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Brain Mets Symptoms (updated 2/20/06)

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Monday, February 20, 2006 · Last updated 7:22 p.m. PT Doctors want to find spreading cancer By LAURAN NEERGAARD
AP MEDICAL WRITER WASHINGTON -- No one ever checked whether Leslie Bather's breast cancer was spreading to her brain, until the day tumors caused three frightening seizures. MRI scans can help spot when cancer in another part of the body sends seedlings into the brain, but few patients get routine checks. Neurology specialists say it's time to change that: More patients are surviving initial tumors long enough for their brains to be at risk, as treatments get better at battling cancer below the neck yet fail to protect the brain. And improved technology is making it easier and safer to treat those new brain tumors, if they're caught early. "If I were diagnosed with cancer tomorrow, the first thing I'd want is a brain scan," says Dr. Leonard Cerullo, director of the Chicago Institute of Neurosurgery and Neuroresearch. This type of brain cancer "is becoming a bigger and bigger clinical problem," adds Dr. Frank Lieberman, neuro-oncology chief at the University of Pittsburgh Cancer Cancer. Already, about 150,000 Americans a year are diagnosed with what is called a "metastatic brain tumor" - cancer that spread into the brain from some other part of the body. Any cancer can spread to the brain. But lung cancer is the leader; it will happen in up to 40 percent of lung cancer patients, often very early in their disease. Up to a third of breast cancer patients will experience a brain metastasis. Also common spreaders are melanoma and kidney and colon cancer. Not too many years ago, doctors mostly discovered metastatic brain cancer when its victims already were close to dying from tumors riddling other parts of their bodies. Now, breast specialists in particular are reporting an increasing number of women who beat back cancer elsewhere in the body, only to have it flare in the brain. It seems to be a special concern among users of Herceptin, a powerful drug that targets an aggressive type of breast cancer - everywhere except in the brain, because it's too large a molecule to penetrate the blood-brain barrier, explains Lieberman. But it's a more widespread concern. While the American Cancer Society doesn't yet have a count of the reported increase, it notes that cancer patients overall are living longer, providing more time for microscopic tumor cells incubating in the brain to take root. Scientists are beginning to fight back: -Studies are under way to see if an experimental drug called lapatinib, made by GlaxoSmithKline, can treat breast cancer that spreads to the brain. Lapatinib targets the same aggressive breast cancer as Herceptin does but is thought to easily penetrate the brain. -Also under study is whether some commonly used cancer drugs could ever cross into the brain, especially if used in conjunction with brain radiation. -And neurology specialists are urging general oncologists to start checking patients, especially those with lung or breast cancer, for spread to the brain well before symptoms appear. There are no formal guidelines, but at Pittsburgh, MRI scans - not CT scans that Lieberman calls less sensitive in the brain - are being incorporated shortly after original diagnosis. After that initial scan, Chicago's Cerullo advises including the brain in any routine check for cancer spread. He says insurance generally pays. High doses of whole-brain radiation once were the only treatment for metastatic brain cancer, and could cause such troubling side effects as memory loss, Cerullo says. Now, treatment is more sophisticated, especially for tumors caught early. Topping the list: radiosurgery, using focused beams of radiation to zap just the cancerous cells and not surrounding healthy brain tissue. Whole-brain radiation today comes in safer doses with fewer side effects, but when to use it is controversial. Some studies suggest a preventive course could protect certain lung cancer patients, for example. Lieberman and Cerullo advise patients to ask about a brain scan. It's advice that Bather, the Chicago patient, echoes. She calls her 2004 seizures "definitely divine intervention" because only then did she get a brain scan - even though tests that same week had found breast cancer spreading in her lungs and liver. "You want to think you're OK," says Bather, 52, whose brain seems clear after treatment of more than 40 tumor sites, but she still is battling cancer elsewhere. Instead, "what you don't know can hurt you." --- EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

*****My brain cancer is GONE! I had a brain, MRI this week and three of the four lesions do not light up anymore and the 4th one lights up a tiny bit but the report said that it is probably scar tissue formation. I was told the lesions would never go away but that 
they can be controlled. So basically, they are dead!" I know and she knows that this doesn't mean they can't come back - but isn't it great? Just thought I'd share... (from a BCMETSTER)*****

My sister was first diagnosed with brain mets in May 2005. She did not have typical symptoms so it was not caught until she had a spread to her lymph nodes and her whole body was scanned. She had developed significant short term memory loss (which despite radiation treatments that eliminated most of the mets has not eased.) The Drs believed the memory loss was stress related and it took them some time to believe that it was mets related. More subtle things included personality changes i.e. poor grooming habits, growing irrationality. She thankfully has not had any physical symptoms such as headaches or seizures. She now has leptomeningeal mets which were found via MRI but have not caused her any symptoms as yet. Carmen in Aurora, On, Canada

Headaches began to increase about 5 months ago. Finally told the oncologist. My vision (especially the left eye) has grown worse since chemo in 97; however, I'm progressively losing vision in the left eye. Denial has kept me from the ophthalmologist. I have drusen in both eyes. Mild double vision in the left eye, and slight shadows appearing in the right eye. My vertigo has not been the best post-chemo, and most recently my balance stinks. I can be standing still and suddenly sway losing my footing. Nausea is common, I've taken meclizine for years PRN. Haven't really told the onc. doc. about the dizziness and balance problem growing more constant of late. Had 1st MRI of the brain Feb. 02'. At first the radiologist thought I may have multiple sclerosis,(from Susan A.:if you view both mets and ms lesions on films, they look a lot alike), vascular ischemia, et al. Saw a neurologist. Neurologist sent me for 2nd brain MRI, after doing a piss-poor neurological evaluation (in my opinion). 2nd MRI shows Mild High Left-Greater-Than-Right Increased T2 weighted signal within the pons. At this appt. the neuro doc tells me I have a brain lesion. He's running late, and must go. I ask, "and what does this mean?", and his reply is he doesn't know. Says it doesn't mean brain mets necessarily. Says to call him if I have any symptoms (!)... like what? He says, "You'll know". o.k., I think... Tells me I'll need a 3rd MRI in June and to come see him again June 14th. I have the next MRI scheduled for May 24th. I'll hand-carry the films to him 6/14. My onc. doc is running bloodwork every 6 weeks. (This makes me nervous, but he tells me everything looks good.) I'm trusting him (them). I don't know what questions to ask as far as the CA tests go. He told me what he ran, but I don't recall if it was 15-3 or another type. What do I need to ask? and what are the markers about? My symptoms seem to be mildly increasing, but then it could be all in my head (tee hee... ok... I've got to lighten up here a little or I'll go nuts!) i just posted that my eye 
doctor (after being pressed on it) told me that behind the eye 
twitching, "caused by stress, irregular sleep, lack of exersize, too 
much caffeine" was actually an increase in adrenalin---i.e. all those 
things can cause an increase in adrenalin--and i'm guessing some of our 
treatments do as well. i think this is helpful information in terms of 
how to view and treat symptoms.

getting brain MRIs every 3 months, and having had 4 
brain mets diagnosed in the last year (when prior brain MRI showed 
nothing), is that these suckers can grow mighty quickly, and that above 
2cm (which in my case developed within 6 months, from no detectable 
lesions), stereotactic radiation isn't considered a good option, and brain 
surgery (craniotomy) is indicated. BTDT...not fun. If your insurance 
permits, I'd ask for a second opinion if I were in your shoes - maybe at 
Stanford? where they have CyberKnife (state of the art stereotactic 
radiation equipment) available. *********************


My sister was first diagnosed with brain mets in May
2005. She did not have typical symptoms so it was not caught until she had a spread to her lymph nodes and her whole body was scanned.
She had developed significant short term memory loss
(which despite radiation treatments that eliminated
most of the mets has not eased.) The Drs believed the
memory loss was stress related and it took them some
time to believe that it was mets related. More subtle
things included personality changes i.e. poor
grooming habits, growing irrationality.
She thankfully has not had any physical symptoms such
as headaches or seizures.
Carmen


From: Midge 
I had severe pain in the base of my skull, my neck and head on one side, which increased over the months, but my onc felt that since I had responded to other chemo so well and the research seemed to support only doing these brain MRI's when some symptoms present themselves. The onc seemed to feel it was a waste of time, until I insisted, because I was suffering so much. Sure enough, I had brain mets, even though I SO hoped I didn't, and had 4 tumors, 2 2cm. and 2 1cm, and
considerable edema/swelling of the brain. So why
didn't they think my symptoms were reflective of
possible brain mets? I still don't understand, and it
took me several months to convince them to please do
the MRI. we have to be as assertive as possible about things when our gut tells us to. And what can it hurt for them to do a routine check, if our insurance doesn't hassle us about it?Like I said, they also need to ?examine what would constitute the symptoms that would set them on the trail, since mine didn't start to effect my vision until the actual day I had the MRI. The intense pain
WAS the symptomology!
 
 My 2.9x3.6cm cerebellum bcmets brain tumor was
dx'd by MRI in  March 2005, about 10 months
after my previous, "clear" brain MRI  -
equilibrium problems,  which I tried  to ignore at first. Continuously & increasingly, I could not
sustain my balance with my weight on one leg (and I awoke & found myself staggering to the
bathroom,  balancing myself by putting a hand on
a wall- as though I were drunk!
-Sandy
 
It really depends on the location. Mine, left parietal
lobe, affects mainly my right arm and leg (clumsiness, numbness, focal seizures). I've also at times had dizziness, nausea, confusion and light sensitivity. -Menya

the most frequent symptoms of brain tumors: Headaches
that tend to be worse in the morning and ease during
the day
Seizures (convulsions)
Nausea or vomiting
Weakness or loss of feeling in the arms or legs
Stumbling or lack of coordination in walking
Abnormal eye movements or changes in vision
Drowsiness
Changes in personality or memory
Changes in speech. 
 
 My family doctor diagnosed congestion. I finally knew I had to get a 2nd opinion. Believe me, this felt very different from anything I'd ever felt in almos 70 years of life. For me it was morning headaches, nausea, and loss of balance. All depends on where the tumor is.-Marilyn

My wife had seizures in early June and discovered a
single lesion on the front of her brain. They removed
it surgically and she had 23 days of whole brain
radiation. She did fairly well with it, but noticed
after she was done she was having a little trouble
hearing. The ear, nose, throat specialist put in ear
tubes in both ears to let fluid drain. The theory was
that her estuachian tubes were plugged from the
radiation and fluid was accumulating from breakdown
of tissue. Her hearing acuity still comes and goes
some. The tubes evidently get plugged some too. She
has been a little confused at times, but that may be
due to the surgery also.
-Dean

 Short term memory problems but they were attributed to stress. She subsequently found a lump on her neck ?> lymph node which was biopsied and determined to be malignant. had numerous brain mets but no other mets in her body.
-Carmen

I have always been nearly asymptomatic. With increased
dizziness and peripheral vision lights in left eye on
a few occasions. That was all of my 'symptoms'.
-pattyz

I went to my (ex) family doctor and told him I
thought I had a brain tumor or something very serious.
He shined a light up my nose and declared it was
congestion. Well, I wanted to believe him, so I took
Clariton D and returned in 3 days, this time reeling
like a drunk. He said that was caused by clogged
estuchean tubes and to continue the Claritin and come
back in 3 weeks. After 2 weeks of staggering around
the house, my husband insisted I get a second
opionion. That doc sent me for a CT scan immediately,
and I was put in the hospital the same day. Anytime
you're not satisfied, get a 2nd opinion. My husband
called to cancel my appt. with the old doc and told
him that I was in the hospital getting brain surgery,
and that "apparently his pills didn't work". I was
tempted to call him later and tell him a lot more than
that, but I just changed doctors. One of my very
significant symptoms, according to the doc, was
headaches upon waking in the morning. If they come
later in the day, it isn't so significant.
-Marilyn 







The Dura Mater The outermost of the three meninges is the dura mater (or pachymeninx), a strong, thick, and dense membrane. It is composed of dense fibrous tissue. It can be regarded as a sac that envelops the arachnoid and that has been modified to serve several functions. Within the skull the dura mater surrounds and supports the large venous channels (dural sinuses) carrying blood from the brain toward the heart. It also is prolonged into several partitions, or septa, which lend support to the brain. One of these, the falx cerebri, is a sickle-shaped partition lying between the two hemispheres of the brain. Another, the tentorium cerebelli, provides a strong, membranous roof over the cerebellum. A third, the falx cerebelli, projects downward from the tentorium cerebelli between the two cerebral hemispheres. The outer portion of the dura mater over the brain serves as a covering, or periosteum, of the skull bones' inner surfaces. Within the vertebral canal the dura mater splits into two sheets. These are separated by a space, called the epidural space, which is filled with fat and thin-walled veins. The outer of these two sheets constitutes the periosteum of the vertebral canal. The inner sheet is separated from the arachnoid by the narrow subdural space, which is filled with fluid. In a few places, however, the subdural space is absent, and the arachnoid is intimately fused with the dura mater. The most important area of fusion between these two meninges is in the walls of the large venous channels of the dura mater. There elongations of the arachnoid, like fingers, penetrate the dura mater and project into the veins. These fingerlike processes of the arachnoid, which are referred to as arachnoid villi, or arachnoid granulations, are involved in the passage of cerebrospinal fluid from the subarachnoid space to the dural sinuses.

Beverly was dxd stage four (lungs bones liver) 2003 after reoccurance in her reconstructed breast (MRM w/tram). First MRI of brain two years ago showed what was thought to be a menginoma. Now, it seems that is really dural mets. She had FEC x 6 after original occurance then taxol and gemzar followed by phase II trial of sugen, avastin and gemzar and now zelota. She was just having some very mild headaches and some numbness on her lower lip. We meet with our onc and then an interventional radiologist tomorrow. This is really scary but our onc says its better to have mets in dura rather than the brain. Eric and Beverly

Metastasis to the brain is the most feared complication of systemic cancer. Incidence is rising with improved survival of cancer patients. Currently,cancer patients live longer as a result of important advances in cancer diagnosis and management, and in particular, the widespread use of MRI to detect small metastases. Approximately 40% of intracranial neoplasms are metastatic. Multiple, large autopsy series suggest that, in order of decreasing frequency, lung, breast, melanoma, renal, and colon cancers are the most common primary tumors to metastasize to the brain.
  Early diagnosis and aggressive treatment of brain
metastases may result in remission of brain symptoms
and may enhance the quality of the patient's life and
prolong survival.
The radiologist plays a primary role in the management of cancer patients by helping detect, localize, and diagnose the lesion. Metastatic tumor growth in the brain depends on complex organotropic factors as well as passive
vascular delivery of tumor cells. Lesions are located in the cerebrum (80-85%), in the cerebellum (10-15%), and in the brain stem (3-5%). Slightly more than 50% of the time, multiple as opposed to solitary metastases occur, but this varies with the type of primary tumor. Melanoma, lung, and breast primaries are more likely to produce multiple metastases.
Intracranial metastases can be categorized by location as skull, dura, leptomeninges, and parenchymal brain metastases. Lesions of the brain and leptomeninges account for 80% of intracranial metastases. Meningeal carcinomatosis most commonly occurs in patients with breast carcinoma, malignant melanoma, and, less commonly, with lymphoma, leukemia, and other tumors. Patients usually present with headache, vague
neurologic complaints, and one or more cranial nerve palsies.
Brain metastases represent the most common neurologic
manifestation of cancer, occurring in 15% of cancer patients.
Mortality/Morbidity: Prognosis typically is poor. Therapeutic considerations must be individualized and depend on many factors, which include the patient's neurologic status, extent of systemic tumor, number and location of brain metastases, and sensitivity of the tumor to radiation and chemotherapy. Patients with the best prognostic indicators often die within 18-24
months. Of particular relevance to imaging, patients with a solitary brain metastasis treated by surgical resection show an approximately doubled rate of survival after 1 year. Most available treatment is palliative; however, consider prolonging the patient's quality of life through specific therapy to the brain.
Clinical Details: Approximately two thirds of brain metastases are symptomatic at some point. Symptoms primarily are caused by (1) increased intracranial pressure resulting in headache, nausea, vomiting, confusion, and lethargy and (2) focal irritation or destruction of neurons resulting in hemiparesis,visual field defects, aphasia, focal seizures, ataxia,
and other focal neurologic signs or deficits. The most common symptoms in order of decreasing frequency are headache, focal weakness, and mental status changes. Symptoms typically have a gradual onset. However, if seizures are excluded, 5-10% of
patients may develop other acute symptoms. An acute strokelike presentation may occur and often is precipitated by hemorrhage into the tumor. Hemorrhage is present in 3-14% of metastases and most likely is seen in metastases from melanoma,choriocarcinoma, renal, thyroid, lung, breast, and
germ-cell tumors.  Generalized or focal seizures may occur in 20% of patients with brain metastases. Different primary tumors spread to the brain at different points in the disease course. The median latent interval between the initial diagnosis of a primary tumor and diagnosis of brain metastases varies from 6-9 months for lung cancer and 2-3 years for
melanoma, breast, and colon cancer. In 20% of patients, metastases are detected during diagnosis of the primary tumor, and in 50% of patients, they are detected within 1 year following diagnosis.Surgical resection is the preferred treatment in patients with one apparent metastasis detected on enhanced CT or MRI. Radiosurgery provides a simple, effective, noninvasive, cost-effective method to treat surgically inaccessible lesions and is a therapeutic option for 2-6 metastases. MRI in patients with primary cancers that frequently metastasize to the brain is probably cost-effective. Numerous studies have shown that contrast-enhanced MRI detects 2-3 times as many lesions as contrast-enhanced CT, especially lesions less than 5 mm in diameter. In addition,
approximately 20% of patients with solitary metastatic
lesions on CT show multiple lesions on MRI. Perform
imaging on patients with other cancers based on their
clinical evaluation. If a lesion is found and a definitive diagnosis
cannot be established, perform a biopsy. Surgical removal of the lesion is indicated for single or solitary brain metastasis in patients with good systemic performance status, since surgery is both diagnostic and therapeutic. Patients with multiple
brain metastases or poor systemic performance status are possible candidates for whole-brain radiation therapy or radiosurgery. Preferred Examination: Most patients with a known primary tumor receive imaging studies when neurologic
signs and symptoms develop. MRI with contrast enhancement currently is the procedure of choice, since MRI is more sensitive and specific than other imaging techniques in determining the presence, location, and number of metastases. Contrast-enhanced CT is used widely because of its easy accessibility and low cost.

Findings: Metastases frequently are multiple and seen at the junction of gray and white matter, usually with significant surrounding edema Currently, FDG-PET is not considered superior to CT or MRI in the initial evaluation of suspected brain metastases.


(part of an article I borrowed, I didn't put a link because the link wouldn't take you to the site without  a membership)


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