Brain metastases: Specialists and information

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

Brain metastases are cancer metastases that have settled in the brain. They contain cells from the tumor from which they have spread (primary tumor) and usually form in the cerebrum. Metastases in the brain differ from normal brain tumors. Normal brain tumors develop from tissue of the central nervous system, i.e. the brain or spinal cord. Brain metastases, however, develop from cells of the primary tumor.

Further information and selected specialists for brain metastases can be found below.

ICD codes for this diseases: C79.3

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Brief overview:

  • What are brain metastases? Cancer daughter tumors that form in the brain as a result of other types of cancer. Patients suffering from lung cancer, breast cancer and bowel cancer are frequently affected.
  • Cause: Malignant cells from the primary tumor enter the brain through the bloodstream and often settle in the cerebrum.
  • Symptoms: Sudden epileptic seizures and non-specific symptoms such as nausea, headaches, dizziness and impaired vision. Nerve damage and paralysis on one side of the brain can also occur.
  • Diagnosis: Checking the intracranial pressure by means of ophthalmoscopy, general physical examination, MRI and CT scan. A tissue sample confirms the diagnosis.
  • Treatment: Alleviation of symptoms, for example to combat epilepsy. Sometimes chemotherapy is useful, surgery is also a standard therapy. This is followed by four weeks of radiotherapy.
  • Prognosis: If the primary tumor can be treated well, this improves the patient's chances. However, if there are very many metastases or metastases in the meninges, life expectancy is only a few months.

Article overview

More than 25 percent of all cancer patients develop metastases in the brain as the disease progresses. Patients with

Skin cancer patients and those with renal cell carcinoma are also at high risk. Around a third of normal brain tumors are brain metastases.

How do brain metastases develop?

The malignant cells detach from the original tumor and migrate to the brain via the bloodstream. They cross the blood-brain barrier and spread in the cerebrospinal fluid. This is located in the brain between the skullcap and the surface of the brain and is also found in the nerve tissue.

As the brain metastases grow, they exert pressure on the surrounding nerve tissue due to the limited space in the brain. The neighboring brain regions swell. Tissue fluid collects under the skull.

Only around 20 percent of patients have a single metastasis in the brain. If the initial tumor is not found, the physician refers to this as CUP syndrome (cancer of unknown primary).

Symptoms of brain metastases

One of the symptoms by which brain metastases can be recognized is the sudden occurrence of epileptic seizures. In some types of cancer that metastasize to the brain, non-specific symptoms occur as a result of increased intracranial pressure. The cancer patient suffers from

Many cancer patients initially have headaches that last longer than usual. They do not respond to painkillers. They also often experience nausea and vomiting. The ambiguous symptoms indicate that the cancer cells have already damaged the entire nervous system by forming swelling in the brain.

Tumors in the brain also manifest themselves in the form of nerve loss and hemiplegia: The affected person

  • suddenly drops objects for no apparent reason,
  • loses their balance or
  • speaks indistinctly.

Paralysis of the right leg indicates that the brain metastases are located in the left cerebral hemisphere.

Some patients develop brain-organic psychosis syndrome (HOPS). In this disease, the physical changes affect the psyche. Patients behave abnormally and are sometimes no longer able to carry out simple everyday tasks.

Brain metastases that grow on the cerebral cortex (surface of the brain) trigger severe seizures. Rapidly enlarging daughter tumors sometimes also cause bleeding into the surrounding brain tissue. Cancer patients then show symptoms that are typical of a stroke.

Anyone who experiences one or more of these symptoms should seek medical help as soon as possible.

Diagnosis of brain metastases

When diagnosing brain metastases, the family doctor works together with a neurologist (specialist for nerve diseases). The intracranial pressure is checked by means of an ophthalmoscopy. The general physical examination is followed by an examination of

  • the reflexes,
  • movement sequences and
  • the sense of balance

follows.

If damage to the central nervous system is suspected, magnetic resonance imaging (MRI) can provide information. With the help of this imaging procedure, the pathologically altered tissue and cerebral edema (accumulation of water in the brain) can be visualized. The doctor can also see partially dead tissue (necrosis) on the images.

Computed tomography (CT) - another imaging technology - can be used to visualize bleeding into the brain and calcified brain tissue.

Bilder von Hirn-Scans via MRT
Specialists can usually recognize metastases well on MRI images of the brain © ganusik1304 | AdobeStock

A biopsy is also necessary. To do this, the doctor takes a tissue sample from the brain metastasis and has it examined for malignant cells in the cancer laboratory. They also try to determine where the primary tumor is located in the body.

If the metastasis is too unfavorably located for the tissue sample to be taken or if it is too large, brain surgery by a neurosurgeon is required.

How are brain metastases treated?

The symptoms of brain metastases often cause severe discomfort and restrictions in everyday life. Therefore, alleviating the symptoms is the first step in treatment.

Patients with epileptic seizures are given anticonvulsant medication. The specialist also uses the usual anti-epileptic drugs.

The cerebral edema surrounding the metastases is reduced with cortisone therapy. The patient receives a high dose of this anti-inflammatory agent.

Alternatively, he is given infusions of osmodiuretics to drain the excess tissue fluid via the urinary tract. A drip with a certain type of dehydrating agent is used for this purpose. This application supplements cortisone treatment or is given as part of emergency therapy.

Brain metastases can only be treated with chemotherapy if they originate from small cell bronchial carcinoma, a form of lung cancer. In contrast to most other tumors in the brain, these brain metastases respond well to chemotherapy. The drugs used inhibit the growth of the cancer cells.

Brain tumor operations are also part of standard medical therapy. However, as they are associated with a certain residual risk, only metastases larger than 3 centimeters are operated on. Brain tumor surgery is usually not performed if there are multiple metastases and/or they are in an unfavorable location.

Surgical removal of the brain metastasis is followed by 4 weeks of radiotherapy . The entire head, with the exception of the face, is irradiated several times a week.

Radiotherapy is the only therapeutic option for patients who

  • are very severely physically affected or
  • have more than three tumors in the brain.

Some cancer clinics treat brain metastases on an outpatient basis using radiosurgery: An extremely high dose of radiation is directed precisely at the tumor and destroys it in a single session. Neighboring tissue or cells penetrated by the radiation are not damaged. The prerequisite for radiosurgery is

  • a tumor diameter of less than 3 centimeters and
  • that only a few metastases are present.

What is the prognosis for patients with brain metastases?

If the underlying cancer can be treated well, patients with brain metastases have a longer life expectancy. The same applies to younger cancer patients and people in good general physical condition. If the primary tumor does not spread to the brain until some time after the cancer diagnosis, the prognosis is also more favourable.

Patients with

  • many brain metastases and/or
  • tumors on the meninges

usually only have a life expectancy of around 3 to 6 months.

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