Only 10% of
all cancers metastasize to the brain.
most commonly metastasize to the brain are:
Approximate % with brain metastases.
cancers that most commonly develop brain metastases are small
(oat) cell and adenocarcinomas.
tumors can occasionally spread to the brain. Brain metastases
are multiple in over 80% of cases.
intra-cranial pressure (ICP)
features of raised ICP are early-morning headaches (worse on
coughing or straining) and vomiting (often with little
preceding nausea). Papilledema may be absent.
of patients present with seizures, either focal (often
starting in the thumb or hand, or corner of the mouth) or
generalized, however, for most patients routine prophylaxis
with anti-convulsants is unnecessary, and usually need only be
started after the first seizure.
of patients present with an acute stroke-like illness, due to
sudden hemorrhage around a metastasis. Unlike a cerebro-vascular
accident (CVA) a continued step-wise deterioration then tends
to occur. (Remember, cancer patients can also suffer an
Personality change or confusion (frontal)
- Disorientation (parietal)
- Hemianopsia (parietal, occipital)
is confirmed by CT or
cranial nerve lesions suggest carcinomatous meningitis.
(see Meningeal Metastases)
study median survival varied with treatment:
(30% had 1-year survival)
steroids (dexamethasone 16mg per day) can dramatically reduce
cerebral edema and ICP and can often alleviate focal
neurological signs. In lymphomas steroids can shrink the
cerebral deposits themselves. 75% of patients experience
short-lived symptom relief with steroids.
indications for radiotherapy are:
irradiation can be helpful for brain metastases from carcinoma
of the breast, or small (oat) cell lung cancer, or lymphoma.
It is usually indicated for troublesome focal symptoms such as
hemiparesis or cerebellar ataxia. It is not indicated if the
patient’s condition is deteriorating rapidly unless it is
considered that the treatment would facilitate nursing care.
Relatively fit patient
- Disease-free interval of 1 year
who show a good response to steroids are likely to benefit
from radiotherapy. Most studies show that about 75% of
patients selected for radiotherapy derive worthwhile benefit,
with neurological improvement from 3 to 6 months. Median
survival is around 16 weeks (double the life expectancy
without treatment) and 10% will live at least a year. Breast
cancer patients tend to survive the longest.
brain should be irradiated because of the high probability of
multiple lesions. Hair loss occurs, but few other immediate
problems occur if steroids are given simultaneously. A high
dose can be used (for example, 3,000cGy over 10 days) because
brain cells do not divide. However, if the patient should
survive 2 years or more a dementia-like syndrome can occur.
indications for neurosurgical excision are:
indications for surgery may be uncertain diagnosis, or
relatively radio-resistant solitary metastasis (especially in
melanoma, renal cell cancer or sarcoma).
should be followed by radiotherapy.
The author and publisher have taken
precautions to ensure that the information in this book is
error-free. However, readers must be guided by their own
personal and professional standards of good practice in
evaluating and applying recommendations made herein. The
contents of this book represent the views and experience of
the author, and not necessarily those of the publisher.