The MIT Braintrust Center for Neurological Disorder Information
Also called secondary brain tumors, brain metastases are tumors arising
from cancer cells originating from areas of the body such as the lungs
or breast, which then travel via the bloodstream to the brain before
they proliferate. The resulting tumors may be localized to a small
area or can be invasive (spreading to nearby areas). The tumors may directly
destroy brain cells or indirectly damage cells through inflammation, compression
resulting from growth of the tumor, cerebral edema (brain swelling), or
increases in intracranial pressure (the pressure within the skull).
Part 1: General Information
Part 2: Self-Help
Part 3: Further Information
I. General Information
The most common brain tumor in adults is the metastatic brain tumor. It
accounts for approximately 50% of brain tumors in adults. Brain metastases
are very commonly associated with cancer. The number of cancer patients
with brain metastasis at autopsy ranges from 15% to 20%. Brain metastasis
may cause the first symptoms that the patient has of cancer. This occurs
in up to 15% of cancer patients. The cancers which are most likely to form
metastasis in the brain are cancers of the lung and breast (more than 50%
of brain metastases are from lung and breast); kidney, gastrointestinal
and melanoma cancers also form brain metastases. The location of
most brain metastasis is in the hemispheres of the brain where the temporal,
parietal and occipital lobes are located. Brain metastasis can also spread
to the cerebellum. Tumors in other parts of the body can also spread to
the meninges around the brain. Classification of metastatic brain
tumors depends on the exact site of the tumor within the brain, type of
tissue involved, original location of the tumor, and other factors.
Physiological symptoms include headache, vomiting, may or may not be
accompanied by nausea, seizures, vision changes (double vision, or decreased
vision), changes in sensations of a body area, and weakness of a body area.
Some other noticeable changes might include coordination problems (clumsiness,
falls), personality chances, emotional instability such as rapid emotional
changes, intellectual decline, speech difficulties, memory loss, calculating
deficiencies, and impaired judgment. The initial symptoms may also
include fever, lethargy, general ill feeling (malaise), or different pupil
sizes in the eyes. Like most tumors, the specific symptoms
vary. Symptoms commonly seen with most types of metastatic brain tumor
are the symptoms caused by increased pressure in the brain.
Complications include brain herniation (fatal); permanent, progressive,
profound neurologic losses; loss of ability to interact; or loss of ability
to function or care for self .
Early examination can reveal focal (localized) or general neurologic
changes that are specific to the location of the tumor. Signs of increased
intracranial pressure are also common. Some tumors may not show symptoms
until they are very large and then cause rapid neurologic decline. The
original (primary) tumor may already be known, or it may be discovered
after examination of the tumor tissues indicates that it is a metastatic
type of tumor. A head CT scan or MRI of the head confirms the diagnosis
of brain tumor and localizes the tumor. Diagostic tests could include
cerebral angiography which may occasionally be performed. If performed,
it may show a space-occupying mass, which may or may not be highly vascular
(filled with blood vessels). A chest X-ray, mammogram, and other
tests are performed to look for the original site of the tumor. An
EEG may also reveal focal (localized) abnormalities. Examination
of tissue (removed from the tumor during surgery or CT scan-guided biopsy)
is used to confirm the exact type of tumor. If the primary tumor can be
located outside of the brain, the primary tumor is usually biopsied rather
than the brain tumor.
Treatment varies with the size and type of the tumor, primary site
of the tumor, and the general health of the person. The goals of treatment
may include relief of symptoms, improved functioning, and comfort. Radiation
is currently the primary treatment approach with either whole brain radiation
or more recently with radiosurgery (or the variation Gamma Knife). Lung
metastases to the brain are somewhat responsive to radiation therapy, however
melanoma has almost no response to either chemotherapy or radiation therapy.
Surgery is indicated for metastatic brain tumors when there is a single
lesion. Some may be completely excised (removed). Tumors that are deep
or that infiltrate brain tissue may be debulked (removal of much of the
mass of the tumor to reduce its size). The medical treatments include anti-seizure
medications and steroids. Surgery is indicated for cerebral metastasis
when the primary tumor is not active or to reduce intracranial pressure
and relieve symptoms in cases when the tumor cannot be removed.
Medications may include corticosteroids such as dexamethasone to reduce
swelling of the brain, osmotic diuretics such as urea or mannitol to reduce
brain swelling, anticonvulsants such as phenytoin to reduce seizures, and,
analgesics to control pain. When multiple metastases (widespread
cancer) is discovered, treatment may focus primarily on relief of pain
and other symptoms.
Comfort measures, safety measures, physical therapy, occupational therapy,
and other interventions may improve the quality of life. Counseling, support
groups, and similar measures may be needed to cope with the disorder.
Legal advice may be helpful in forming advanced directives, such as power
of attorney, in cases where continued physical or intellectual decline
The American Brain Tumor Association maintains a computerized list of
brain tumor support groups and clearinghouses. Call (800) 886-2282.
The American Cancer Society sponsors "I CAN COPE" groups and offers
a variety of services. Refer to your telephone directory for the number
of the local chapter, or contact their headquarters in Atlanta, Georgia
at (800) 227-2345 or (404) 320-3333.
The National Coalition for Cancer Survivorship in Silver Spring, Maryland,
(301) 585-2616 is a clearinghouse for information and can direct you to
local support groups. The NCCS has prepared a sourcebook: An Almanac of
Practical Resources for Cancer Survivors. It is available at your local
library, or can be purchased from Consumer Reports Books, Fairfield, Ohio,
National Cancer Institute (NCI)
If you are newly-diagnosed with cancer, this should be the first resource
to call. NCI is a government agency that provides information and referrals
for cancer needs. When you dial the 800-number, select "option 3" for an
information specialist who will transfer your call to one of NCI's nineteen
Regional Offices. NCI also offers a very broad range of cancer information
and publications, including their Physician Data Query (PDQ) service. Ask
for a PDQ search of the latest clinical trials, which will give you an
instant snapshot of current cancer research. Their online component, CancerNet,
is a very helpful and immediate service.
American Cancer Society
1599 Clifton Northeast
Atlanta GA 30329-4251
Your local or state ACS chapter is listed in the White Pages of your
phone book. Local chapters are able to address individual needs and requests
better than the national organization. The ACS Web site is also an excellent
resource for people coping with all types of cancer.
6500 Wilshire Boulevard Suite 500
Los Angeles CA 90048
This organization sponsors support groups for everyday concerns of
cancer survivors. They can put you in touch with a local group or give
you information to help you start your own.
Cancer Care, Inc.
1180 Avenue of the Americas
New York, NY 10036
1-800-813-HOPE (4673) toll-free
A non-profit social service agency providing information from social
workers on topics including medical referrals and seeking second opinions,
counseling and support groups, financial assistance information for non-medical
expenses, home visits by trained volunteers, and referrals to local services
such as housekeeping and health aids. Cancer Care is focused in New York,
but provides as much information as they have available to people calling
from other areas. They are currently striving to develop local/area information
and support resources nationwide.
OncoLink: the University of Pennsylvania Cancer Resource
Oncolink provides a wide array of information from the government (National
Cancer Institute) and some periodical literature. It also provides a direct
link with some of the relevant newsgroups that discuss cancer. While not
comprehensive, this site does have a lot of information that won't be found
in other sites.
Here you will find general information about how and why individuals
should research their cancer. Basic information on various types of cancer
and their treatments are covered as well.
Newsgroups are discussions that take place on the Internet. They can
be accessed via the Internet by searching for "newsgroups" and then selecting
the appropriate group. Depending on your 'news reader' program (usually
part of your Internet Service Provider's software package), the way that
you communicate with these groups will vary.
What are Listservs?
A listserv is a discussion of a particular topic, which may be mediated
by a specific individual. Listservs are conducted entirely through email,
although they may be archived in other parts of the Internet. When you
subscribe you will receive a message that confirms your subscription. This
message will also contain the information about how to unsubscribe -- this
is vital, so store it in a good place.
III. Further Information
Comprehensive page about brain surgery for brain tumors in non-technical
language that explains the entire process from prognosis to actual surgery
and follow up treatment.
AMERICAN BRAIN TUMOR ASSOCIATION LITERATURE
Free publications about specific brain tumors, newsletters, and support
groups in hard copy as well as online format.
MIT Braintrust Center
for Neurological Disorder Information