Brain metastases

What are brain metastases?

Metastases, also called metastatic tumours, are tumours that have spread from the place in the body where they originally started to another part.

Brain metastases are tumours which have spread to the brain from a different part of the body.

How does this happen? The tumour cells can sometimes break away from the main tumour, and travel around the body in the bloodstream helping them to do this.

Tumour cells from particular types of tumours located in the lung, breast, colon, kidney and a type of skin cancer called ‘melanoma’ can do this.

It is very rare for a tumour that has originated in the brain to spread anywhere outside of the central nervous system.

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How are brain metastases diagnosed?

If you’ve been diagnosed with a tumour that’s at risk of spreading, doctors sometimes organise scans to look at areas of your body where the tumour could spread to. This could include your brain.

Or, sometimes you might have signs that show the tumour could have spread to your brain. These signs could be seizures or weakness of a particular part of your body.

If experts see something on your brain scan that could be a brain tumour, your multi-disciplinary team will meet and decide what the next steps should be. This team could include neurosurgeons, radiologists, neuropathologists, specialist nurses and oncologists,

This team will also talk about next steps with you and your family.

They might decide to do a biopsy, where a small piece of the abnormal tissue is taken for tests. Or they might want to operate to remove the area of concern.

The team must carefully balance the risks and benefits of each option.

If a tissue sample is available, the neuropathologist will be able to look at it under a microscope and do different tests (including molecular/genetic tests). These tests are to find out if the sample is the same as the original tumour.

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How are brain metastases treated?

If brain metastases (mets) are suspected on a brain scan, then the oncologist will take this into consideration when planning treatment.

Treatment options for brain mets depend on size, number, symptoms and your overall health.

Your team could use a combination of treatments. Some might be to control the cancer and others to manage your symptoms. These treatments could include surgery, radiotherapy and medication.

Surgery

Surgery can be offered as a treatment for brain mets depending on their size and location. Doctors usually prefer surgery for larger metastases or if there is a lot of swelling. But, they’ll think about your fitness and treatment options and will work with an oncologist to be sure it’s the right choice for you.

Radiotherapy

High energy x-rays can be given as a course of external radiotherapy to help control the growth of the cancer cells and symptoms. This is usually offered as one treatment a day Monday – Friday, for 1 to 2 weeks, with weekends to rest and allow the healthy cells to recover.

Radiotherapy is usually managed by the treating cancer team. For several areas of brain mets, you may be offered whole brain radiotherapy. This might happen more or less often.

Stereotactic radiotherapy could also be offered. This is a targeted treatment that can be used for one or two smaller areas of brain mets. You might also be offered stereotactic radiosurgery, where the full dose is given in one treatment rather than split up in smaller treatments over multiple days.

Radiotherapy might take a few days or weeks to work. It can cause swelling at first which may make your symptoms feel worse. You will usually be prescribed steroids during radiotherapy to help with this.

Medication

You might also be offered medication which will depend on where your cancer began and your individual situation. Options could include:

• Chemotherapy – kills fast-growing cells in the body which includes cancer cells.
• Targeted therapy drugs – these focus on blocking specific abnormalities present with cancer cells, causing them to die.
• Immunotherapy – helps your immune system recognise and attack the cancer cells.
• Hormone therapy – lowers the levels of hormones that the cancer cells need to survive.
• Anti-epileptics – helps to prevent seizures (fits), which are a sudden burst of electrical activity in the brain.
• Steroids – help to control swelling to hopefully improve your symptoms.

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How can brain mets affect my everyday life?

Dealing with physical and cognitive difficulties

Brain tumours can develop in parts of the brain that control motor skills, speech, vision and thinking.

So, if you’re affected by any difficulties in these areas, you might find rehabilitation useful. Physiotherapy might help you to regain motor or muscle skills, occupational therapy might help you get back to your normal daily activates and speech therapy might improve speech difficulties.

Brain metastases and driving

Brain tumours can also cause seizures and sight issues, which can make driving dangerous. If you are diagnosed with a brain tumour, you must tell the Driver & Vehicle Licensing Agency (DVLA) or if you live in Northern Ireland, the Driver & Vehicle Agency (DVA). Your medical team will assess your fitness to drive and you might have to give up your license for some time.

Dealing with the emotional aspects of your diagnosis

There can often be a lot to adjust to which can feel overwhelming and difficult to process. You may find talking therapies useful.

You can also connect with your supportive (palliative) care team.

Palliative care is often misunderstood as only being offered when there is no curative treatment option left, but it can be given alongside your standard treatment, at any point after your diagnosis.

The service focuses on providing relief from your symptoms and what matters most to you by addressing any emotional, social, practical and spiritual needs.

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