Leptomeningeal Disease

Advanced, or late-stage, cancers can spread from the breast, lung, or elsewhere to the brain and spine fluid.

In many cases, people who have LMD have been living with cancer for many years.

About 5% of people with cancer get LMD.

Any cancer can spread to the fluid and membranes that surround the brain and spinal cord.

But some cancers are more likely than others to cause LMD, such as:

• Lung cancer
• Breast cancer
• Melanoma
• Non-Hodgkin's lymphoma (NHL)
• Leukemia

Experts across the country, including at UPMC, are researching why some cancers progress to LMD. Their goal is to stop this process.

But at this point, doctors don't know how to prevent it.

If you have symptoms that suggest LMD, doctors may do one or both of the following tests to confirm a diagnosis.

MRI to diagnose LMD

An MRI is an advanced imaging test that uses a magnetic field and radio waves to make an image of the brain. It's safe and doesn't use radiation.

During an MRI, you lie on a table that moves in a large scanning machine. The MRI tech will give you a shot of a safe contrast dye, or you can take it by mouth.

The dye gives doctors a clear contrast between healthy tissue and cancer cells.

Lumbar puncture to diagnose LMD

For a lumbar puncture, the doctor carefully inserts a needle between two vertebrae to take a sample of fluid.

They then send the fluid to the lab to check for the presence of cancer cells.

Symptoms of LMD increase and get worse in a short time and include:

• Confusion.
• Headaches, chiefly headaches that get worse over days or weeks.
• Double vision.
• Neck or back pain.
• Seizures.
• Numbness.
• Extreme fatigue.
• Problems with speech.
• Clumsiness or weakness in the arms or legs.

Chemo kills rapidly forming cells.

The goal of chemo in treating LMD is to slow tumor growth in the fluid and membranes. This helps you live longer with fewer neurological symptoms.

You may take chemo drugs orally or through an IV in the arm.

Doctors may also inject chemo drugs directly into the fluid of the spinal cord.

Or a surgeon may implant a small, dome-shaped device — about the size of a quarter — under your scalp. This lets your doctor direct chemo straight into the spinal fluid through a catheter.

Your doctor at UPMC Hillman Cancer Center will decide which method is likely to work best for your type of cancer.

Radiation treatment uses high-energy beams to kill cancer.

Doctors often use both radiation and chemo to treat LMD.

Doctors may operate to remove certain tumors that block the flow of spinal fluid. This can improve brain function, as the fluid delivers vital nutrients to the brain.

But in most cases of LMD, the cancer cells are too small and widespread to remove through surgery.

Newer medications target the proteins that specific types of cancers use to copy.

These drugs can help some cancers that have spread to the brain or spinal cord membranes. This includes some types of melanoma and non-small cell lung cancer.

Targeted drugs can effectively replace radiation or other chemo in cases where tumors with certain gene mutations cause LMD cancer.

These genes that can cause leptomeningeal cancer include:

• HER2-Neu
• ALK
• ROS-1
• EGFR

Without treatment, LMD is often fatal within one to two months. With treatment, people can live 6 months or longer.

In rare cases, people survive beyond two years, particularly when any gene mutations are present.

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