Leptomeningeal Carcinomatosis: Cerebral spinal fluid tumours

Leptomeningeal Carcinomatosis (LC) is the dissemination of cancer, commonly breast, lung, melanoma, acute lymphoblastic leukaemia and Non-Hodgkin lymphoma occurring through either direct extension from surrounding tumours or metastasis of a preexisting, parenchymal central nervous system tumour. A rise in the diagnosis of leptomeningeal disease has been seen with increased survival rates of cancer due to improved medical treatment, with 5-8% of patients with cancer going on to develop LC.

Leptomeningeal Carcinomatosis spreads to the meninges, the outer covering of the brain and spinal cord, directly migrating into the cerebral spinal fluid (CSF), arachnoid and pia mater. This migration of tumour cells occurs throughout the arachnoid vessels or choroid plexus into the surrounding outer layers extending into the CSF. On entry into the CSF, tumour cells are infiltrated in a diffuse or multifocal manner where the leptomeninges cover the surface of the brain and spinal cord. This covering causes the meninges to become irritated causing patients to exhibit signs of photophobia, neck stiffness, neurological decline and cranial nerve defects. LC has a significant morbidity and mortality rate with a median survival of 4-6 weeks if untreated and 2-3 months if treated. Diagnosis is based on analysis of the cerebral spinal fluid, through detection of positive cytology of LC tumour cells, elevated protein and CSF pressures. Magnetic resonance imaging findings identify areas of meningeal enhancement indicative of meningeal irritation.

The neuroscience nurse role in the patient care includes providing a supportive environment and thorough assessment of vital and neurological signs. Treatment aims to improve or maintain a patient’s neurological status while prolonging survival and palliation. The literature review will highlight the diagnosis, progression and treatment for LC to further increase awareness and inform neuroscience nurses of increasing trends in management.