23B. Nervous system metastases
Brain metastases are the most common form of adult brain tumour, and they occur in approx. 30% of people with cancer. In 70% of cases there are multiple brain metastases rather than single ones. The development of brain metastasis considerably worsens the patient’s condition and prognosis. Brain metastases is rare in paediatric cancers.
Etiology
- Lung cancer (most common)
- Breast cancer
- Melanoma
- Lymphoma
Clinical features
The symptoms are as for other brain tumours.
Diagnosis and evaluation
Contrast-enhanced MRi is the gold standard. Metastases are usually multifocal and have large perifocal oedema. Biopsy is performed in most cases.
Treatment
Steroids can be used to reduce the oedema, and antiepileptic medication may be required in case of seizures.
Radiosurgery (gamma knife) can be used with curative intent if there are few lesions. Otherwise, whole brain radiation therapy is usually used to prolong survival. If the primary tumour is chemosensitive, chemotherapy may cure the brain metastases as well.
Other metastases
Meningeal carcinomatosis/leptomeningeal carcinomatosis refers to metastasis to the meninges from any carcinoid tumour, but most commonly from breast or lung cancer, or melanoma. This usually results in cranial nerve symptoms, but can cause any symptom of CNS tumour. Tumour cells are present in the CSF and confirms the diagnosis.
Metastases to the vertebral column can compress the spinal cord and cause back pain or lumboischialgia. The primary tumour may be any thoracic or abdominal cancer, most commonly prostate, lung, or breast.