Congress Abstracts 2003

183

COULD THIS BE LEPTOMENINGEAL METASTASIS? Katherine Picconi, RN, FNP, CS, OCN^®, and Rose Ann Caruso, RN, BBA, AS, OCN^®, Memorial Sloan-Kettering Cancer Center, New York, NY.

Leptomeningeal metastasis (LMD) occurs in 3%–8% of all cancer patients, most commonly adenocarcinomas of the breast, lung, and melanoma, as well as, leukemia and lymphoma. Invasion of the cerebrospinal fluid by tumor cells allows access to all regions of the central nervous system (CNS). The diagnosis of LMD is a devastating neurological complication of cancer and is associated with major neurologic disabilities and a high mortality rate.

A patient’s clinical presentation is usually the first clue that the primary tumor has invaded the CNS. The presentation of LMD may be a mixed and confusing picture depending upon the area or areas of the neuroaxis involved. Signs and symptoms (S/S) are divided into the three anatomical regions of the CNS: cerebral, cranial nerves, and spinal cord. It is not unusual for a portion of each region to be affected making the S/S varied and multiple. Subtle S/S include headache, nausea and vomiting, change in vision, and difficulty walking. Not so subtle S/S include confusion, seizures, loss of vision, and cauda equina symptoms.

Oncology nurses see patients in a variety of settings during the course of cancer diagnosis and treatment. Early identification and diagnosis of LMD is key to immediate treatment, prolonged survival, and quality of life. Patients with good performance status, minimal neurological dysfunction, and a low tumor burden are most likely to respond favorably to treatment. Rarely are patients diagnosed with LMD as a presenting symptom, LMD is most commonly a sign of recurrence.

At this NCI-designated cancer center, patients are seen in a variety of inpatient and outpatient settings and call the center to report new physical and emotional changes. Often, patients and caregivers confide and report to nurses symptoms and/or situations they have not reported to their physicians. Therefore, the nurse in any setting may be the first professional to be informed of S/S of LMD. This presentation will provide oncology nurses with an overview of LMD, define subtle and not so subtle S/S, and emphasize skills for assessment of high-risk individuals to optimize early identification of LMD.