Lung Cancer Metastasis to the Brain: Symptoms, Diagnosis, Treatment, and Prognosis

Lung cancer is one of the cancers most likely to spread to the brain. Roughly 25 percent of people with lung cancer have brain metastases at their initial diagnosis, and as many as 50 percent will eventually develop brain tumors over the course of the lung disease, according to the American Lung Association. And because non-small cell lung cancer (NSCLC) is the most common type of lung cancer, people with NSCLC have an elevated risk of brain metastases, according to a review .e60dc2a1-f33c-4a05-9b50-8e3e8e597629501340a2-0c51-4fdd-86ff-1727e8eeaec3e60dc2a1-f33c-4a05-9b50-8e3e8e597629b9c8dd03-1acc-412e-8eb8-9c37ed83af21 Brain cancer originates in the brain and consists of brain cancer cells. But brain metastases from lung cancer occur when cancer cells break off from the tumor in the lungs and enter the bloodstream or travel through the lymph system to the brain, where they multiply.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298688950e-934c-4777-b0b8-10e819ed75ce While metastatic lung cancer can rarely be cured, improvements in the detection and treatment of brain metastases are allowing people to live longer, with a higher quality of life. Standard treatments, such as surgery and radiation, for brain metastases have gotten better and more precise. And the last few years have also brought newer, systemic therapies that can target these brain tumors in many people. Recognizing the Signs of Brain Metastases As metastatic brain tumors grow, they can directly damage cells or affect the brain indirectly by compressing parts of it or causing swelling and increased pressure within the skull. Early warning signs can be subtle and easily attributed to other causes, including chemotherapy, says Jonathan Goldman, MD , a clinical instructor of hematology and oncology at UCLA Health Jonsson Comprehensive Cancer Center in Los Angeles. Symptoms vary by where the metastases are in the brain but often include: Headaches Fatigue Nausea or vomiting Seizures Blurred vision Balance problems Loss of sensation or weakness along one side of the body Difficulty walking Loss of coordination (such as reaching for a door handle and missing) Speech problems Cognitive problems or memory loss Personality or behavior changes If you consistently experience any of these symptoms, it’s important to alert your cancer care team as soon as possible. To diagnose brain metastases, your doctor will most likely perform a neurological exam (which may include checking your vision, hearing, balance, coordination, strength, and reflexes) and order a magnetic resonance imaging ( MRI ) scan of your head. An MRI can not only detect cancer but also precisely identify the location and size of each brain lesion. Other imaging tests your doctor may use include positron-emission tomography (PET) and computed tomography (CT) scans. A biopsy may also be done to confirm a diagnosis and help determine the best course of treatment. Brain tumor tissue is removed either as part of surgery to remove the tumor or during a procedure in which a small sample is taken with a needle. The tissue is then viewed under a microscope to determine whether it’s cancerous. If it is, the biopsy can also determine if it’s a primary or metastatic tumor.e60dc2a1-f33c-4a05-9b50-8e3e8e597629303b7c51-0b1d-4b11-b038-6231b6f020ac
How Brain Metastases From Lung Cancer Are Treated If diagnosed and treated early, brain metastases usually respond to therapy. Your treatment plan will depend on your tumors (size, number, location in the brain, and genetic characteristics); the extent of disease outside the brain; and your overall health. Treatment may include: Surgery Surgery may be an option for people with only one or two brain metastases that are easy to access and remove. It may also work for people who have a larger tumor that’s causing compressive symptoms, and removing even a portion of the tumor may help alleviate symptoms. According to a review, surgery is commonly followed by radiation therapy. Radiation This therapy uses X-rays or other high-energy beams to kill cancer cells. Different methods of radiation are used to treat brain metastases. People who have smaller brain tumors or tumors that are not surgically accessible or are too advanced for neurosurgery may be good candidates for stereotactic radiosurgery, in which MRIs, CT scans, and computer guidance are used to deliver large doses of radiation directly to tumors.e60dc2a1-f33c-4a05-9b50-8e3e8e597629efade8c0-7cf7-4758-85de-e2a23aa4366f “This approach can effectively treat metastases with little radiation exposure to other parts of the brain and with minimal side effects,” says Dr. Goldman. If you have many tumors throughout your brain or a large tumor deep in the brain, your doctor may recommend whole-brain radiation, in which radiation is applied to the entire brain to kill tumor cells.e60dc2a1-f33c-4a05-9b50-8e3e8e59762918fa636a-12d1-4d48-8bf0-66f5b0a6fc09 “This method,” Goldman explains, “treats the whole area but, unfortunately, comes with more side effects, such as headache, fatigue, nausea, hair loss, and some slowed cognition.” Systemic Therapy With systemic therapies, including chemotherapy , immunotherapy, and targeted therapy, drugs travel through the bloodstream to reach cancer cells throughout the body. Because many chemotherapy drugs are unable to cross the blood-brain barrier — a network of capillaries that keeps certain substances from reaching the brain — targeted therapy is the primary form used to treat brain metastases, according to a journal article .e60dc2a1-f33c-4a05-9b50-8e3e8e5976296fb5ec67-3f76-464b-89c3-dfa5eeb9d941 Targeted therapies can identify and attack specific cancer cells with minimal harm to normal cells. For people with lung cancer cells that have specific mutations (such as EGFR and ALK), these therapies can be highly effective. But if your lung cancer doesn’t carry these specific mutations or has spread elsewhere in the body , your doctor may consider other systemic therapies, such as immunotherapy (which uses medicine to activate your own immune system to recognize and kill cancer cells) or chemotherapy. Palliative Care This type of specialized medical care can include pain management, mental health counseling, spiritual support, and stress management techniques. It’s a key component of treatment for patients with metastatic NSCLC.e60dc2a1-f33c-4a05-9b50-8e3e8e597629560d6651-88e6-483d-8dc2-ab873deb7d4a Palliative care can help mitigate the side effects of both the cancer and its treatment and significantly improve quality of life. Information and support are available for people with lung cancer and their families at Go2 for Lung Cancer , the American Cancer Society , and the Global Resource for Advancing Cancer Education (GRACE) . Looking Ahead: After Brain Metastases Treatment After radiation, surgery, or systemic treatment for brain metastases, your doctor will most likely order an MRI to determine how much of the tumor is gone and then follow up with MRIs every few months. The prognosis for people with NSCLC that’s metastasized to the brain is highly variable, so it’s important to keep in mind that statistics don’t necessarily pertain to your situation. While the outlook was traditionally poor for people with NSCLC and brain metastases, advancements in treatment are continually improving survival rates. Clinical trials are regularly being conducted to find ways to improve treatment for people with NSCLC that’s metastasized to the brain. Ask your doctor whether you may be a candidate for such a trial. You can also search for a clinical trial in your area at ClinicalTrials.gov . “Brain metastasis has traditionally been an area that was difficult to study,” Goldman says. “But, thankfully, more and more studies are focused on exactly this problem.” Additional reporting by Erica Patino .



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