Brain metastases

Diagnosis

The tests and procedures for brain metastases diagnosis include:

• Neurological assessment. A neurological assessment may include many procedures such as checking one’s vision, hearing, balance, coordination, strength or reflexes. Any abnormality in one of these functions might determine which area of the brain is invaded by the brain tumor.
• Imaging tests. This approach mostly uses Magnetic Resonance Imaging (MRI), where a dye is injected into a vein to detect brain metastases. There are many specialized MRI scans which make tumor evaluation and treatment planning more effective, such as functional MRI, perfusion MRI and magnetic resonance spectroscopy.
  A doctor might use other imaging tests for the diagnosis, such as Positron Emission Tomography (PET) or Computerized Tomography (CT) scan.
• Biopsy. It is a process of collecting and testing a sample of abnormal tissue, which is performed using a needle or during a surgery to remove a brain tumor. The doctor uses biopsy to diagnose and plan the treatment by viewing the biopsy sample under a microscope. This helps the doctor to see if the disease is malignant or benign and determine if it is metastatic or from a primary tumor.

Treatment

Brain metastasis treatment may alleviate symptoms, reduce tumor growth and increase life expectancy. Brain metastasis can be recurrent even after successful treatment, close follow up with your doctor are recommended after treatment.

Treatment options include medication, surgery, stereotactic radiosurgery, whole-brain radiation therapy and a combination of these. Drug treatments are sometimes also recommended.

The doctor will choose the best treatment method based on the tumor’s type, size, number and area, as well as your signs and symptoms, general health, and treatment choice.

Medications

Signs and symptoms of brain metastases can be managed with medications such as:

• Steroids. Certain drugs such as high-dose corticosteroids alleviate swelling around the brain metastases and control the symptoms.
• Anti-seizures. Medicine is sometimes recommended for patients with seizures to prevent them from recurring.

Surgery

In surgery, a surgeon strives to remove most of the brain metastases to reduce signs and symptoms. Surgery is recommended for metastases that are located in places accessible for an operation.

Radiation therapy

In radiation therapy, powerful energy beams such as X-rays and protons, are used to destroy tumor cells.
Brain metastases treatment may involve one or both of the following radiation therapy methods:

• Whole-brain radiation. Whole-brain radiation uses radiation to kill tumor cells throughout the brain. In most cases, this method of radiation is required to be performed 10 – 15 times over a period of 2 – 3 weeks.

Fatigue, nausea and hair loss are among possible side effects. Radiation for a long time can cause cognitive problems.

• Stereotactic radiosurgery (SRS). Stereotactic Radiosurgery uses non-powerful radiation beams target directly at the brain tumor. The brain tumor receives a very large dose of radiation and destroyed. SRS is usually a one-time treatment, which can also treat multiple tumors in one session. Nausea, headache, seizures and dizziness or vertigo are among the common side effects. Long-term SRS treatment poses a lower risk of developing a cognitive decline than whole-brain radiation.

There have lately been progresses in the understanding of whole-brain radiation and stereotactic radiosurgery, as well as their effect on the chance of surviving, cognitive function and life of quality. Various factors are taken into account to decide the best type of radiation therapy for each patient, these include other treatments the patient is undergoing and the risk of the cancer to recur after treatment.

Medications

In some cases, medications might be recommended to control brain metastases. The cancer’s original location and other individual factors determine how effective medication treatment will be. Options include:

• Chemotherapy. Utilizes medications to destroy fast-growing cells as well as cancer cells.
• Targeted therapy. Targeted drug treatments help block specific abnormalities and kill cancer cells.
• Immunotherapy. Immunotherapy uses and provokes one’s own disease-fighting immune system to fight cancer. Cancer cells produce proteins that shields them from being recognized by the body’s immune system as a threat, immunotherapy breaks this shield.

Rehabilitation after treatment

In case brain tumors affect motor skills, speech, vision or thinking, the doctor may recommend rehabilitation to help in recovery. Rehabilitation includes:

• Physical therapy: helps recover motor skills or regain muscle strength.
• Occupational therapy: allows patients to be able to perform everyday tasks again.
• Speech therapy: speech pathologists perform speech therapy to treat speech difficulties.