When cancer that started elsewhere in the body spreads to the brain and causes a brain mass or tumor, it is called a metastatic brain tumor. The resulting tumors are called brain metastases or “brain mets”. Neurosurgeon Johns HopkinsChetan Bettegowdaprovides information on metastatic brain cancer and treatment options.
What happens when cancer spreads to the brain?
Cancer cells can break away from the primary tumor and travel to the brain, usually via the bloodstream. They usually go to the part of the brain called the cerebral hemispheres or cerebellum, where they form a mass.
Some metastatic brain tumors appear many years after the primary cancer. Others metastasize so quickly that they are identified before the primary cancer.
When cancer cells reach the brain and form a tumor, it can result in a variety of symptoms that can also be shared by non-metastatic brain tumors.
What are the symptoms of brain metastases?
Common signs and symptoms of brain metastases include:
- weakness in arms or legs
- loss of balance
- memory loss
- Speech disorders/problems
Other symptoms can include:
- behavior and personality changes
- Blurred vision/impaired vision
Who is at risk of developing metastatic brain cancer?
About a third of people with another type of cancer will develop one or more metastatic brain tumors. The risk of metastatic brain tumors begins to increase after the age of 45 and is highest in people over 65 years of age.
How are metastatic brain tumors diagnosed?
Metastatic tumors of the brain and spine are usually not diagnosed until symptoms appear. Here are some ways doctors can diagnose a metastatic brain tumor:
- Physical exam: After gathering information about your symptoms and your personal and family health history, your doctor will perform a physical exam and test your vision and reflexes.
- neurological examination
- Computed Tomography(CT-Scan oder CT-Scan)
- MRI image(magnetic resonance)
- Diffusion tensor imaging (DTI) is a type of MRI that visualizes water molecules passing through parts of the brain. It reveals microscopic differences in tissue structure, including very early infiltration of cancer cells.
- Biopsy: Surgical removal of a piece of tumor may be necessary if the diagnosis is unclear from other tests.
Treatment of metastatic brain tumor
It is important to realize that metastatic brain tumors are often treatable and well controlled. In general, the sooner you start treatment, the better your chances of killing or controlling the disease.
Treatment options for brain metastases may include:
- Targeted drug treatment
- clinical trials
In many cases, surgery or radiation therapy can improve or completely eliminate symptoms.Read more about brain tumor treatment.
Metastatic brain tumor surgery
Surgery provides quick relief from the "mass effect" - pressure in the skull resulting from a growing metastatic tumor and swelling of the brain. Some patients may see an improvement in symptoms just a few hours after surgery if crowd effects are causing their symptoms.
The goal of surgery is to minimize the space taken up by the tumor by debulking, which means removing as much of the tumor as possible while preserving neurological function.
In general, doctors recommend surgery for metastatic brain cancer when:
- There is a clear correlation between the symptoms and the location of the tumor.
- Primary cancer is treatable and under control.
- The tumor can be safely removed.
The most common type of surgery to remove metastatic brain tumors is calledCraniotomy, which can be performed using a variety of approaches, including keyhole craniotomy.
Learn more about brain tumor surgery and recovery.
Radiation therapy for metastatic brain tumors
radiotherapytreats metastatic brain tumors with X-rays and other forms of radiation (light energy) to destroy cancer cells or stop a tumor from growing. It is also called radiation therapy.
These painless treatments send rays through the brain that can treat cancer in areas that are difficult to reach with surgery. Procedures may include one or a combination of the following:
- external radiation therapydelivers radiation from a machine and through the body to target metastatic tumors.
- Whole-brain radiation targets the entire brain to target multiple tumors or any metastatic disease that is hidden from an MRI.
- Stereotactic radiosurgery(e.g. Cyberknife) directs a high dose of targeted radiation to the specific shape of the tumor and protects surrounding healthy tissue from unnecessary radiation exposure.
- Protonentherapieuses protons (instead of X-rays) to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes damage to healthy tissue around the tumor.
- In brachytherapy, radioactive material is implanted into a tumor to stop it from growing.
These procedures can be done after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.
The choice of radiotherapy is complex and often requires close collaboration with your treatment team. For some people, stereotactic radiosurgery may offer a better prognosis than surgery. Others may receive whole-brain radiation or a combination of both therapies. You will have a risk-benefit discussion with your radiation team to weigh the potential benefits against possible risks and side effects.
Because radiation therapy has been so successful in treating brain metastases — and because many live long lives after treatment — studies are now investigating how to manage the long-term effects of the treatment.
Chemotherapy for metastatic brain tumors
Because traditional chemotherapy cannot cross the blood-brain barrier, newer treatments called targeted therapies are used as the main form of chemotherapy to treat metastatic brain tumors.
These drugs identify and attack cancer cells (the target) with minimal damage to normal cells while preventing the cancer cells from growing and spreading. Targeted therapy can be given after surgery or in conjunction with radiation therapy to destroy any remaining cancer cells.
Targeted therapies used to treat metastatic brain tumors include:
- Trastuzumab for breast cancer that has spread to the brain
- Erlotinib for the most common type of lung cancer (non-small cell lung cancer) that has spread to the brain
Immunotherapy for metastatic brain tumors
Cancer immunotherapy is a rapidly growing area of research aimed at developing drugs, vaccines and other therapies that activate the immune system's natural abilities to fight cancer. Many immunotherapy drugs for metastatic brain tumors act as "checkpoint inhibitors". Normally, tumor cells can evade attack by activating certain proteins (called checkpoint proteins) that disarm your immune system. Checkpoint inhibitors prevent tumor cells from exploiting this process.
Immunotherapy drugs used to treat metastatic brain tumors include:
Clinical trials for new treatments
Researchers are always finding new ways to treat metastatic brain tumors. These new methods will be tested inclinical trials. Talk to your doctor to find out if there are any clinical trials you should consider.
How do you decide which metastatic brain cancer treatment is right for you?
Your neurosurgeon will discuss with you the most appropriate treatment approach, considering these and other factors:
- The type of primary cancer, its response to treatment, and current status
- The location and number of metastatic tumors in the brain or spine
- Your general health and preferences regarding possible treatment options
- your current symptoms
Along with the benefits, doctors also consider the potential risks and side effects of each treatment. Many patients are concerned about the effects of radiation. Others balk at the idea of surgery. Tell your doctor about your concerns - it's important to take them into account.
Prognosis of metastatic brain tumor
The prognosis for metastatic brain tumors varies greatly. Remember that every patient is unique and many patients are living longer with newer treatments. Talking to your care team about your unique diagnosis can help you get an accurate prognosis.
How long can you live with metastatic brain tumors? ›
Most patients with brain metastases from extracranial primary tumors such as lung or breast cancer receive palliative treatment approaches, because the common pattern of polymetastatic spread may cause compromised performance status (PS) and eventually also limited survival, often in the range of 3–9 months .Is metastatic brain cancer a terminal? ›
Metastatic brain cancer is usually terminal. While some people are able to live longer than others and while a few survive much longer than average, most people have months to live by the time they receive a diagnosis.What are the final stages of metastatic brain cancer? ›
- Frequent headaches.
- Agitation and delirium.
- Agonal breathing (gasping breaths that occur when a person is struggling to breathe)
- Prolonged confusion.
- Loss of appetite.
- Vision loss.
- Involuntary movements.
It is important to know that metastatic brain tumors are often treatable, and can be well-controlled. Generally, the faster you start treatment, the better the chances of killing or controlling the disease. The treatment options for brain metastases may include: Surgery.Is brain mets a death sentence? ›
Once brain metastasis has occurred, the outcomes are dismal. If left untreated, the average survival is less than 2 months ; palliative therapies including corticosteroids, chemotherapy, and radiotherapy can extend survival, in the best case, to an average of less than one year .What is end of life like with a brain tumor? ›
Drowsiness or loss of consciousness is one of the most frequently reported symptoms in the final weeks of a brain tumor patient's life. Lethargy, confusion, and night/day reversal are often early signs of decreasing level of consciousness.Can metastatic brain cancer go into remission? ›
Moreover, radiation therapy for brain metastases can be deferred or even withheld especially when osimertinib is used as first-line treatment, because complete CNS remission can be occasionally achieved as early as one month even in patients with as many as twenty lesions.How do you know death is near with brain cancer? ›
Cold hands and feet. Breathing changes (such as rapid or shallow breathing, brief pauses between breaths, a rattling sound while breathing) Decreased urination or passing dark-colored urine. Altered perceptions, such as delusions or hallucinations.What are the signs of brain metastases? ›
Though symptoms vary from patient to patient, common brain metastasis symptoms include: Headaches: These are often the first symptoms of a brain metastasis. They are caused by the tumor putting pressure on the brain and skull. A headache caused by brain metastases usually becomes progressively worse as time passes.What are the signs of brain cancer getting worse? ›
- increased sleepiness;
- decreased ability to move around;
- trouble speaking or understanding conversation;
- loss of memory and especially the ability to form new memories;
- impaired judgment, especially the ability to judge how much help one needs to get around;
What causes death in metastatic brain cancer? ›
If a metastasis lands near or inside these structures, then it may simply block, squeeze, or crush these parts in a way that can be devastating. For example, a metastatic tumor may block an airway or press on the part of the brain that controls breathing.How long does hospice give you brain cancer? ›
Typically, patients with this type of tumor live for a median of 15 months. Five-year survival is only 5 percent for this form of tumor. Three- and seven-day hospice lengths of stay match quality of care minimum guidelines established by the American Society of Clinical Oncology, which has begun tracking them.What is the best treatment for brain metastases? ›
Metastases are the most common intracranial tumors in adults, accounting for more than one-half of all intracranial tumors. The primary approaches to the treatment of brain metastases include surgery, stereotactic radiosurgery (SRS), and whole brain radiation therapy (WBRT).What is the biggest symptom of brain tumor? ›
Headaches are the most common symptom of brain tumors. Headaches happen in about half of people with brain tumors. Headaches can happen if a growing brain tumor presses on healthy cells around it. Or a brain tumor can cause swelling in the brain that increases pressure in the head and leads to a headache.Can you have a brain tumor for years without knowing? ›
Can you have a brain tumor with no symptoms? Brain tumors don't always cause symptoms. In fact, the most common brain tumor in adults, meningioma, often grows so slowly that it goes unnoticed. Tumors may not start causing symptoms until they become large enough to interfere with healthy tissues inside the brain.What is the survival rate for brain Mets? ›
The 5-year survival rate for people in the United States with a cancerous brain or CNS tumor is almost 36%. The 10-year survival rate is almost 31%. Age is a factor in general survival rates after a cancerous brain or CNS tumor is diagnosed. The 5-year survival rate for people younger than age 15 is about 75%.How common is brain metastases? ›
Brain metastases are the most common intracranial tumors in adults, accounting for significantly more than one-half of brain tumors. In patients with systemic malignancies, brain metastases occur in 10 to 30 percent of adults and 6 to 10 percent of children [1-5].How many days a brain tumor patient can live? ›
The median survival for patients with low-grade tumors may be more than 10 years, and for patients with high-grade tumors, it ranges from 1 to 3 years. For glioblastoma (the most common primary brain tumor in adults), the median progression-free survival is 9 months and the overall survival is 19 months.How long can you live with a Stage 4 brain Tumour? ›
A grade 4 astrocytoma is called a glioblastoma. The average survival time is 12-18 months – only 25% of glioblastoma patients survive more than one year, and only 5% of patients survive more than five years.Can a brain tumor cause sudden death? ›
Primary cerebral tumors rarely provoke sudden death. The incidence is often underestimated with reported frequencies in the range of 0.02 to 2.1% in medicolegal autopsy series.
What hospice does not tell you? ›
What Does Hospice Care Not Include? Hospice care does not include curative treatment. The goal of hospice care is to provide comfort and support rather than to cure the disease. Hospice may not include medications you have grown accustomed to taking, such as chemotherapy or other medical supplements.How fast can metastatic cancer spread? ›
Most malignant tumors that metastasize do so within five years after the primary tumor has been detected, so this raises the question of how one can explain “dormancy” among tumor cells for decades.What is the burst of energy before death called? ›
This difficult time may be complicated by a phenomenon known as the surge before death, or terminal lucidity, which can happen days, hours, or even minutes before a person's passing. Often occurring abruptly, this period of increased energy and alertness may give families false hope that their loved ones will recover.What is the most common source of brain metastases? ›
Brain metastases occur when cancer cells spread from their original site to the brain. Any cancer can spread to the brain, but the types most likely to cause brain metastases are lung, breast, colon, kidney and melanoma.Does chemo work on brain Mets? ›
Chemotherapy is not usually a treatment for brain metastases because these medicines have a hard time getting into the brain. However, for people with meningitis from cancer, chemotherapy may be injected right into the fluid that surrounds the brain and spinal cord.Do you sleep a lot with brain cancer? ›
Poor sleep can be particularly bothersome, especially when patients with brain tumors also report hypersomnia. Hypersomnia was reported in more than 90% of primary brain-tumor patients undergoing cranial radiation therapy.What are the red flags for brain tumor? ›
Changes in personality or behavior. Weakness, numbness, or loss of movement in one part or one side of the body. Difficulty with balance or dizziness. Sensory changes like difficulty hearing, difficulty seeing, or loss of smell.What are the worst types of brain cancer? ›
Glioblastoma, previously known as glioblastoma multiforme (GBM), is the most aggressive and most common type of cancer that originates in the brain, and has very poor prognosis for survival. Initial signs and symptoms of glioblastoma are nonspecific.Is brain metastases Stage 4? ›
Brain metastases, a specific form of Stage IV melanoma, are one of the most common and difficult-to-treat complications of melanoma. Brain metastases differ from all other metastases in terms of risk factors, diagnosis, and treatment.How quickly does a brain tumour progress? ›
The more aggressive a tumor is, the faster it grows. Generally speaking, a brain tumor can take several months or even years to develop. Glioblastomas are the most common and aggressive brain cancer. Their ability to grow undetected by the immune system makes them one of our primary examples.
How do you know what stage a brain tumor is? ›
Because tumors in the brain or spinal cord almost never spread to other parts of the body, they do not have a formal staging system like most other cancers. Some of the important factors that help determine a person's outlook include: The person's age.Can a brain tumor appear suddenly? ›
Symptoms can be caused by the location of the tumor or from the tumor pressing on brain tissue or the spinal cord and nerves. Brain and spine tumor signs and symptoms also can occur gradually over days or months or they can happen suddenly.How long can you live with Stage 4 brain tumor? ›
Grade 4 – Glioblastoma
A grade 4 astrocytoma is called a glioblastoma. The average survival time is 12-18 months – only 25% of glioblastoma patients survive more than one year, and only 5% of patients survive more than five years.
If a metastasis lands near or inside these structures, then it may simply block, squeeze, or crush these parts in a way that can be devastating. For example, a metastatic tumor may block an airway or press on the part of the brain that controls breathing.What percentage of brain tumors are metastatic? ›
Brain metastases are the most common intracranial tumors in adults, accounting for significantly more than one-half of brain tumors. In patients with systemic malignancies, brain metastases occur in 10 to 30 percent of adults and 6 to 10 percent of children [1-5].What is worst brain tumor? ›
Glioblastoma, previously known as glioblastoma multiforme (GBM), is the most aggressive and most common type of cancer that originates in the brain, and has very poor prognosis for survival.How long can you have a brain tumor before symptoms show? ›
The symptoms can develop gradually over some months or even years if the tumour is slow growing. Or quickly over days or weeks if the tumour is fast growing.Does Chemo work on brain Mets? ›
Chemotherapy is not usually a treatment for brain metastases because these medicines have a hard time getting into the brain. However, for people with meningitis from cancer, chemotherapy may be injected right into the fluid that surrounds the brain and spinal cord.Can brain mets go into remission? ›
Moreover, radiation therapy for brain metastases can be deferred or even withheld especially when osimertinib is used as first-line treatment, because complete CNS remission can be occasionally achieved as early as one month even in patients with as many as twenty lesions.Does metastasis mean death? ›
Metastasis is the general term used to describe the spread of cancer cells from the primary tumor to surrounding tissues and to distant organs and is the primary cause of cancer morbidity and mortality. It is estimated that metastasis is responsible for about 90% of cancer deaths.
What medication is used for brain metastasis? ›
A variety of chemotherapeutic agents have been used to treat brain metastasis from lung, breast, and melanoma, including cisplatin, cyclophosphamide, etoposide, teniposide, mitomycin, irinotecan, vinorelbine, etoposide, ifosfamide, temozolomide, fluorouracil (5FU), and prednisone.What age does brain metastasis occur? ›
Patients age 35 or younger are particularly at risk of brain metastasis independent of biological subtype.Which cancers are most likely to metastasize to the brain? ›
Any cancer can spread to the brain, but the three most likely to do so are breast cancer, lung cancer and melanoma. Other cancers that often spread to the brain include colon cancer, gynecologic cancers and renal cell carcinoma.