Brain metastases are secondary cancerous growths in the brain that can disrupt brain function and cause neurological issues.
What are brain metastases?
Brain metastases are cancerous tumors that have spread to the brain from cancer that originated in another part of the body. In other words, they are secondary brain tumors, as opposed to primary brain tumors that originate in the brain itself. primary cancers have a higher likelihood of spreading to the brain, such as:
- Lung cancer: Especially small cell lung cancer. Learn more about lung cancer.
- Breast cancer: Particularly certain subtypes like triple-negative and HER2-positive. Learn more about breast cancer.
- Melanoma: Certain melanomas can be quite aggressive, leading to brain metastases. Learn more about melanoma.
- Kidney cancer: Renal cell carcinoma is a common type of kidney cancer and can lead to brain metastases. Learn more about kidney cancer.
Brain metastases are, unfortunately, quite common. A study from the National Institutes of Health states it’s estimated that there are around 100,000 cases annually. A multidisciplinary approach, like that at AHN, is critical for a successful treatment plan.
AHN Neuro-Oncology Center of Excellence
Our experts in the AHN Neuro-Oncology Center of Excellence offer some of the newest, most innovative care for patients with benign and malignant brain tumors. We use the latest tools and procedures to make the diagnosis process as minimally invasive as possible. You can get numerous tests done on the same day and in one location, to reduce your wait and travel time. We know this is a difficult and stressful time. Our understanding staff is by your side, guiding you and answering your questions. We also offer robust support services to treat the whole person.
Why choose AHN for your brain cancer treatment?
Our highly experienced team of neuro-oncologists (brain cancer specialists) and neurosurgeons (brain surgeons) performs treatments that are only available at the very best hospitals in the country. By choosing AHN for your care, you will find:
- Improved survival rates: We use aggressive treatments while making sure you are feeling as well as you can. Helping you live a longer, more comfortable life is our priority.
- Advanced technology: Sophisticated tools, such as ChemoID®* and genome analysis, and genome analysis, allow us to understand how the tumor will respond to different treatments before we prescribe them. Our goal is to use our advanced technology in a way that works for you — tailoring your treatment to your specific needs.
- Minimally invasive treatments: Many of our treatment options are outpatient procedures that involve a short recovery time. Instead of spending all your time in a hospital, you can live your life and enjoy your family and friends.
- A collaborative approach: We discuss all our patients in a weekly meeting with our brain cancer experts. You benefit from the combined experience of a team that includes neuro-oncologists, radiation oncologists, neurosurgeons, medical oncologists, and neuroradiologists. Because we are always up to date on your progress, we are able to give you the best possible care.
- Robust support: We invite all patients with brain cancer to join our weekly support group to share feelings, discuss symptoms, and help one another cope. It may help you feel better during treatment and experience an improved state of mind.
- A convenient, after-hours cancer clinic: If you experience side effects from treatment, call your physician’s office first, then visit our After Hours Oncology Clinic, conveniently located at West Penn Hospital. We treat you quickly, without exposing your compromised immune system to the germs you may encounter at a traditional emergency room. Plus, our clinic is more affordable than a visit to the ER. And since our oncology specialists have access to your records, they may even be able to advise you over the phone and save you from making a trip.
- Clinical trials: If you meet the eligibility requirements, you may be able to participate in an experimental clinical trial. You could gain access to a groundbreaking treatment before it is widely available. Learn more about our clinical trials program.
Brain metastases symptoms and signs
Brain metastases can show up in a wide range of symptoms and signs depending on the size, number, and exact location of the tumors in the brain. The tumors can disrupt normal brain function, leading to various neurological issues. This disruption can cause the following symptoms and signs:
- Headaches: Often persistent, throbbing, or dull. They can be worse in the morning and improve throughout the day, though this isn't always the case. The headaches may worsen over time, become more frequent, or change in character and may also be accompanied by nausea or vomiting.
- Seizures: These can range from subtle, localized movements to full-body seizures.
- Neurological deficits: These symptoms can often correspond to the area of the brain that’s affected by the metastasis and include numbness or tingling in an arm, speech and language problems, vision problems, slurred or difficult to understand speech, dizziness, and hearing loss.
- Cognitive and behavioral changes: With tumors in the frontal lobe, some people can experience memory problems, confusion and disorientation, personality changes, concentration difficulties, and slowed thinking.
- Nausea and vomiting: Often associated with headaches, nausea and projectile vomiting due to rapidly increasing pressure in the brain.
- Fatigue: Profound and persistent tiredness that isn't relieved by rest. This can be a symptom of the cancer itself, but also exacerbated by brain involvement.
Causes and risk factors
Brain metastases are caused when cancer cells from a primary tumor in another part of the body break away, travel through the bloodstream, and establish new tumors in the brain. The risk of developing brain metastases varies significantly depending on the original cancer type. For instance, lung cancer, breast cancer, and melanoma are among the most common cancers that spread to the brain, due to their aggressive nature and propensity to disseminate. Certain genetic mutations within a tumor or advanced stages of cancer can further increase a patient's susceptibility to brain metastases.
Brain metastases screening and diagnosis
Screening for brain metastases is not routinely recommended for everyone with cancer. It is typically considered for individuals with primary cancers that have a higher likelihood of spreading to the brain.
Neurological examination
The diagnostic process typically begins with a detailed discussion of your medical history, including any known primary cancer diagnoses, symptoms you are experiencing, and any relevant risk factors. A comprehensive neurological examination is performed to assess brain function. This exam evaluates various aspects of your nervous system, including:
- Mental status: Assessing alertness, orientation, memory, and cognitive abilities.
- Cranial nerves: Testing the function of the twelve cranial nerves, which control various sensory and motor functions of the head and neck (e.g., vision, hearing, facial movements).
- Motor function: Evaluating muscle strength, coordination, and reflexes.
- Sensory function: Assessing the ability to perceive sensations such as touch, pain, temperature, and vibration.
- Gait and balance: Observing your walking pattern and balance.
Imaging studies
Imaging studies help your AHN care team identify brain metastases and understand the extent of the spread. These images will show your care team where and how the tumors have spread — helping to create a care plan to treat your specific condition.
MRI (Magnetic Resonance Imaging) with contrast
The most common and effective imaging study for identifying brain metastases is an MRI of the brain, especially with intravenous contrast. MRI provides highly detailed images of soft tissues, allowing for the detection of even small metastatic lesions or tumors. The use of a contrast agent (gadolinium) helps to highlight abnormal tissue, making it easier to identify tumors and assess their size, location, and characteristics.
CT scan (Computed Tomography Scan)
When used to identify brain metastases, a CT scan can reveal abnormalities in the brain's structure, such as tumors, swelling, or changes in blood flow. Often, a contrast dye is injected intravenously before the scan; this dye helps to highlight abnormal areas, including tumors, making them more visible on the images. While effective for detecting many brain lesions, particularly larger ones, CT scans are generally less sensitive than MRI for very small metastases or those in areas surrounded by bone, where X-ray signals can be obscured.
Biopsy
A biopsy is sometimes needed to confirm the diagnosis of brain metastases and determine the type of cancer. A biopsy may be considered if:
- The diagnosis is uncertain based on imaging alone.
- There is no known primary cancer.
- The imaging characteristics of the tumor are atypical.
- Knowledge of the tumor type is needed to guide treatment decisions.
Types of biopsy procedures:
- Stereotactic biopsy: A minimally invasive procedure that uses imaging guidance (MRI or CT) to precisely target and sample the tumor.
- Surgical resection: If the tumor is accessible and surgically resectable, the entire tumor may be removed and sent for pathological examination.
Types and stages of brain metastases
Brain metastases can occur as a single tumor or as multiple tumors scattered throughout the brain. A single brain metastasis refers to the presence of only one tumor in the brain. Multiple brain metastases indicate the presence of two or more tumors in the brain. The size, growth rate, and even the specific type of cancer cells making up the metastasis can vary, influencing how aggressive the treatment needs to be.
The location of brain metastases can vary and may affect the symptoms and treatment options. Brain metastases can occur in different regions of the brain, including:
- Cerebrum: The largest part of the brain, responsible for higher-level functions such as thinking, memory, and language.
- Cerebellum: Located at the back of the brain, responsible for coordination, balance, and motor control.
- Brain stem: Connects the brain to the spinal cord, controlling vital functions such as breathing, heart rate, and blood pressure.
- Histological subtype: The histological subtype of brain metastases refers to the specific type of cancer cells that make up the tumor.
This information is determined through a biopsy and can help guide treatment decisions.
While there isn't a universally adopted, single staging system for brain metastases like there is for other cancer types (e.g., TNM staging), doctors evaluate several key factors to assess the extent of the disease and guide treatment. These factors essentially serve as a form of staging for brain metastases. The main considerations include:
- Number of lesions: This is a crucial factor. Patients can have a single brain metastasis, oligometastases (typically two to four or two to 10 lesions, depending on the definition), or multiple brain metastases (more than 10). The number significantly impacts treatment options and prognosis.
- Size of lesions: The dimensions of each individual metastasis are important, as larger lesions can cause more significant symptoms and may require different treatment approaches than smaller ones.
- Location of lesions: As discussed, the precise area of the brain where the metastases are located can affect symptoms, neurological function, and the accessibility for surgery or focused radiation.
- Systemic disease control: This refers to whether the primary cancer outside the brain is stable, progressing, or well-controlled. Good control of the primary cancer and any other distant metastases (e.g., in the lungs or liver) often leads to a better prognosis for brain metastases.
- Performance status (e.g., Karnofsky Performance Status or ECOG score): This assesses the patient's overall health, functional abilities, and how well they can perform daily activities. It's a critical factor in determining a patient's tolerance for various treatments.
- Presence of neurological symptoms: Whether the metastases are causing symptoms like headaches, seizures, weakness, or cognitive changes is also a key consideration.
Based on these factors, doctors determine a patient's prognosis and formulate a treatment plan that might involve surgery, radiation therapy (like stereotactic radiosurgery or whole brain radiation therapy), or systemic therapies.
Brain metastases treatment
When facing brain metastases, it's reassuring to know that your treatment will be as unique as you are. At AHN, we believe in a highly personalized approach, understanding that each patient's situation is distinct. Your dedicated AHN care team will thoroughly assess your specific case, considering the precise location and number of tumors, to craft a tailored treatment plan designed just for you. This individualized care is central to achieving the best possible outcome.
Surgery
As pioneering surgeons in Pennsylvania to use cutting-edge surgical options to treat brain metastases, AHN offers options that aren’t available at other hospital systems in the area. Our surgeons blend their expertise and compassion to deliver care that is tailored to your specific needs.
GammaTile Brachytherapy®
Our surgeons were the first center in Pennsylvania to implant radiation tiles at the end of a brain tumor resection. GammaTile Brachytherapy® ** allows patients to receive necessary radiation treatment to their brain tumor while recovering surgery, sometimes minimizing the need to travel back to the hospital for postoperative radiation.
Gamma Knife® Radiosurgery
We have one of the busiest radio-surgical programs in the country, treating over 300 patients a year with minimally invasive radiation therapy for benign and cancerous brain tumors. The Gamma Knife® *** is a sophisticated form of stereotactic radiosurgery (SRS) that uses highly focused beams of radiation to target and treat tumors and other abnormalities in the brain.
Laser interstitial thermal therapy (LITT)
The LITT procedure results in less pain and a faster recovery compared to traditional surgery. Here's what you can expect:
- We will give you general anesthesia so you won’t feel any pain.
- The neurosurgeon will use a specialized drill to make a tiny hole in the skull near the tumor.
- With MRI guidance, the surgeon will maneuvers\ a laser wire toward the cancerous area in the brain.
- The wire will destroy the tumor cells using thermal heat.
- The surgeon will then remove the wire and close up the small open area with stitches.
Advanced radiation therapies
We use advanced technologies to target the radiation beam directly to a tumor. This approach minimizes overall exposure and results in a more precise treatment and less harm to healthy tissue. The Cancer Institute is the only radiation oncology network accredited in western Pennsylvania by both the American Society for Radiation Oncology and American College of Radiology. These accreditations mean that our facilities meet specific guidelines for patient safety, quality control, and equipment performance. Our radiation therapies used advanced imaging so that the proper radiation dose is administered, and to precisely target the tumor. Radiation therapies used include:
- Intensity-modulated radiation therapy (IMRT)
- Volumetric arc radiotherapy (VMAT)
- 3-D conformal external-beam radiation therapy (3DCRT)
We also pioneered an advanced radiation therapy technique here at AHN called stereotactic radiosurgery (SRS). It has dramatically improved our ability to control the growth of tumors. This method delivers high, effective doses of radiation in as few as five treatments.
Supportive care
At AHN, we understand that a diagnosis of brain metastases, or any life-limiting illness, can be overwhelming. That's why we are proud to be among the few programs in Western Pennsylvania with a team of dedicated palliative care specialists ready to support you. Our team provides comprehensive care, including treatments to manage symptoms, vital emotional support, and expert coordination services, all designed to ease the burden you and your loved ones may be experiencing. With regular communication among our specialists, we ensure that your care is always responsive and tailored to your evolving needs, offering comfort and support every step of the way.
Clinical trials
You have access to a variety of promising active clinical trials right here. Clinical trials are studies designed to test the newest approaches to care. You may not have to travel for additional treatment options.
Brain metastases FAQs
Hearing you might be facing a brain metastases diagnosis is likely overwhelming and can bring up a lot of emotions. AHN is here to help. We have expert brain surgeons who have pioneered some of the most technologically advanced treatments available. Your care team is here to help guide you through your diagnosis and treatment and is here to answer any and all questions you have. To help you get started, we’ve compiled answers to some of our patients’ most frequently asked questions. You can use these to inform your conversations with your care team.
Can brain metastases be cured?
While a complete cure for brain metastases can be challenging, especially when there are multiple lesions or widespread disease, significant advancements in treatment mean that many patients can achieve excellent control of their disease. Treatments like surgery, stereotactic radiosurgery (focused radiation), and targeted therapies can eliminate or shrink tumors, manage symptoms, and extend life. For some patients, particularly those with a single metastasis and well-controlled primary cancer, a long-term remission is possible. The goal of treatment is often to control the disease, improve quality of life, and prolong survival.
What is the life expectancy of someone with brain metastases?
Predicting life expectancy for someone with brain metastases is highly individual and depends on many factors, making it impossible to give a single number. Key factors include the type of primary cancer, the number, size, and location of the tumors; the patient's overall health and functional status; and how well the cancer outside the brain is controlled. Advances in treatment have significantly improved outcomes, with some patients living for many months or even years after diagnosis. Your care team will discuss your specific prognosis based on these individualized factors.
Which cancers metastasize to the brain?
While nearly any cancer can potentially spread to the brain, some types are more commonly associated with brain metastases. The cancers most frequently seen to metastasize to the brain include:
- Lung cancer: This is the most common primary source of brain metastases.
- Breast cancer: Often spreads to the brain, particularly certain subtypes.
- Melanoma: This aggressive form of skin cancer has a high tendency to spread to the brain.
- Kidney (renal cell) cancer: Also frequently metastasizes to the brain.
- Colorectal cancer: While less common than the others listed, it can also spread to the brain.
How do brain metastases progress?
Brain metastases progress when cancer cells from a primary tumor, located elsewhere in the body, break away, travel through the bloodstream, and form new tumors in the brain. Once established, these metastatic tumors can grow, potentially causing symptoms by putting pressure on surrounding brain tissue, disrupting normal brain function, or causing swelling. The rate of progression varies greatly depending on the original cancer type, the aggressiveness of the brain metastases, and the effectiveness of treatments. Without treatment, they generally continue to grow and can lead to increasing neurological symptoms. With treatment, their growth can often be halted or reversed.
Contact us
To schedule an appointment or learn more about AHN neuroscience services, call 412-359-6200 in Pittsburgh or 814-452-7575 in Erie.
Second opinions
If you want a second opinion regarding a cancer diagnosis, treatment options, or prognosis, our team of oncology specialists can review your medical records at AHN. To get started, fill out our Second Opinion Request form. Our Navigation Team will contact you within the next 24 – 48 hours to discuss next steps and schedule.
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