Brain Metastases

Brain metastases are secondary tumours that spread to the brain from another location in the body. They are the most common cause of intracranial mass lesions, and nearly half of all cancer patients eventually develop brain metastases during the course of their illness.One can distinguish between solitary, singulary and multiple metastases.

 

solitary: single metastasis, no others in rest of the body

singulary: single metastasis in brain, futher ones in other organs

multiple: several metastases in central nervous system

 

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Distribution of Brain Metastases in Metastases from

  • 40-60% bronchial carcinoma (lung cancer)
  • 15-20% mamma carcinoma (breast cancer)
  • 10-15% malignant melanoma (pigmented skin cancer)
  • 10-20% primary tumour unknown, 5% remain unknown
  • 5%  gastrointestinal carcinoma (digestive tract)
  • 5% renal cell carcinoma

 

Development of Brain Metastases from

 

  • 45% of malignant melanoma (pigmented skin cancer)
  • 45% of small-cell bronchial carcinoma (lung cancer)
  • 30% of non-small-cell bronchial carcinoma (lung cancer)
  • 20% of mamma carcinoma (breast cancer)
  • 20% of renal cell carcinoma
  • 8% of gastrointestinal carcinoma (digestive tract)
  • 6% of tumours of urinary tract/ bladder
  • 2% of prostate carcinoma

 

Symptoms of Brain Metastases

 

  • depending on localisation
  • 50% headache
  • 50% neurological deficits
  • 30% organic brain syndrome
  • 15-20% epileptic seizure
  • further signs of intracranial pressure (nausea, emesis, fatigue)  

 

Diagnosing Brain Metastases 

 

  • with CT or MRI with contrast agent
  • if primary tumour is unknown, biopsy to determine tissue
  • if necessary liquor examination
  • annular contrast agent enhancement
  • edema
  • often hemorrhages
  • main localisation: mainly in cerebrum, less often in cerebellum and brain stem

 

Therapy of Brain Metastases

 

  • depending on quantity, localisation and size of metastases and the primary tumour
  • surgery
  • radiation of the entire head
  • stereotactic radiosurgery
  • chemotherapy

 

Therapy of Recurrent Brain Metastases

 

  • requires individual decision
  • renewed surgery of brain metastases
  • second irradiation
  • chemotherapy

 

Aftercare of Brain Metastatses

 

  • check-ups every three months (CT and/or MRI)
  • completely oncological aftercare

 

Course of Brain Metastases

 

  • strong tendency to recurrence 
  • rarely local resolution

 

Prognosis of Brain Metastatses 

 

  • depending on course of underlying disease
  • metastases show progression of cancer
  • without treatment median survival of few weeks
  • bad prognosis despite therapy
  • positive prognostic factors: age, controlled primary tumour and no extracranial metastases

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