Brain Metastases

The longer cancer is in the body, the greater the chance it will spread to other parts, including the brain.

As people are living longer with cancer, due to treatment advances, brain metastases are becoming more common.

Studies have found that cancer will spread to the brain in about 10 to 20% of people who have cancer.

Some cancers are much more likely to spread to the brain, such as:

• Lung cancer, which accounts for half of all brain metastases.
• Breast cancer.
• Kidney cancer.
• Skin cancer.
• Colon and rectal cancer.

Many studies are looking into ways to reduce the spread of cancers to the brain.

Potential options include radiation to the brain and treating the primary cancer with certain types of chemotherapy. Researchers base these treatments on the cancer's origin and type.

Symptoms of cancers that spread to the brain include:

• Headaches that get worse and more frequent over time, and don't respond well to treatment.
• Weakness in the legs or arms, perhaps only on one side of the body.
• Numbness in the limbs or face, often on only one side.
• Confusion.
• Speech problems.
• Trouble swallowing.
• Changes in behavior or personality.
• Poor coordination or clumsiness.
• Seizures.
• Nausea and throwing up.
• Loss of bladder control.

Your doctor will ask about your symptoms and health history.

They may ask you to do simple tasks to assess brain function by testing your:

• Reflexes
• Eye movements
• Balance

If the doctor suspects a brain tumor based on this assessment, they'll order the following tests.

MRI to diagnose brain cancer

This is the most common test to diagnose a brain metastasis.

MRIs are safe scans that don't use radiation. Instead, they use magnetic fields and radio waves to make an image of the brain.

When an MRI could interfere with a metal implant in the body, then the doctor will order a CT scan.

Other tests to diagnose brain metastases

Sometimes, doctors find a brain metastasis before they find the primary cancer.

In these cases, the doctor will order blood tests to look for markers, or proteins, in the blood. This can help them find out where the cancer started.

Your doctor may do a biopsy. They will take a tiny sample of the brain tumor and send it to the lab to find its origin and type.

The doctor may also order a chest CT scan or PET scan to look for cancer elsewhere in the body.

Standard chemo kills fast-forming cancer cells.

Newer, targeted chemo drugs act on unique proteins that only cancer cells use, rather than targeting all fast-dividing cells. For this reason, targeted therapies often have fewer side effects, as they don't affect healthy cells as much.

Many chemo drugs that work for cancers elsewhere in the body don't work as well for tumors in the brain. This is because they don't get past the blood-brain barrier — the brain's complex system that stops many molecules from entering.

For brain metastases, doctors choose chemo drugs that can pass this barrier and effectively treat the cancer.

Chemo may or may not work, depending on the type of cancer. If it's not an option for your type of brain tumor, we will pursue other treatments.

Radiation involves high-energy beams to damage the DNA of the cancer cells, which limits their ability to divide.

Radiation can also damage normal cells and cause side effects like:

• Hair loss
• Memory loss
• Headaches

But fast-dividing cancer cells are much more sensitive to the damaging effects of radiation compared to normal cells.

Your doctor may use radiation on the whole brain or directly to the locations of one or more tumors. Whole-brain radiation has more side effects than radiation aimed at one or more tumors in the brain.

Surgery is an option if you have a small number of brain tumors that doctors can access.

In some cases, doctors don't suggest surgery because it could damage too much healthy brain tissue.

This is a new option for treating metastatic brain cancers. These drugs help the immune system fight tumors.

For instance, doctors can inject lab-produced antibodies into the bloodstream to kill some types of cancer cells.

Immunotherapy drugs can work against certain brain metastases. but don't yet have an established role for treating primary brain tumors. It's hard for the immune system to recognize primary brain tumors as a target and for immune cells to traffic into it.

Doctors at UPMC are taking part in several clinical trials working to find ways to make immunotherapies more effective.

Along with drugs that act on the cancer cells, doctors also treat brain metastases symptoms with:

• Steroids to reduce swelling in the brain.
• Drugs to reduce nausea.

People with metastatic brain cancer live, on average, between 8 to 16 months. The survival depends on how early doctors find that the cancer has spread to the brain, and from where in the body.

For instance, people with breast cancer that spreads to the brain live longer, on average, than those with other brain metastases.

People whose tumors harbor certain mutations that doctors can target with precision drugs can often do quite well for several years.

Learn more about brain and nervous system cancer treatments at UPMC Hillman.