COVID-19 – 

Coronavirus information and updates from RWJBarnabas Health.

TEMPORARY VISITATION POLICY CHANGE:

Metastatic Brain Cancer

Compassionate Cancer Care

Optimal metastatic brain cancer treatment requires a personalized treatment plan from physicians practicing in multiple fields. At The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health, our multidisciplinary team includes board-certified neurologists, neurosurgeons, oncologists, neuro-oncologists, neuropathologists, neuroradiologists, and other dedicated healthcare professionals. By using this coordinated approach, our patients benefit from “brain-directed” treatments in a targeted, precise way.

Treatments for metastatic brain cancer are constantly improving, and our hospitals are a leading provider for neuro-oncology. By using state-of-the-art technology, we make treatment of brain metastases safer, less invasive, and more effective. With high-quality treatment, patients with metastatic brain cancer can live longer with improved quality of life, as well as stabilized neurocognitive function.

What Is Metastatic Brain Cancer?

Brain metastases are the result of cancer spreading to the brain from another part of the body. It is also called metastatic brain cancer, brain metastasis, or a secondary brain tumor. There may be a single tumor or multiple tumors in the brain. Any cancer may spread from its original site to the brain, but the most common tumors to spread to the brain originate in the lung, breast, skin (melanoma), colon, kidney, and thyroid.

Every year, about 150,000 to 200,000 people are diagnosed with brain metastases, according to the American Association of Neurological Surgeons. Early detection efforts have greatly improved over the last decade, which may explain why more people are being diagnosed than ever before.

Some of the terminology regarding metastatic cancers includes:

  • Metastasis means one tumor has spread from its original site.

  • Metastases is the plural form of “metastasis,” which means there are two or more tumors present.

  • Metastasize is the process of cells migrating from their original site to another part of the body.

  • Primary site is the location of the original tumor. For instance, breast cancer that has spread to the brain is still breast cancer, because the cells resemble malignant breast cells, not brain cells.

Am I at Risk for Brain Metastases?

Brain metastases occur in 10 to 30% of patients diagnosed with cancer. Patients at the highest risk are those originally diagnosed with lung, breast, colon, kidney, or skin (melanoma) cancer; however, any malignancy can metastasize to the brain. Men and women are diagnosed at equal frequency, and adults are at a higher risk than children. Lung cancer is the most common source of metastatic brain cancer in males, and breast cancer is the most common source in females.

Brain Metastases Symptoms

Often, a patient with undiagnosed brain metastases experiences neurological symptoms, which prompts healthcare providers to perform a brain scan. According to the American Brain Tumor Association, 90% of patients were diagnosed with a primary cancer before metastatic brain cancer is diagnosed. In the remaining 10% of patients, their brain tumor(s) may be diagnosed incidentally, when a brain scan is done. In these cases, the primary site may have been too tiny to see or caused no symptoms. By performing a biopsy of the malignant tissue in the brain, the primary disease site is often found, and this can help guide treatment.

Brain metastases have many signs and symptoms. Overall, patients will experience neurocognitive changes as their brain tumors grow and put pressure on, invade, and destroy the surrounding tissues.

Signs and symptoms of metastatic brain cancer include:

  • Headaches: This is often the first symptom of brain metastases, and it is caused by the brain tumor(s) putting pressure on the surrounding brain tissues and skull. These headaches often become worse over time, and are not responsive to over-the-counter painkillers, which can also exacerbate any nausea. Headaches may become more intense as you lie down, bend over, or have a bowel movement.

  • Changes in mental function, mood, and personality: Those with brain metastases often cannot notice the gradual changes in their mental function, which may include depression, anxiety, drowsiness, confusion, and memory problems. It can be difficult to concentrate, and you may be inefficient at work.

  • Seizures: These seizures are not always dramatic events with noticeable convulsions. Those who have seizures may experience episodes of staring while being unresponsive to stimuli, and you may notice numbness, tingling, a metallic taste, and other strange sensations.

  • Speech difficulties: Expressing and understanding language may become more difficult, and you may have trouble finding words.

  • Changes in pulse and/or breathing rates: This is caused by the tumor pressing against your brainstem.

  • Changes in the senses: Metastatic brain cancer may impact your ability to see, smell, hear, or detect sensation.

Brain Metastases Diagnosis

If your doctor suspects cancer has spread to the brain, a number of tests and procedures are recommended to make a definitive diagnosis. These include:

  • Neurological exam: This includes checking your vision, coordination, balance, strength, and reflexes. If you have difficulty in one or more of these areas, it could indicate where the tumor is located in the brain.

  • Imaging tests: Magnetic resonance imaging (MRI) scans are the most commonly ordered tests to check for metastatic brain cancer. A contrast MRI may be ordered, which is performed by injecting a dye through a vein in the arm. A computerized tomography (CT) scan can reliably show the number and location of your tumor or tumors.

  • Biopsy: This involves collecting and testing abnormal tissues for inspection. It can be performed as part of keyhole craniotomy surgery where large tumors are removed, or using a needle. A biopsy is the only way to definitively diagnose metastatic brain cancer. A neuropathologist will look at the tissue cells under a microscope to determine if they are cancerous or noncancerous, and whether the cells are metastatic brain cancer (derived from another primary site, such as the breast or lung) or a primary tumor (originating in the brain, meaning it is not a brain metastasis). The information collected from the biopsy is crucial, because it establishes a diagnosis, prognosis, and guides treatment.

Advanced Brain Metastases Treatment

Treatment for metastatic brain cancer seeks to relieve symptoms and prolong life. Early diagnosis and treatment can ease symptoms and slow tumor growth, but tumors may recur after treatment. The most effective treatments include surgery, radiation therapy, or both. Chemotherapy or immunotherapy may also be helpful.

Treatment varies from one patient to the next, and depends on the size, number, and location of brain tumors. The patient’s symptoms, overall health, and personal preferences for treatment also play a role in how your team of physicians will plan your treatment.

Surgery

If your tumor(s) are in places that are accessible for an operation, your neurosurgeon will remove as much as the cancer as possible. Surgery used to remove brain tumors is called keyhole craniotomy. This involves carefully mapping the brain to determine the precise location of the tumor(s), and having a neurosurgeon remove a portion of the skull to access the brain. Candidates for surgery are those who have larger, symptomatic brain metastases over 2-3 centimeters in diameter, causing brain swelling.

Removing brain metastases through craniotomy surgery has certain risks, including the possibility of neurologic deficits, infection, and bleeding. Depending on the location of the tumor(s), patients will experience different side effects from surgery.

Stereotactic radiosurgery

Some patients are suited for both traditional surgery as well as stereotactic radiosurgery in a combination approach. Many metastatic brain cancer patients are ideally suited to radiosurgery treatment such as those delivered by Gamma Knife or CyberKnife® technology. Although these procedures both have “knife” in their name, neither involve any incisions.

Tumors suited for radiosurgery are typically small (less than 3 centimeters) and displace rather than infiltrate the brain. Sometimes the tumors are inaccessible through traditional craniotomy surgery. Both Gamma Knife and CyberKnife radiosurgeries are safe and noninvasive. Treatment consists of delivering beams of high-dose radiation to the tumor sites with extreme accuracy.

Medication

High-dose corticosteroids can reduce brain swelling and decrease neurological symptoms.

Clinical trials

These research studies explore and test new treatments to prevent, detect, and manage metastatic brain cancer.

Coping and support

Enduring your symptoms is only one piece of the puzzle in metastatic brain cancer treatment. As a patient, you will need to come to terms with the news that your cancer spread beyond its original site. It helps to ask your doctors questions about the details of your cancer and treatment options available. Express your feelings by writing in a journal, talking to a psychotherapist, or participating in local support groups for chronically ill patients.

Alternative medicine

While no alternative medicine approach has been proven to cure cancer, complementary therapies can help patients cope with side effects of their other treatment. These treatments can help patients cope with anxiety, fatigue, pain, sleep disturbances, and stress. Some examples include gentle exercise, aromatherapy, massage, music therapy, hypnosis, relaxation techniques like meditation, and others. Make sure you discuss any alternative medicines you wish to try with your treatment team.

Metastatic Brain Cancer Prognosis

Patients diagnosed with metastatic brain cancer often have questions regarding survival. There is no way to tell exactly how long someone can live with brain metastases, as every patient is different. It depends on a multitude of factors, such as the type of primary cancer, the number of brain tumors, and which treatments are used. The best person to ask about survival is your treatment team, who may be able to estimate how long you can live with brain metastases based on what they know about your situation; but even then, it is only an estimate.

Request an appointment online now or call 833-656-3876.