Metastatic brain cancer (also known as secondary brain cancer) is the spread of cancer cells in the brain from a malignant tumor located in another part of the body. Some facts and figures:
- The secondary could occur 10 times more often than the primary, that is, the one that initially develops in the brain;
- Brain metastases occur in 20-40% of cancer patients (on average, every fourth);
- Every year, brain metastases are diagnosed in 50,000 - 70,000 Russians;
A couple of decades ago, with multiple metastases to the brain, the patient could be given up - neurosurgical institutions that were making progress in the treatment of primary brain tumors did not accept such patients, because surgical treatment in this case was already almost impossible. Even in the capital, no more than three specialists were ready to try radiation therapy, while several dissertations were defended on this topic, demonstrating very good results. But practical activities encountered clinical difficulties that made saving the patient very labor-intensive.
Metastases of malignant tumors in the brain occur in every fourth patient, and during post-mortem examination they are found in six out of ten. Metastases are detected an order of magnitude more often than primary tumors of the central nervous system, which neurosurgeons readily treat. Russian oncology statistics take into account only primary brain tumors and primary cancers in general, but do not know how many patients have metastases anywhere, and not just in the brain.
Any tumor metastasizes to the brain, but most often lung cancer, especially extremely aggressive small cell cancer - up to 80% of patients, as well as breast cancer, colon cancer, kidney cancer and melanoma, but all of them metastasize much less often than lung cancer. Today, brain metastases are found more often than at the end of the last century, which is greatly facilitated by neuroimaging methods - CT and MRI and increased survival of cancer patients as a result of advances in oncological science. The activity of oncologists has also increased noticeably, not only deciding to treat the most difficult patients, but also having the opportunity to care for such patients.
As a rule, by the time intracranial metastases are identified, most patients have other, sometimes incurable and widespread, tumor foci, their condition leaves much to be desired, and local therapy for intracranial metastases is fraught with early relapse. The introduction of high-tech treatment, both surgical and radiation, helped get rid of professional pessimism and increased the 5-year survival rate of patients, giving them a completely acceptable quality of life.
Why do brain metastases occur?
Metastasis is a rather complex process. It consists of several stages. The tumor must grow into neighboring tissues, then its cells break off and penetrate the blood or lymph vessels. Migrating with the bloodstream, cancer cells settle in different organs. They “dormant” for some time, then rapid growth begins.
Most often - in 48% of cases - brain metastases are associated with lung cancer. Non-small cell lung cancer is the most aggressive - it metastasizes to the brain in 80% of cases. Metastases are less common in breast cancer (15%), genitourinary system (11%), osteogenic sarcoma (10%), melanoma (9%), and head and neck cancer (6%).
Differential diagnosis
All of the above symptoms are often found in a wide variety of diseases, even not always related to the brain. Some of these diseases:
- psychiatric illnesses;
- endocrine pathology;
- neurotic syndromes;
- vascular disorders;
- abscess;
- parasitic diseases;
- infectious diseases, for example, meningitis, encephalitis.
Each of the above symptoms smoothly flows into the other. They are interconnected to such an extent that sometimes it is difficult to see that fine line that indicates the appearance and growth of signs of a terrible pathology. The slightest suspicion of a problem should lead you to see a doctor. Timely medical assistance has saved the lives of millions of patients with brain tumors.
Clinical manifestations of metastases
Symptoms depend on the size of intracranial tumor foci, their number and location. Basically, clinical symptoms can be divided into two groups:
- local, due to the location of the tumor in a specific part of the brain responsible for certain functions of a certain organ;
- general cerebral symptoms associated with the size of additional tumor tissue interfering with the functioning of the brain itself.
For example, a tumor near the structures that provide innervation to the eye will manifest itself as a loss of visual fields, when the eye does not perceive certain parts of the viewing sector. Many small nodes will give a picture of cerebral edema, since extra grams of tumor in a closed cranium interfere with the normal circulation of fluids and compress normal tissues.
In half of the patients, secondary brain tumors respond with headaches; very often the intensity of the pain changes along with the position of the head, when, when tilted at a certain angle, partial restoration of cerebrospinal fluid circulation temporarily leads to a decrease in pain. Unfortunately, over time, the growth of metastases will make the pain constant, and the confined space will lead to unbearable intensity. Dizziness and double vision are common when looking with both eyes.
Every fifth patient develops motor disorders up to paresis of half the body. Every sixth suffers from intellectual abilities, the same number suffers from changes in behavior, disturbances in movement and gait, seizures are slightly less common, but a completely asymptomatic course, when metastatic formations are detected only during examination, is also not uncommon. However, as the size of the tumor increases, even in such a relatively favorable situation, the functions of the body are quickly disrupted.
Swelling of the tissue around the tumor - perifocal edema, coupled with increased intracranial pressure (ICP) causes general cerebral symptoms with headache, dizziness, double vision, vomiting at the slightest movement or even when opening the eyes, constant hiccups, leading to depression of consciousness up to cerebral coma. A decrease in heart rate and breathing rate with very high “upper” systolic pressure indicates extremely high and potentially fatal intracranial pressure.
In practice, variants of the development of primary symptoms in cancer metastases to the central nervous system are distinguished according to the prevailing set of clinical signs.
- The apoplexy variant, similar to a stroke, develops acutely and is manifested by focal disorders - evidence of damage to a certain area of the brain. This option is usually associated with either blockage of the vessel or its rupture by a tumor, followed by hemorrhage into the brain.
- The relapsing-remitting variant is characterized by an undulating course, when the symptoms either decrease or progress, resembling atherosclerotic vascular damage.
In some patients, brain metastases are asymptomatic. They are discovered only during examination.
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Displacement or dislocation of brain matter
As the tumor of the frontal lobe of the brain increases in volume, symptoms of damage to the occipital lobe, brainstem, and cerebellar disorders develop.
A tumor of the frontal lobe of the brain can cause a displacement towards the opposite hemisphere or towards the back of the head. Posterior displacement pushes the brain stem toward the foramen magnum. It indicates infringement. The brain stem contains vital centers responsible for breathing and blood circulation. Their defeat leads to death.
Clinical picture of dislocation syndrome
Unlike injuries, dislocation syndrome with tumors develops gradually. The person manages to adapt, and the clinical picture of brain displacement becomes obvious even in advanced cases.
The following symptoms gradually increase:
- Impaired consciousness to the point of stupor or coma, which is manifested by constant drowsiness. It is impossible to wake a person.
- The reaction of the pupils to light decreases and then disappears completely.
- Trembling movements of the eyeballs appear.
- If the patient had neurological symptoms on one side, then it becomes bilateral. For example, if one arm and leg were paralyzed, then with the development of dislocation, paresis progresses to all four limbs.
- Pathological symptoms increase.
- Muscle tone first increases and then decreases.
- Respiratory and cardiovascular disorders lead to death.
How are brain metastases diagnosed?
The “gold standard” in diagnosing metastatic brain cancer is magnetic resonance imaging (MRI). During this test, images of the internal structures of the body are obtained using a strong magnetic field. From the images, the doctor can judge the number, size, and location of metastatic foci.
A biopsy is a test during which a piece of tissue is removed and examined for cancer cells. If a person has already been diagnosed with cancer in another organ and lesions are found in the brain, there is usually no need for this diagnostic method. A biopsy is needed if there are lesions in the brain, but the primary tumor has not been found.
How often does lung cancer metastasize?
Often. According to statistics, 40% of patients who have recently been diagnosed with lung cancer have metastases. With this picture, the fourth stage of a malignant tumor is diagnosed. Naturally, the prognosis is significantly worse than in the early stages, when there are no metastases.
The reason for such frequent late diagnosis is that in the early stages lung cancer does not manifest itself, or there are symptoms, but they resemble another disease, for example, chronic bronchitis or COPD. Many smokers do not pay attention to a constant cough and shortness of breath, taking them for granted - but these may be the very “first bells”.
Treatment of metastases
Without treatment, the life expectancy of a patient from the moment a metastatic lesion of the brain is detected hardly exceeds a month, but this is on average. Only the addition of high doses of hormones can double life expectancy and slightly improve its quality, but again only temporarily, while chemoradiotherapy can give up to six months of life.
Treatment tactics depend on several factors:
- Number, size and location of metastases;
- Possibility to remove lesions surgically;
- Sensitivity of the primary tumor to chemotherapy and radiation therapy;
- General condition of the patient;
- The presence of other metastases, the ability to fight them.
Prognostically unfavorable is the localization of the tumor in the posterior cranial fossa, inaccessible for manipulation, impaired circulation of cerebrospinal fluid and the likelihood of tumor wedging into natural cranial foramina. There is no doubt that only surgery, coupled with additional drug and radiation treatment, gives great hope. But neurosurgical intervention is possible with one or single tumor nodes, and, of course, technically accessible ones. Palliative surgery is performed when there is a threatening increase in pressure and bleeding, when the removal of even one of many nodes can radically improve the clinical picture in order to add conservative treatment in the future. There are different options for removing tumor nodes.
For types of cancer that are technically unremovable and sensitive to antitumor drugs, such as breast, small cell lung cancer and germ cell tumors of the testicle, chemotherapy is used at the first stage, which is then followed by irradiation of the entire brain. For radiosensitive tumors, treatment can begin with total brain irradiation. For tumors no larger than 3.5 cm and less than four nodes, stereotactic radiosurgery is effective as the only method. Several beams of radio waves are applied to the tumor from different sides; they intersect in one place - where the metastasis is located. As a result, cancer cells are destroyed, and surrounding healthy tissues receive the minimum safe dose. In combination with brain irradiation and chemotherapy, the result is better.
Radiation therapy is always accompanied by an increase in swelling of the brain tissue, so irradiation is always carried out against the background of dehydration - symptomatic therapy that relieves excess fluid. Therefore, the radiologist may refuse treatment to a patient who is resistant to diuretics, as well as with an already displaced brain, since further displacement can be fatal for the patient. They will not accept irradiation for a seriously ill patient with severe clinical manifestations, especially with convulsions or cloudy consciousness. After just one or two sessions of irradiation, the existing high intracranial pressure will be joined by radiation-induced tissue edema, and the patient’s already very unimportant condition will worsen.
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Variants of sequences and combinations of methods are possible, both for newly detected brain metastases and for relapse after treatment. In any case, if active tactics are impossible and the process progresses, clinical guidelines recommend resorting to chemotherapy along with the best supportive symptomatic therapy (steroids, painkillers, anticonvulsants, etc.). The regimen is determined by the primary tumor, that is, some drugs help with lung cancer, and others with kidney cancer. Chemotherapy is carried out until signs of tumor progression are detected.
Treatment of metastases of malignant tumors in the brain is not the work of single enthusiasts, it is the work of a team of oncologists, neurosurgeons, radiologists, chemotherapists and resuscitators, armed with knowledge and excellent equipment for diagnosis and treatment, as in the European clinic.
What is the prognosis for brain metastases?
The prognosis depends on the type of primary tumor, the number of metastases, the age and condition of the patient. On average, patients live 2-3 months. But if there are single metastases, the patient is under 65 years old, and there are no other metastases in the body, the average life expectancy can be 13.5 months.
Oncologists and resuscitators at the European Oncology Clinic know how to help a patient with metastatic cancer. Competent treatment will relieve severe symptoms and give you valuable time.
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How long do such patients live?
Metastatic cancer is very difficult to treat:
- The 5-year survival rate (percentage of patients still alive 5 years after diagnosis) is 1–2%.
- Median survival (time after which half of the patients died, the other half remained alive) is 6-12 months (without treatment - 2-4 months).
However, such negative statistics are not a reason to give up.
Some patients (even if only a few out of a hundred) still remain alive for a very long time, many years. No one knows in advance which of those newly diagnosed with stage IV lung cancer will be among these survivors.
In addition, science does not stand still. Now doctors and scientists have high hopes for immunotherapy and targeted drugs. Treatment methods are improving, which means the chances of defeating cancer are increasing.
