The MIT Braintrust Center for Neurological Disorder Information

Brain Metastasis

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 is likely.

II. Self-help

Support groups:

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, (513) 860-1178.

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
(213) 203-9232
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.

Internet Newsgroups
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.

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