Brain Metastases – Diagnosis and Treatment
Diagnosis
Doctors use several tests and exams to check for brain metastases or a metastatic brain tumor.
A neurological exam can spot changes in speech, vision, balance, reflexes, and muscle strength, helping to detect symptoms like headaches, seizures, or visual problems.
Imaging tests help locate and size the brain tumor. Magnetic resonance imaging (MRI) serves as the main tool. Sometimes, a contrast dye makes tumors clearer on the scan.
Doctors may also use other tests like computed tomography (CT) or PET scans. Doctors may perform a biopsy to confirm cancer cells in brain tissue.
They usually use a needle or conduct this during surgery. These steps help determine if the tumor is secondary (from cancers like lung cancer or breast cancer) or a primary brain tumor.
Treatment
Medications to Help with Symptoms
Doctors often prescribe medicines to manage problems caused by a brain tumor. Steroids lower swelling inside the brain, decreasing headaches or other pressures.
Anti-seizure medication helps stop or prevent seizures, especially if a tumor affects certain brain areas. Doctors choose the type and strength of these medicines based on each person’s needs and symptoms.
| Medication Type | Primary Purpose | Possible Effects |
|---|---|---|
| Steroids | Lower brain swelling | Improved comfort |
| Anti-seizure meds | Prevent or control seizures | Fewer seizure episodes |
Note: Medications to control symptoms do not treat the tumor itself but are important for making daily life easier.
Surgical Approaches
Surgeons often operate when a tumor is in a location they can reach safely. During the procedure, they remove as much of the tumor as possible.
Surgery can quickly decrease symptoms by lowering pressure or taking out a mass that causes severe problems. Neurosurgeons often collect tissue samples during surgery to confirm the tumor type.
Sometimes, doctors combine surgery with other treatments to improve outcomes. Risks include trouble with movement, talking, memory, numbness, weakness, infection, or bleeding.
The surgical team considers the tumor’s size, position, patient’s overall health, and treatment plan before making decisions.
Common surgical methods include:
- Craniotomy: Surgeons open the skull to reach and remove the tumor.
- MRI-Guided Surgery: Surgeons use detailed scanning to guide precise removal.
Targeted Radiation Treatments
Doctors use radiation treatment to direct strong energy at the tumor and kill cancer cells. They may use different types of energy, such as X-rays or protons, to focus treatment on the tumor and limit damage to healthy brain tissue.
Main types of radiation therapy:
| Radiation Method | Treatment Area | Usual Duration | Side Effects |
|---|---|---|---|
| Whole-brain radiation | Entire brain | 2-3 weeks | Tiredness, headache, memory loss |
| Stereotactic radiosurgery | Selected spots | 1-5 days | Headache, nausea, rare memory issues |
- Whole-Brain Radiation: This method treats the entire brain to attack all possible tumor spots. It often lasts from two to three weeks, with several treatments each week. Some people experience side effects like tiredness, hair loss, headaches, and in some cases, problems with memory, thinking, or skin changes.
- Stereotactic Radiosurgery (SRS): This approach uses focused beams from many directions, targeting one or a few small tumors. Most of the time, this needs only one or a few treatments. SRS helps avoid side effects that can happen with whole-brain radiation, but can still cause headaches, dizziness, or rare seizures.
Medicines to Target Tumor Cells
Doctors may prescribe drugs that target the cancer directly:
| Drug Type | How It Works | When Used |
|---|---|---|
| Chemotherapy | Kills fast-growing cells | For certain tumor types |
| Targeted therapy | Blocks specific cell signals | When tumor has right signals |
| Immunotherapy | Boosts immune response to cancer | For some eligible patients |
- Chemotherapy: This uses strong chemicals that move through the body (often by IV or sometimes as pills) to kill cancer cells. Types of chemotherapy vary by the cancer’s source and type.
- Targeted Therapy: These newer treatments attack specific parts of the cancer cells. For example, if a certain protein helps the tumor grow, targeted drugs will block it. This approach often causes fewer side effects than usual chemotherapy.
- Immunotherapy: This kind of drug helps the body’s own immune system seek out and destroy cancer cells. It works best for some types of cancer and can help the immune system notice and attack tumors that normally hide.
Support and Therapy After Medical Treatment
Brain tumors can cause problems with movement, speech, vision, and memory, even after treatments end. Recovery programs help address these issues.
- Physical therapy helps people regain strength and improve movement and balance.
- Occupational therapy assists with relearning daily tasks, including personal care or returning to work or school.
- Speech therapy supports people with speaking or swallowing issues.
- Cognitive therapy may help with memory loss, focusing, or mood changes that happen from brain disease or treatment.
Specialist teams often provide these rehabilitation therapies to help people return to their usual roles as much as possible.
Comfort and Supportive Care
Supportive care, or palliative care, focuses on helping people feel better and manage symptoms rather than treating the cancer itself. This might include relief from pain, sickness, or stress from illness.
A team of doctors, nurses, social workers, and other comfort care experts works together to provide supportive care.
Patients can begin supportive care at any time, even while receiving other treatments. The main goal is to offer a better quality of life for both patients and their families during the entire cancer journey.
Ways to Manage and Find Support
Adjusting after a diagnosis of brain metastases can be difficult. Patients and families often face new challenges, including changes to everyday routines, concerns about quality of life, and questions about survival.
Support and information can help people feel more prepared and hopeful as they move through treatment and follow-up care.
Key strategies that may help include:
- Seeking accurate information. Ask health professionals for up-to-date information about types of brain metastases, expected outcomes, and treatment plans. Knowing what to expect can reduce anxiety and help with decision-making.
- Being aware of life changes. Brain metastases and their treatment may affect the ability to drive or perform certain tasks. Discuss these changes openly with the care team. They can assess neurological health, reflexes, and safety, especially regarding driving.
- Talking about emotions. Coping is not just physical—it is also emotional. Expressing worries, sadness, or fears with trusted friends, therapists, or support groups can ease stress. Activities like journaling or talking with others in similar situations can help people feel less alone.
- Discussing quality of life and future care. For some, treatment may not lead to a cure. It is important to discuss what is important for comfort, dignity, and symptom relief. End-of-life planning and hospice care are available to support patients and families in these circumstances.
Getting Ready for Your Visit
Steps to Prepare Before Your Appointment
Taking some time to get organized before a medical visit can help patients feel more confident and prepared.
Here are smart steps to take:
- Check for any special instructions. Ask if you need to change what you eat or drink, or if there are other rules to follow before your visit.
- Record all symptoms. List every symptom you have, even if it seems minor or unrelated. Note when the symptoms started, how often they happen, and if anything makes them better or worse.
- Write down important health details. Include any history of cancer, major stresses, or recent life events.
- Keep a medication log. Make a list of all medicines, vitamins, and supplements you take, along with the dosages.
- Bring support. Ask a close friend or family member to come with you, if possible. They can help remember information and offer support.
- Create a list of questions. Preparing questions ahead of time can help you get the answers you need and use your appointment time well.
Common questions to consider asking:
| Example Question |
|---|
| What could be causing what I’m feeling? |
| What tests will I need, such as MRI, CT scan, or lumbar puncture? |
| Which treatments do you suggest, and what are their side effects? |
| How might treatment affect my day-to-day routine? |
| How long will treatments like radiation or surgery take? |
| Are there experimental or trial treatments I can try? |
| How will my other health problems change my treatment plan? |
If tests such as a spinal tap (lumbar puncture) are mentioned, ask what they involve and if you should do anything to get ready. This can help reduce anxiety and avoid surprises on the day of the test.
Questions the Healthcare Provider May Ask
It helps to be ready for the types of questions a medical professional may ask. Some of the most common include:
- When did the symptoms begin?
- Do the symptoms remain the same or come and go?
- How strong or severe are the symptoms?
- What seems to help make the symptoms less noticeable?
- Does anything make the symptoms worse?
Other details a doctor may request:
- Your history of past illnesses or cancer treatments, even ones from many years ago.
- Information about any family history of brain injuries or nervous system diseases.
- Details about medical tests you have already done.
