Intracerebral metastases (patient information)

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Overview

A metastatic brain tumor is cancer that started in another part of the body and spread to the brain.

What are the symptoms of Intracerebral metastases?

• Symptoms may include any of the following:

• Decreased coordination, clumsiness, falls
• Fever (sometimes)
• General ill feeling or lethargy
• Headache -- new or more severe than usual
• Memory loss, poor judgment, difficulty solving problems
• Numbness, tingling, pain, and other changes in sensation
• Personality changes
• Rapid emotional changes or strange behaviors
• Seizures that are new
• Speech difficulties
• Vision changes -- double vision, decreased vision
• Vomiting -- with or without nausea
• Weakness of a body area

• Specific symptoms vary. The symptoms commonly seen with most types of metastatic brain tumor are those caused by increased pressure in the brain.

What causes Intracerebral metastases?

• Many tumor or cancer types can spread to the brain. The most common are:

• Bladder cancer
• Breast cancer
• Certain sarcomas
• Germ cell tumors
• Kidney cancer
• Leukemia
• Lung cancer
• Lymphoma
• Melanoma

• Some types of cancer rarely spread to the brain, such as colon cancer and prostate cancer. In other rare cases, a tumor can spread to the brain from an unknown location. This is called cancer of unknown primary (CUP) origin.

• Growing brain tumors can place pressure on nearby parts of the brain. Brain swelling due to these tumors also causes increased pressure within the skull.

• Brain tumors that spread are classified based on the location of the tumor in the brain, the type of tissue involved, the original location of the tumor, and other factors. In rare cases, doctors do not know the original location. This is called cancer of unknown primary (CUP) origin.

• Metastatic brain tumors occur in about one-fourth (25%) of all cancers that spread through the body. They are much more common than primary brain tumors (tumors that start in the brain).

Diagnosis

• A neurologic examination can show brain and nervous system changes based on where the tumor is in the brain. Signs of increased pressure in the skull are also common. Some tumors may not show signs until they are very large. Then, they can cause a very quick decline in nervous system function.

• The original (primary) tumor may be found by examining tumor tissues from the brain.

• Tests may include:

• Chest x-ray; mammogram; CT scans of the chest, abdomen, and pelvis to find the original tumor site
• CT scan or MRI of the brain to confirm the diagnosis and identify the tumor location (MRI is usually more sensitive for finding tumors in the brain)
• EEG
• Examination of tissue removed from the tumor during surgery or CT scan-guided biopsyto confirm the type of tumor
• Lumbar puncture (spinal tap)

When to seek urgent medical care?

Call your health care provider if you develop a persistent headache that is new or different for you.

Call your provider or go to the emergency room if you or someone you know suddenly develops stupor, vision changes, or speech impairment, or has seizures that are new or different.

Treatment options

• Treatment depends on the size and type of the tumor, from where in the body it spread, and the patient's general health. The goals of treatment may be to relieve symptoms, improve functioning, or provide comfort.

• Radiation to the whole brain is often used to treat tumors that have spread to the brain, especially if there is more than one tumor.

• Surgery may be used when there is a single tumor and the cancer has not spread to other parts of the body. Some tumors may be completely removed. Tumors that are deep or that extend into brain tissue may be reduced in size (debulked).

• Surgery may reduce pressure and relieve symptoms in cases when the tumor cannot be removed.

• Chemotherapy for metastatic brain tumors is usually not as helpful as surgery or radiation. Some types of tumors, though, do respond to chemotherapy.

• Stereotactic radiosurgery may also be used. This form of radiation therapy focuses high-power x-rays on a small area of the brain.

• Medicines for brain tumor symptoms include:

• Antacids or antihistamines to control stress ulcers
• Anticonvulsants such as phenytoin or levetiracetam to reduce or prevent seizures
• Corticosteroids such as dexamethasone to reduce brain swelling
• Osmotic diuretics such as urea or mannitol to reduce brain swelling
• Pain medicines

• When the cancer has spread, treatment may focus on relieving pain and other symptoms. This is called palliative or supportive care.

• Comfort measures, safety measures, physical therapy, occupational therapy, and other treatments may improve the patient's quality of life. Some people may want to seek legal advice to help them create an advance directive and power of attorney for health care.

What to expect (Outlook/Prognosis)?

For many people with metastatic brain tumors, the cancer is not curable. It will eventually spread to other areas of the body. Prognosis depends on the type of tumor and how it responds to treatment.

Possible complications

Brain herniation (fatal) Loss of ability to function or care for self Loss of ability to interact Permanent, severe loss of nervous system function that gets worse over time