Brain Metastases

Brain metastases develop most often in people with lung cancer, breast cancer, and melanoma, but also with other types of cancer. Brain metastases can be found at the same time as the primary cancer or later.

Brain metastases are usually single spots, but some types of cancer can cause meningitis (swelling of the linings of the brain). This is mostly seen with leukemias, lymphomas, or very advanced forms of other types of cancer. Symptoms of meningitis from cancer can be harder to pick out.  

Symptoms of brain metastases

Symptoms of brain metastases depend on the location, size and number of growths in the brain, or the amount of swelling. Metastases can push on or cause swelling in specific areas causing specific symptoms. Not everyone with a brain metastasis will have symptoms but most do.

The most common symptoms are:

• Headache
• Not being able to move parts of your body, like an arm or leg
• Sleepiness
• Memory problems
• Changes in emotions or how a person acts
• Problems hearing, seeing, or swallowing
• Seizures
• Nausea or vomiting

Treatment of brain metastases

Steroid medicines, such as dexamethasone, are often used to reduce swelling in the brain around the metastases. This can often help with symptoms right away while further treatment is planned.

Anti-seizure medicines may also be used if a patient has had a seizure. This can help prevent more seizures.

Radiation therapy is often used to manage brain metastases and control symptoms. For people with several brain metastases or meningitis from cancer, whole brain radiation can be used. This can help improve symptoms and prevent them from getting worse.

Surgery is also sometimes used to treat brain metastases, especially if there are no more than three spots. For some people, a specialized procedure called stereotactic radiosurgery may be used. Either procedure is most often followed by whole brain radiation therapy for the best results.

Chemotherapy is not usually a treatment for brain metastases because these medicines have a hard time getting into the brain. However, for people with meningitis from cancer, chemotherapy may be injected right into the fluid that surrounds the brain and spinal cord. This can be done during a lumbar puncture (needle into the back) or through a device called an Ommaya reservoir.

An Ommaya reservoir is a dome-like device that is placed under the skin of the head and accessed with a needle. If the patient has an Ommaya reservoir, they can get chemo into the fluid that surrounds the brain and spinal cord without having to get repeated lumbar punctures.

For a few types of cancer, there are new medicines that can get into the brain when given into a vein. Your cancer care team will let you know if this treatment is an option for you.