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Definition
of Brain Metastases
Brain Metastases is a cancer that has spread to the brain
from another site in the body, commonly the lung or breast.
Description of Brain Metastases
Other primary tumors that metastasize to the brain include
melanoma, sarcomas, and tumors arising in the kidney or
colon. In addition, unknown primaries sometimes present
with brain metastases. The incidence of brain metastasis
is far more prevalent than primary brain cancer.
When a cancer spreads (metastasizes) from its original site
to another area of the body, it is termed metastatic cancer.
Virtually all cancers have the potential to develop this
way. Whether metastases do develop depends on the complex
interaction of many tumor cell factors, most of which are
not completely understood.
Metastases spread in three ways - by local extension from
the tumor to the surrounding tissues; through the bloodstream
to distant sites; or through the lymphatic system to neighboring
or distant lymph nodes. Each kind of cancer may have a typical
route of spread.
Symptoms of Brain Metastases
Many patients have no or minimal symptoms related to the
tumor, and their metastases are found during a routine medical
evaluation. If there are symptoms, they depend on the site
involved. Brain metastases may cause headaches, dizziness,
blurred vision, nausea or other symptoms related to the
nervous system.
Diagnosis of Brain Metastases
Studies may include head MRI (magnetic resonance imaging)
and head CT (computed tomography) scanning.
Treatment of Brain Metastases
The treatment of brain metastases depends on factors such
as the tumor of origin, the number and location of lesions
within the brain and the extent of cancer in places other
than the brain.
Radiotherapy is the primary treatment for brain metastases.
Cranial irradiation provides palliation to the large majority
of patients. Higher doses may be considered for patients
whose systemic metastases are controlled.
Steroids are usually administered with radiotherapy in patients
with symptoms due to brain metastases; steroids are sometimes
administered with radiotherapy in asymptomatic patients.
Surgical treatment of brain metastases is limited to a few
situations, such as diagnosis in patients with obvious primary
tumor. Emergency craniotomy to relieve increased intracranial
pressure is sometimes life-saving. In most cases, however,
treatment with high-dose corticosteroids (dexamethasone
in particular) may eliminate the need for such surgery.
In the rare patient with presentation of a resectable tumor
and single brain metastasis, surgical resection of the solitary
brain lesion is indicated with appropriate postoperative
chemotherapy and/or irradiation of the primary tumor site,
and postoperative whole-brain irradiation.
Chemotherapy has a limited role in treating brain metastases.
Many chemotherapy drugs do not cross the blood-brain barrier
but can reach malignant tumors in the brain, presumably
through a local breakdown in the blood-brain barrier. In
some chemotherapy-sensitive tumors like lymphoma, testicular
carcinoma, small cell lung cancer, and breast carcinoma,
chemotherapy can produce complete radiographic remissions,
but its eventual place as a solitary therapy is still under
evaluation.
Questions To Ask Your Doctor About Brain Metastases
Do any tests need to be done to determine what kind of cancer
is involved and/or its origin?
What treatment do you recommend?
How soon will you start treatment and how long will it last?
What are the side effects of them treatments?
What is the success rate of the treatment?
Will you be prescribing any medications?
What are the side effects?
Will surgery be considered?
If so, what can be expected from surgery?
What is the prognosis?
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