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Brain Metastasis

Updated : April 30, 2024





Background

Brain metastasis is a common type of the tumor. It effects the 10 to 26 % of the cancer patients. Conventional drug can treat a small percentage of the brain-spreading cancers. As the survival rate increases, the quality of life and neurocognition become key results.

Epidemiology

Brain metastasis is a common type of intracranial cancer. About 98000 to 17000 cases diagnosed in the US every year. The cases are increased because of the new systemic medicines like immunotherapy. These drugs provide long survival time to patients who have systemic metastatic cancer. Precise MRI (magnetic resonance imaging) is used to diagnose the asymptomatic brain metastasis.

Anatomy

Pathophysiology

Metastatic cancer spreads via blood brain barriers. It causes cellular cell proliferation, invasion, displacement, inflammation and edema in affected areas. Distribution across the central nervous system is greater in location with a high flow of blood. Histological groups have different pattern across the brain.

Etiology

Cancers like lung, melanoma and breast are susceptible to brain spread. It makes cranial irradiation. Brain metastases are rare in other types of tumors like head and neck carcinoma and prostate. This makes it difficult to determine that who has progress to cerebral metastases.

Genetics

Prognostic Factors

Several factors affect the prognosis of brain metastases like

  • Age of patient
  • Size and number of metastasis
  • Location of primary tumor
  • Additional metastasis locations
  • Presence of mass effect
  • Radiosensitivity and chemosensitivity of tumor

Clinical History

Age Group: Brain metastasis can occur at any age but specifically above 45 age.

Physical Examination

Neurological assessment: To assess the mental health of patient, function od cranial nerve and sensory, coordination, motor function and reflexes.

Examination of cranial nerves: This can detect the abnormalities like visual field defects, facial weakness or abnormal eye movements.

Fundoscopic examination: A fundoscopic examination of the eyes is performed to assess the signs of papilledema. This can indicate increased intracranial pressure.

Associated comorbidity: Lung cancer, breast cancer, melanoma, colorectal cancer, renal cell carcinoma, and other primary malignancies. Neurological symptoms include are like headaches, seizures, cognitive deficits and behavioral or personality disorders.

Acuity of presentation: Neurological impairments like weakness or numbness in one side of the body, trouble balancing or moving around, changes in vision, trouble speaking, and cognitive abnormalities.

Age group

Associated comorbidity

  • In patients with brain metastases the Lung cancer, breast cancer, melanoma, colorectal cancer, renal cell carcinoma, and other primary malignancies are frequetly seen. 
  • Neurological symptoms foe e.g., headaches, seizures, cognitive deficits and behavioral or personality disorders, can causes the brain metastases. 

Associated activity

Acuity of presentation

  • The neurological impairments, such as weakness or numbness in one side of the body, trouble balancing or moving around, changes in vision, trouble speaking, and cognitive abnormalities are mainly seen in brain metastasis.  
  • This is in the cerebral cortex or close to the surface of the brain as seizures may be present as one of the symptoms. 

Differential Diagnoses

Primary brain tumors: It includes meningiomas and metastatic primary brain tumors. These may are similar to presentation of brain metastasis.

Vascular lesions: This can cause neurological impairment and imaging abnormalities. This may be similar to brain metastasis.

Metabolic or toxic encephalopathy: Metabolic disorders and toxic exposures can cause encephalopathy and neurological symptoms.  This may be similar to brain metastasis.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Surgery: Surgical excision is often suggested for single or oligometastatic brain lesions. This will produce severe neurological symptoms or mass effect.

Radiation therapy: A type of a radiation therapy known as whole brain radiation is used for multiple brain metastasis. It reduces the rate of recurrence in brain.

Systemic therapy: It includes therapies like hormone therapy. It is used to control intracranial and extracranial disease.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Use of non-pharmacological approach for Brain Metastasis

  • Home environment: Make sure home environment of patient is safe, comfortable and accessible. This can improve the quality of life.
  • Symptom management: Management of the symptoms like pain, nausea, fatigue and cognitive changes is necessary.
  • Nutrition and hydration: Make sure patient receive sufficient nutrition and hydration.
  • Physical activity and rehabilitation: Encourage the patient to do some physical activity and be the part of the rehabilitation programs. This can help to gain strength, mobility.

Role of Corticosteroids

  • Dexamethasone: Dexamethasone reduces the vascular permeability , inhibit tumor progression and decrease the CSF production in brain.

Role of Anticonvulsants

  • Valproic Acid: It is an antiepileptic drug. It is used to prevent or control seizures in patients with brain metastasis.

Role of Antineoplastics

  • Ifosfamide: It is an alkylating chemotherapy drug. It is commonly used in the treatment of various solid tumors and hematological malignancies.

Role of immunotherapy drugs

  • Atezolizumab: Atezolizumab is a monoclonal antibody. It targets programmed death-ligand 1 (PD-L1). It is a protein in cancer cells that inhibit the ability of immune system to recognize and attack tumors.
  • Pembrolizumab: It is a monoclonal antibody. It targets programmed death 1 (PD-1). It blocks the PD-1/PD-L1 interaction. It inhibits the ability of immune system to recognize and attack tumors.
  • Nivolumab: Nivolumab is a PD-1 inhibitor. It targets programmed death 1 (PD-1). It blocks the PD-1/PD-L1 interaction. It inhibits the ability of immune system to recognize and attack tumors.

Use of Intervention with a procedure in treating Brain Metastasis

  • Surgical Procedure: The surgical procedure involves craniotomy. In this procedure, a portion of the skull is removed to access the brain. The neurosurgeon carefully identify and remove the metastatic lesion using specialized tools and techniques.

Use of phases in managing Brain Metastasis

  • Diagnosis and Staging: The initial stage involves to diagnose the brain metastasis and stage of the disease. It is used to determine the spread of metastasis in the brain and other organs.
  • Treatment Planning Phase: This stage involves the discuss of the treatment.  Advantage and disadvantages of methods. Factors like type of cancer and the location of brain metastasis.
  • Acute Management: This stage involves treatments like antiepileptic medications, corticosteroids. It reduces cerebral edema.

Medication

Media Gallary

Brain Metastasis

Updated : April 30, 2024




Brain metastasis is a common type of the tumor. It effects the 10 to 26 % of the cancer patients. Conventional drug can treat a small percentage of the brain-spreading cancers. As the survival rate increases, the quality of life and neurocognition become key results.

Brain metastasis is a common type of intracranial cancer. About 98000 to 17000 cases diagnosed in the US every year. The cases are increased because of the new systemic medicines like immunotherapy. These drugs provide long survival time to patients who have systemic metastatic cancer. Precise MRI (magnetic resonance imaging) is used to diagnose the asymptomatic brain metastasis.

Metastatic cancer spreads via blood brain barriers. It causes cellular cell proliferation, invasion, displacement, inflammation and edema in affected areas. Distribution across the central nervous system is greater in location with a high flow of blood. Histological groups have different pattern across the brain.

Cancers like lung, melanoma and breast are susceptible to brain spread. It makes cranial irradiation. Brain metastases are rare in other types of tumors like head and neck carcinoma and prostate. This makes it difficult to determine that who has progress to cerebral metastases.

Several factors affect the prognosis of brain metastases like

  • Age of patient
  • Size and number of metastasis
  • Location of primary tumor
  • Additional metastasis locations
  • Presence of mass effect
  • Radiosensitivity and chemosensitivity of tumor

Age Group: Brain metastasis can occur at any age but specifically above 45 age.

Neurological assessment: To assess the mental health of patient, function od cranial nerve and sensory, coordination, motor function and reflexes.

Examination of cranial nerves: This can detect the abnormalities like visual field defects, facial weakness or abnormal eye movements.

Fundoscopic examination: A fundoscopic examination of the eyes is performed to assess the signs of papilledema. This can indicate increased intracranial pressure.

Associated comorbidity: Lung cancer, breast cancer, melanoma, colorectal cancer, renal cell carcinoma, and other primary malignancies. Neurological symptoms include are like headaches, seizures, cognitive deficits and behavioral or personality disorders.

Acuity of presentation: Neurological impairments like weakness or numbness in one side of the body, trouble balancing or moving around, changes in vision, trouble speaking, and cognitive abnormalities.

  • In patients with brain metastases the Lung cancer, breast cancer, melanoma, colorectal cancer, renal cell carcinoma, and other primary malignancies are frequetly seen. 
  • Neurological symptoms foe e.g., headaches, seizures, cognitive deficits and behavioral or personality disorders, can causes the brain metastases. 
  • The neurological impairments, such as weakness or numbness in one side of the body, trouble balancing or moving around, changes in vision, trouble speaking, and cognitive abnormalities are mainly seen in brain metastasis.  
  • This is in the cerebral cortex or close to the surface of the brain as seizures may be present as one of the symptoms. 

Primary brain tumors: It includes meningiomas and metastatic primary brain tumors. These may are similar to presentation of brain metastasis.

Vascular lesions: This can cause neurological impairment and imaging abnormalities. This may be similar to brain metastasis.

Metabolic or toxic encephalopathy: Metabolic disorders and toxic exposures can cause encephalopathy and neurological symptoms.  This may be similar to brain metastasis.

Surgery: Surgical excision is often suggested for single or oligometastatic brain lesions. This will produce severe neurological symptoms or mass effect.

Radiation therapy: A type of a radiation therapy known as whole brain radiation is used for multiple brain metastasis. It reduces the rate of recurrence in brain.

Systemic therapy: It includes therapies like hormone therapy. It is used to control intracranial and extracranial disease.

  • Home environment: Make sure home environment of patient is safe, comfortable and accessible. This can improve the quality of life.
  • Symptom management: Management of the symptoms like pain, nausea, fatigue and cognitive changes is necessary.
  • Nutrition and hydration: Make sure patient receive sufficient nutrition and hydration.
  • Physical activity and rehabilitation: Encourage the patient to do some physical activity and be the part of the rehabilitation programs. This can help to gain strength, mobility.

  • Dexamethasone: Dexamethasone reduces the vascular permeability , inhibit tumor progression and decrease the CSF production in brain.

  • Valproic Acid: It is an antiepileptic drug. It is used to prevent or control seizures in patients with brain metastasis.

  • Ifosfamide: It is an alkylating chemotherapy drug. It is commonly used in the treatment of various solid tumors and hematological malignancies.

  • Atezolizumab: Atezolizumab is a monoclonal antibody. It targets programmed death-ligand 1 (PD-L1). It is a protein in cancer cells that inhibit the ability of immune system to recognize and attack tumors.
  • Pembrolizumab: It is a monoclonal antibody. It targets programmed death 1 (PD-1). It blocks the PD-1/PD-L1 interaction. It inhibits the ability of immune system to recognize and attack tumors.
  • Nivolumab: Nivolumab is a PD-1 inhibitor. It targets programmed death 1 (PD-1). It blocks the PD-1/PD-L1 interaction. It inhibits the ability of immune system to recognize and attack tumors.

  • Surgical Procedure: The surgical procedure involves craniotomy. In this procedure, a portion of the skull is removed to access the brain. The neurosurgeon carefully identify and remove the metastatic lesion using specialized tools and techniques.

  • Diagnosis and Staging: The initial stage involves to diagnose the brain metastasis and stage of the disease. It is used to determine the spread of metastasis in the brain and other organs.
  • Treatment Planning Phase: This stage involves the discuss of the treatment.  Advantage and disadvantages of methods. Factors like type of cancer and the location of brain metastasis.
  • Acute Management: This stage involves treatments like antiepileptic medications, corticosteroids. It reduces cerebral edema.