Brain Metastases

Many patients, who have cancer, will develop a "spot" on the brain during their lives. This is usually a metastasis (met ) from the primary cancer. Patients who have cancer of the lung and breast provide most of the metastases ( mets) to the brain. The first symptom of a metastasis is headache. This may be dull and located on the crown of the head; or it can be pounding and last all day and all night. Patients who have had cancers of the lung, breast, melanoma, colon or kidney removed in the past must be on constant look out for symptoms of brain metastases. Brain mets may first present as unexpected seizures, or as spontaneous movements which are usually localized to uncontrolled tremors of the hands, the legs, or the face. Many patients have no symptoms at all. The metastases are found by routinely checking the brain for tumors. If you are a patient who has had one of the aforementioned cancers, it would be good to remind your doctor, every so often, to order a routine MRI of the brain with a contrast material, as this is the best way of diagnosing tumors before they become problems. Breast cancer patients can develop metastases up to fifteen years after the initial cancer is removed but most occur around the third year. Lung cancer patients will develop metastases if they live long enough. Here it would be good to know what type of cancer you have because Squamous Cell cancers metastasize very infrequently, while Oat Cell cancers and Adenocarcinomas occur much more frequently. With lung cancers, the majority of metastases occur about nine months after the original diagnosis. Twenty percent of patients with lung cancer will metastasize ONLY to the brain and these metastases can easily be controlled with Gamma-Knife radiation. These patients may have a long life. Metastases that occur in young patients usually occur from sarcomas, neuroblastomas or germ cell tumors. Most metastases are multiple except for kidney which is frequently single. Most tumors occur in the cortex of the brain, a smaller number in the cerebellum and very few in the mid brain. Metastases will frequently respond to chemotherapy and get smaller, but few will seldom disappear. If patients have mets and are starting chemotherapy, further treatments with either radiation therapy or Gamma- knife can be held off until it is seen what response patients get to chemotherapy. Brain Metastases are treated with radiation therapy or surgery. Surgery is considered only if the metastases are single and are occurring more that two years after the primary cancer has been removed. Radiation therapy can be given with the Gamma-Knife or through whole brain radiation. Gamma-knife therapy has less side effects and can be used repeatedly. If Brain metastases reoccur after radiation therapy, then systemic chemotherapy can be administered. Or, localized chemotherapy, through intra-carotid, can be tried. In these times, most metastases can be successfully treated; fewer and fewer patients are dying of brain metastases.