Brain metastases are growths that have spread from a cancerous area of the body to the brain. These tumours are a frequent side effect of systemic malignancies and a significant factor in patient mortality and morbidity.
WHAT IS BRAIN METASTASES?
The location of the tumour determines the symptoms resulting from a brain metastasis. For example, vision issues could result from a tumour in the part of the brain responsible for visual processing.
While each patient experiences brain metastases differently, typical symptoms include:
- Seizures
- Headaches (sometimes accompanied by nausea and vomit) especially in the morning)
- Hemiparesis is the inability to utilise one arm or leg due to weakness on that side of the body
- Cognitive issues, such as mood swings and short-term memory loss
- Inability to speak or comprehend speech
- Issues with vision, especially one side at a time
Brain metastases can also cause severe symptoms by:
- Increasing pressure on the surrounding tissue
- Occupying space and raising the intracranial pressure (the pressure inside the skull)
- Causing the brain’s fluid to accumulate
- Preventing the natural flow of cerebrospinal fluid through the brain’s cavities
- Resulting in cerebral haemorrhage
These are the most typical types of brain metastases:
- Lung cancer: Metastatic brain cancer occurs in around 50% of cases of lung cancer. Small cell lung cancer is associated with a high incidence of brain metastases.
- Breast cancer: Brain metastases occur in 10–15% of patients with metastatic breast cancer. Triple-negative and HER2+ breast cancers are more likely to develop metastatic brain tumours.
- Melanoma: Brain metastases are seen in almost half of cases of melanoma patients.
Brain metastases are less common to result from thyroid, colon, and kidney cancers, among other cancers.
Symptoms
The location of the tumour determines the symptoms resulting from a brain metastasis. For example, vision issues could result from a tumour in the part of the brain responsible for visual processing.
While each patient experiences brain metastases differently, typical symptoms include:
- Seizures
- Headaches (sometimes accompanied by nausea and vomit) especially in the morning)
- Hemiparesis is the inability to utilise one arm or leg due to weakness on that side of the body
- Cognitive issues, such as mood swings and short-term memory loss
- Inability to speak or comprehend speech
- Issues with vision, especially one side at a time
Brain metastases can also cause severe symptoms by:
- Increasing pressure on the surrounding tissue
- Occupying space and raising the intracranial pressure (the pressure inside the skull)
- Causing the brain’s fluid to accumulate
- Preventing the natural flow of cerebrospinal fluid through the brain’s cavities
- Resulting in cerebral haemorrhage
Causes
These are the most typical types of brain metastases:
- Lung cancer: Metastatic brain cancer occurs in around 50% of cases of lung cancer. Small cell lung cancer is associated with a high incidence of brain metastases.
- Breast cancer: Brain metastases occur in 10–15% of patients with metastatic breast cancer. Triple-negative and HER2+ breast cancers are more likely to develop metastatic brain tumours.
- Melanoma: Brain metastases are seen in almost half of cases of melanoma patients.
Brain metastases are less common to result from thyroid, colon, and kidney cancers, among other cancers.
Diagnosis
Doctor would typically conduct a physical examination and obtain a thorough medical history if they suspect brain metastases.
A neurological examination may also be necessary to observe changes in cognitive abilities that include thinking.
A doctor might advise one or more of the following if the preliminary examination indicates that the cancer may have progressed to the brain:
CT scans with contrast
A head CT scan enables doctors to examine the brain and seek for indications of metastatic cancer. Nevertheless, not all cancer types may be detected by this test, so a follow-up MRI scan may be suggested by the doctor.
MRI scan with contrast
This type of test utilises magnets to see different areas of the brain and the blood flow to it. It can identify the location of brain tumours as well as symptoms of swelling and damage to the brain.
Treatment
Brain cancer with metastases cannot be cured. Typically, treatment aims to achieve different objectives:
Lowering or delaying symptoms of raised intracranial pressure
Extending one’s life
Minimising pain
The following are a few options for treating brain metastases:
Steroids
To lessen indications and symptoms, high-dose corticosteroids may be given to minimise swelling around brain metastases.
Antiseizure medications
In the case that you have a seizure, your doctor could prescribe medication to stop more seizures.
Surgery
Your surgeon will try to remove as much of the cancer as they can if surgery is an option for you and the brain metastases are in locations that allow for an operation. Removing even a small piece of the tumour can help lessen your symptoms.
Radiotherapy
Among the radiotherapy techniques may be used in your treatment for brain metastases:
- Whole-brain radiotherapy: To destroy tumour cells, whole-brain radiation exposes the brain to radiation. Typically, patients receiving whole-brain radiotherapy need 10–15 sessions spread out over two–three weeks.
- Stereotactic radiosurgery: Each radiation beam used in stereotactic radiosurgery (SRS) is not extremely potent, but the place where all the beams intersect, at the brain tumour, receives a very high radiation dose that destroys the tumour cells. Doctors can treat several tumours in a single session while using SRS, which is usually completed in one session.
There are circumstances in which your medical team may suggest taking medication to manage brain metastases. Depending on how your cancer started and your unique circumstances, drugs may or may not be able to help you. Possible choices could be:
- Chemotherapy: If the metastases have progressed to the area surrounding your brain, your doctor may administer chemotherapy straight into that fluid.
Prevention
Melanoma and pre-existing lung and breast malignancies are the main causes of metastatic brain tumours. The initial step in decreasing the likelihood of developing brain metastases is to treat those tumours. The next stage is to recognise your risk of developing them.
Prognosis
The extent to which the underlying cancer is under control typically determines how well brain metastases respond to treatment. Treatment for brain tumours that have spread to other areas of the body would be ineffective if the original malignancy was not controlled. Brain metastases can frequently be controllable.
However, treatments can prolong your life and enhance your quality of life even in cases when there is no cure. There was a time when brain metastases had a life expectancy of fewer than six months. However, thanks to advancements in medical care, most individuals with this diagnosis are now living longer and with far better symptom control. Most individuals with brain metastases survive their brain tumours.
However, most individuals with brain metastases have a lot of distinctive questions, such as how quickly their tumour may grow. Among other things, your experience is determined by your first diagnosis of cancer, the number of tumours you have, and your response to treatment.
The best person to discuss how these factors affect your prognosis is your doctor. Find out from them what to anticipate given your condition.
| Type of Metastasis | Prognosis |
|---|---|
Leptomeningeal Metastasis
|
Very poor |
