Metastasis cerebral occurs when cancer cells from elsewhere in the body spread, or metastasize, to the brain. Cancers that commonly metastasize to the brain include lung, liver and breast cancer. In some cases, melanoma (skin cancer) also can metastasize to the brain.
Metastatic brain tumors are common, and can have serious symptoms that can interfere with quality of life. Symptoms vary depending on the size, location and growth rate of the metastases. Signs and symptoms may include headache, nausea, vomiting, memory impairment, weakness, difficulty breathing, drowsiness, seizures, hallucinations, changes in vision, difficulty speaking or trouble walking.
Treatment options include surgery, radiation therapy and chemotherapy. Surgical removal of the primary tumor often results in a more complete remission of brain metastases. Radiation therapy is the mainstay of treatment for many patients with metastatic brain tumors, and can be used alone or in combination with surgery and/or other therapies. Chemotherapy uses drugs to kill cancer cells or prevent them from growing and spreading. It is usually given in a hospital setting under the care of an oncologist or neurosurgeon.
Clinical trials are finding new ways to treat brain metastases. For example, researchers are exploring targeted therapies that target proteins that help tumors evade the immune system. These medicines are called checkpoint inhibitors. Currently, they are available only in clinical trials, but they might offer better control of your cancer.
In a study that compared resection of a single brain metastasis with radiotherapy alone, doctors found that removing the tumor resulted in significantly greater local control than radiation alone. The surgical group had a recurrence rate of 3 percent, while the radiotherapy group had a recurrence of 16 percent. Moreover, the overall survival of the surgical group was three months longer than that of the radiotherapy group.
The best way to determine whether a patient should receive surgery for a brain metastasis is to make a careful diagnosis and evaluate the stage of the primary cancer. Magnetic resonance imaging (MRI) provides superior parenchymal detail, allowing the identification of small asymptomatic lesions and their margins as well as the degree of peritumoral edema and mass effect. Computed tomography scans are also useful, particularly for evaluating bone involvement in the skull base and calvarium.
Once a definitive diagnosis has been made and the patient is stabilized, a multidisciplinary team of physicians will discuss treatment options that maximize control and eradication of brain metastases, while minimizing morbidity. These might include surgery, repeat radiotherapy or both. Palliative care services are also an important part of the treatment for patients with brain metastases. Once the disease is under control, these services can help patients live a symptom-free and independent life at home or in a palliative care setting. They can also provide support and guidance for the patient and family.
