help the body naturally remove dead tumour cells and treat radiation necrosis.

Recovery & prevention

Self careYour primary care doctor and oncologist should discuss any home care needs with you and your family. Supportive measures vary according to your symptoms. For example, canes or walkers can help those having trouble walking. A plan of care to address changes in mental status should be adapted to each patient’s needs.Driving privileges may be suspended while taking anticonvulsant medication. As each state has different rules about driving and seizures, discuss this issue with your doctor.It may also be appropriate to discuss advance medical directives (e.g., living will, health care proxy, durable power of attorney) with your family to ensure your medical care and wishes are followed.RehabilitationBecause brain tumours develop in parts of the brain that control movement, speech, vision and thinking, rehabilitation may be a necessary part of recovery. Although the brain can sometimes heal itself after the trauma of treatment, it will take time and patience. A neuropsychologist can help patients evaluate changes caused by their brain tumour and develop a plan for rehabilitation. A neuropsychological evaluation assesses the patent's emotional state, daily behaviour, cognitive (mental) abilities, and personality. Physical therapy, occupational therapy, and speech therapy may be helpful to improve or correct lost functions. RecurrenceHow well a tumour will respond to treatment, remain in remission, or recur after treatment depends on the specific tumour type and location. A recurrent tumour may be a tumour that still persists after treatment, one that grows back some time after treatment destroyed it, or a new tumour that grows in the same place as the original one.When a brain tumour is in remission, the tumour cells have stopped growing or multiplying. Periods of remission vary. In general, benign tumours recur less often than malignant ones. Since it is impossible to predict whether or when a particular tumour may recur, lifelong monitoring with MRI or CT scans is essential for people treated for a brain tumour, even a benign lesion. Follow-up scans may be performed every 3 to 6 months or annually, depending on the type of tumour you had.

Glossary

anaplastic: when cells divide rapidly and bear little or no resemblance to normal cells in appearance or function.

astrocytoma: a tumour arising in the supportive cells (astrocytes) of the brain or spinal cord; most often in the cerebrum.

benign: does not invade nearby tissues or spread; noncancerous.

biopsy: a sample of tissue cells for examination under a microscope to determine the existence or cause of a disease.

brachytherapy:
a type of radiation therapy where capsules containing radioactive substances are surgically implanted into the tumour to deliver radiation; also called internal radiotherapy.

cancer:
generic term for more than 100 different diseases caused by uncontrolled, abnormal growth of cells. Cancer cells can invade and destroy normal tissue, and can travel through the bloodstream and lymphatic system to reach other parts of the body.

chemotherapy: treatment with toxic chemicals (e.g., anticancer drugs).
chondrosarcoma: a rare, malignant bone tumour arising from primitive notochord cells and composed of cartilage.

chordoma: a rare, bone tumour arising from primitive notochord cells; usually occurs at the base of the spine (sacrum) or at the skull base (clivus).
craniopharyngioma: a benign tumour arising from cells located near the pituitary stalk.

differentiation:
refers to how developed cancer cells are in a tumour. Well-differentiated tumour cells resemble normal cells and tend to grow and spread at a slower rate than undifferentiated, which lack the structure and function of normal cells and grow uncontrollably.

oedema: tissue swelling caused by the accumulation of fluid.

ependymoma: a tumour arising from the ependyma cells lining the ventricles of the brain and central canal of the spinal cord.

epidermoid:
a benign, congenital tumour arising from ectodermal cells; also called pearly tumour.
glioma: any tumour arising from glial tissue of the brain, which provides energy, nutrients, and other support for nerve cells in the brain.hydrocephalus: an abnormal build-up of cerebrospinal fluid usually caused by a blockage of the ventricular system of the brain; also called “water on the brain.”immunotherapy: treatment designed to improve or restore the immune system’s ability to fight infection and disease.intracranial pressure (ICP): pressure within the skull. Normal ICP is 20 mm HG.lesion: a general term that refers to any change in tissue, such as tumour, blood, malformation, infection, or scar tissue.

lymphoma: a rare tumour arising from lymph cells; may metastasise to the brain from lymphoma tumour elsewhere in the body.

malignant: having the properties of invasive growth and ability to spread to other areas.

mass effect:
damage to the brain due to the bulk of a tumour, the blockage of fluid, and/or excess accumulation of fluid within the skull.

medulloblastoma: a tumour arising from primitive nerve cells; most often in the cerebellum.

meningioma: a tumour arising from the meninges, the membrane that surrounds the brain and spinal cord.

metastasis: the spreading of malignant cells.

metastatic: cancerous tumour that has spread from its original source through the blood or lymph systems.

oligodendroglioma: a tumour arising from the support cells (oligodendroglia) that produce myelin, the fatty covering around nerve cells.

pituitary adenoma: a tumour arising from cells in the pituitary gland; tumour may be hormone-secreting (prolactin, adrenocorticotropic, growth hormone) or not.

radiation: high-energy rays or particle streams used to treat disease.

schwannoma (also called neuroma): a tumour arising from Schwann cells that produce myelin.

stereotactic: a precise method for locating deep brain structures by the use of 3-dimensional coordinates.

tumour: an abnormal growth of tissue resulting from uncontrolled multiplication of cells and serving no physiological function; can be benign or malignant.



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