A brain tumor is an extremely rare but serious complication during pregnancy that jeopardizes the lives of both the mother and infant.  There is risk for significant morbidity or mortality. Physiologic changes during pregnancy may worsen the neurological symptoms, have profound effect on tumor growth and affect the pharmacokinetics of chemotherapeutic agents.  Such changes include water retention, engorgement of vessels, increased plasma volume, third spacing in the amniotic fluid and increased renal clearance and hepatic metabolism of drugs. The time of choice for chemotherapy, neuorsurgical intervention and the delivery should be tailored to each patient. Concern for fetal outcomes while treating maternal cancer raises therapeutic, ethical, moral and social dilemmas.

Case:

We recently experienced a 38 year old Gravida 6 Para 1 with a lymphoma metastasis to the brain. On admission at 26 and 4 weeks she was anemic from previous chemotherapy with a Hemoglobin 11.3 and Hematocrit 33.8. The fetal heat rate was 148. She presented with an altered mental status, nausea, vomiting, dysnea and had experienced a seizure at home. MRI study showed a herniated large brain lymphoma with potential for rupture.

The significance of her worsening neurologic status resulted in a collaborative multidisciplinary approach to her care.  The goal for the medical management was to treat the cause, prevent further neurologic deterioration, provide supportive care, prolong the gestation and maintain the mother and baby well-being.  Interventions included daily rounds with the medical and nursing team to discuss the status of the mother and fetus.  On- going assessment and anticipation of the patient’s needs were completed by the nurses.  It was critical that any change in her condition was evaluated for further progression of the disease.  Dietary and psycho-social needs were also addressed.   Extensive counseling and planning is already occurring for post partum chemotherapy and/or surgery.

Conclusion:

The diagnosis of a lymphoma brain tumor required planning for the anticipated delivery and well being of the infant, but also long term planning for the mother.  Significant learning from this case included “on the spot” education for nursing, support for the nursing staff and a multidisciplinary approach to care.  This included multiple physicians and nursing specialties, dietary, social work, and case management meeting frequently to discuss the latest condition of the patient.  The strong collegial relationships that focused on the patient and infant’s welfare contributed to the health and well being of this patient.

Keywords:

lymphoma, brain tumor