Brain Metastases: Causes, Symptoms & Treatment

Brain metastases are settled cancer cells in brain tissue that originate from malignant tumors outside the brain. They enter the head through blood, cerebrospinal fluid, and lymph.

What are brain metastases?

Schematic diagram showing the location of a brain tumor in the brain. Click to enlarge. Brain metastases are cancer tumors that have developed in brain tissue as metastases from other cancers. Thus, brain metastases have their origin in another tumor, which is not located in the brain. The original tumor is also called the primary tumor. This can release cancer cells into the bloodstream or lymphatic system, for example, causing them to spread. Malignant cells can thus enter the brain, settle there and, by multiplying, give rise to a brain metastasis. In addition, tumor cells can be spread through the cerebrospinal fluid to reach the meninges in the brain or spinal canal. Generally, the diagnosis of brain metastasis is considered a symptom that another tumor disease has already reached the advanced stage.

Causes

Brain metastases are caused by malignant tumors that give rise to daughter tumors in the brain. In principle, every tumor has the ability to spread. However, about a quarter of these diseases are based on a causative bronchial carcinoma or lung cancer. Furthermore, tumor types such as breast cancer, black skin cancer and kidney cancer often form daughter tumors in the brain, so that brain metastases develop. Brain metastases can thus be clearly distinguished from a primary brain tumor, which has developed directly from brain tissue and has not spread to the brain from another tumor outside the brain. To better investigate the cause of brain metastases, a tissue sample is taken from the tumor. This is analyzed by a pathologist. It provides information about where the causative tumor for the brain metastases is located.

Symptoms, complaints, and signs

The symptoms caused by brain metastases can vary widely. This is explained by the fact that different areas of the brain may be affected, depending on the specific location of the brain metastases. Depending on this, the affected persons are also limited in different functions in each case. A general sign of possible brain metastases should always be unclear headaches. Headaches that last for a long time, occur repeatedly, are felt clearly especially in the morning after waking up or generally when lying down, may also indicate changes in the brain. It is also characteristic of pain caused by brain metastases that they often do not respond at all or only very poorly to usual painkillers. Motor changes such as sudden clumsiness, problems with walking or similar should also be clarified by a doctor. Problems with speech can be of different nature: Sudden difficulties to find the right words or generally an unclear pronunciation, which has been newly detected, can give a first indication of brain metastases. Since metastases usually increase in size, any symptoms that increase in magnitude should be investigated quickly in particular. This may indicate that brain metastases are demanding further space in the brain and symptoms are increasing accordingly.

Diagnosis and progression

When brain metastases are suspected, imaging techniques are often used for diagnosis. Computed tomography and magnetic resonance imaging provide informative images of the affected region. The course of brain metastases is usually independent of the further development of the primary tumor. However, due to the development of brain metastases, there is a worsening of the prognosis for the original cancer. How long the survival time is depends on the number of metastases in the brain as well as on the treatment. In general, however, the prognosis is unfavorable. Without therapy, the patient usually survives only a few weeks. Radiation can extend the survival time to several months. Only in the case of brain metastases, which have arisen from a spread of a tumor to the testis, does a combined therapy of radiation and chemotherapy promise a satisfactory course.

Complications

Brain metastases are a very serious disease that leads to death in many patients.As a rule, the probability of survival also depends on the onset of treatment, so early diagnosis and treatment is extremely important for the further course of the disease and complications. Severe headaches occur due to the increased pressure in the brain. This headache often spreads to other regions of the body and can also lead to feelings of pressure or pain there. The patient suffers from severe cramps and also from disturbances of consciousness. Possibly certain thought processes are disturbed and not infrequently a coordination disorder occurs. The patient’s everyday life and quality of life are considerably limited by the brain metastases. The treatment of brain metastases is carried out with the help of radiation therapy or surgical interventions. There are no further complications during the treatment itself. However, it cannot be generally predicted whether the affected person will be completely healthy after the treatment. Possibly the life expectancy is reduced by the brain metastases. Without treatment, the patient will die prematurely.

When should you see a doctor?

A visit to the doctor is necessary as soon as the affected person notices abnormalities inside the head. If there is a headache, a pulling sensation in the head or pressure under the top of the skull, a doctor should be consulted. If the hairline hurts, skin changes appear or attention problems occur, this should be examined. If the complaints increase in scope or intensity, a doctor is needed. If there are convulsions, disturbances of consciousness or a loss of consciousness, urgent action is required. A doctor should be consulted as soon as there is repeated flickering of the eyes or disturbances in the ability to see begin. If there is a loss of hearing or irritation of the balance, a doctor is also needed. If speech disorders or problems with mobility occur, there is cause for concern. Sleep disturbances, a general feeling of malaise or sickness should be investigated and treated as soon as they persist for several weeks. A drop in usual performance level, fluctuations in mood, or changes in personality are considered unusual and should be investigated further. If there are behavioral abnormalities, memory problems, or orientation problems, a physician is needed. If the individual suffers from severe fatigue, irregularities in emotion regulation or coordination problems, this indicates inconsistencies that should be investigated. Social withdrawal behavior, dizziness, or facial paralysis should be evaluated by a physician.

Treatment and therapy

Once brain metastases have been diagnosed, there is usually collaboration between physicians from different specialties. These include neurologists, neurosurgeons, oncologists, radiologists and radiation therapists. They develop treatment for the brain metastases and the tumor of origin. The first step in treatment is usually the administration of potent corticosteroids, which act against the symptoms of edema. However, since the effect is not long-term, further therapeutic measures are initiated. For example, the neurosurgeon can remove individual brain metastases with the help of a surgical procedure. This form of treatment is particularly suitable if there has been no relapse of the cancer over a long period of time. Furthermore, surgery can only take place if the patient is in sufficient physical condition to undergo it. If a large number of brain metastases have been discovered, radiation therapy of the entire head is performed. This serves to alleviate the symptoms. Chemotherapy is given to cure the underlying disease. Sometimes, chemotherapy alone is also possible for brain metastases. However, this is often used in combination with radiotherapy. During chemotherapy, it is necessary to consider which type of cancer has spread the metastases to the brain. Only then can the cytostatic drugs effectively target the brain metastases.

Outlook and prognosis

Brain metastases are the result of an existing cancer. Because of this, the prognosis is highly variable and depends on a wide variety of factors. These include the type of cancer, the duration and previous course, the general condition of the patient, the previous tolerance of cancer therapy, and whether further metastases have already occurred outside the brain.As a rule, however, metastases of any kind mean that the prognosis worsens because a high stage of the cancer has already been reached. Brain metastases in particular are critical because, depending on where they are located, they may no longer be able to be removed by surgery. The risks of damage to (vital) functions would be too great. At best, surgical removal is possible, so that subsequent treatment with chemotherapy or radiation can be continued. However, these are often only life-prolonging measures, and there is little prospect of a complete cure. In the case of brain metastases, there is also a risk of severe symptoms. Depending on the location and growth of the tumor, it can result in a number of different symptoms and malfunctions of the body, including speech and movement disorders, sensory organ deficits or, in the worst case, impairment of the functions of vital organs. These can be very distressing for affected individuals and, at worst, life-threatening, which is why this factor also influences the prognosis of brain metastases.

Prevention

There are no specific measures to prevent brain metastases. However, as with other cancers, unnecessary radiation and contact with carcinogens should be avoided. Furthermore, the risk of cancer can be reduced by a healthy lifestyle, a low-fat diet, regular exercise, and abstaining from alcohol and nicotine. This also reduces the risk of brain metastases.

Follow-up

There are usually no options or measures of aftercare available to the affected person for brain metastases. In most cases, brain metastases can also not be treated completely, so that there is always a reduced life expectancy of the affected person due to this disease. The earlier this tumor is detected, the better the further course of the disease usually is. Therefore, a doctor should be consulted at the first symptoms or signs. The treatment of brain metastases can be carried out by taking various medications. The affected person is dependent on a correct dosage and also on a regular intake in order to treat the tumor properly. A doctor should always be contacted first if there are any questions or if anything is unclear. The support and loving care of one’s own family and friends is also very important in this disease, as this can prevent psychological upsets or even depression. This is especially the case if chemotherapy has to be given. If surgery is required, the affected person should definitely rest and take care of his or her body after the procedure.

What you can do yourself

Brain metastases can have a direct impact on coping with everyday life. For example, many sufferers report symptoms that they can directly perceive, some of which negatively affect everyday life. Unfortunately, there is no way to rid oneself of brain metastases, so close monitoring and medically prescribed therapies, such as chemotherapy, are necessary. However, there are many ways to make everyday life with brain metastases a little easier and safer. Since, as with many illnesses, the psyche and psychological well-being play a major role, it is helpful to have one or more confidants nearby in case problems become unmanageable. Some tasks that were manageable with ease a short time ago now pose unsolvable problems. Physical relief can be provided by measures that strengthen the immune system, which is often heavily burdened by chemotherapy, but these should also be chosen in close consultation with the doctor. Dietary supplements, cures or psychological support are all possible options. If balance problems or attacks of dizziness occur, the affected person should, if possible, no longer leave the house alone, but only with an accompanying person. This person can also provide important help with lifting and carrying, for example shopping. Suitable walking aids provide more safety.