Diagnosis
If neurological symptoms occur, the possible presence of brain metastases must usually be considered. An orienting clinical examination provides initial indications of possible neurological deficits. For example, it is examined whether there are signs of cerebral pressure (e.g. a congestive papilla, swelling at the point where the optic nerve exits the eyeball), central paralysis or cranial nerve failure.
During the conversation with the doctor, psychological changes, slower reaction times or disturbances of the experience are noticeable. Since the clinical examination can only make assumptions about the cause of the symptoms, in most cases an imaging diagnosis follows. An MRI of the brain (magnetic resonance imaging) is particularly well suited to visualize brain metastases.
But also a computed tomography computer tomography examination of the head (cCT) or the examination of the cerebrospinal fluid (liquor cerebrospinalis) can be useful under certain circumstances. In principle, the detection of brain metastases requires the identification of the primary tumor that has led to the metastases in the brain. To do this, the entire body is usually examined with the aid of X-rays, ultrasound and imaging procedures (e.g. CT, MRI).
Prognosis
The prognosis for brain metastases is influenced by many factors, which is why it is often not possible to make a general statement about life expectancy. The age of the affected person, the time interval between the occurrence of the primary tumor and the brain metastasis, the number, location and size of the brain metastases and several other factors influence the prognosis. Generally, the overall prognosis for brain metastases is rather poor.
Under certain circumstances, the presence of a brain metastasis can lead to a rapid worsening of the condition up to sudden death, for example, because of bleeding into a brain metastasis. Brain metastases, which are located in the posterior fossa (in the area of the cerebellum or brain stem), can lead to a so-called brain entrapment and thus to death, even with a slight increase in size. The prognosis for brain metastases can be improved by optimal therapy.
Especially an improvement of the quality of life by alleviating the symptoms and complaints is in the foreground of the therapy. An extension of survival is only possible in individual cases by several months up to several years. The course of the symptoms caused by the brain metastases is usually independent of the development of the primary tumor.
Thus, it is possible that despite a well-targeted treatment of the primary tumor, a progression of the symptoms caused by the brain metastases may occur. However, the occurrence of brain metastases is always an indication of a fairly advanced stage of the primary tumor. Often, the brain metastases are then also a life-limiting factor in a disease.
In addition, the symptoms caused by the neurological deficits are often much more stressful than the other concomitant symptoms of cancer. Especially symptoms like seizures or personality changes in an already emotionally stressful time are often very limiting. The poor prognosis of brain metastases is also related to the fact that they can often only be treated very poorly or not at all.
Thus, surgery is often not possible due to the location and number of metastases, or simply not feasible due to the patient’s condition. One of the reasons for surgery isB. the presence of only one individual or a few very large brain metastases and a high chance of being able to treat the underlying disease.
Even with very strong symptoms surgery is more likely to be considered. However, if surgery is not possible, radiotherapy can be used to alleviate the symptoms and prolong the patient’s life, as part of a palliative approach. In this approach, the tumor cells are bombarded with high-energy radiation.
This can partially destroy the tumor tissue or at least inhibit its growth. However, many people find radiotherapy very unpleasant and stressful. Moreover, not all tumor tissues respond to radiation.
Therefore, one must ask oneself individually to what extent this treatment is worth this short extra time of life. Some symptoms, such as seizures, can be at least somewhat alleviated by medication, even without radiation. The administration of cortisone preparations also helps at least to alleviate the symptoms due to their decongestant effect. In some cases, chemotherapy can also be promising. Especially in the case of testicular cancer, a cure can still be achieved in some cases despite existing brain metastases.