How Brain Metastases From Lung Cancer Are TreatedIf diagnosed and treated early, brain metastases usually respond to therapy. Your treatment plan will depend on the size and number of tumors, where they’re located in the brain, and their genetic characteristics; the extent of disease outside the brain; and your overall health. Treatment may include: Show
Surgery Surgery may be an option for people with only one or two brain metastases that are easy to access and remove or a larger tumor that’s causing compressive symptoms, according to Johns Hopkins Medicine. It may involve complete or partial removal of a tumor to help alleviate symptoms and is typically followed by whole-brain radiation. Radiation This therapy involves the use of X-rays or other high-energy beams to kill cancer cells, and different methods of radiation are used to treat brain metastases. People with fewer than five lung cancer metastases in the brain may be good candidates for stereotactic radiation, in which advanced imaging and computer guidance are used to deliver large doses of radiation directly to tumors. “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. “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, targeted therapy, and immunotherapy, 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. 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 metastasized elsewhere in the body, other systemic therapies, such as immunotherapy (which uses medicine to activate your own immune system to recognize and kill cancer cells) and chemotherapy, may be considered. Palliative care This type of specialized medical care, which can include physical therapy, relaxation techniques, exercise, speech therapy, and pain management, is also a key component of treatment for patients with metastatic NSCLC. These complementary approaches can help mitigate the side effects of both the cancer and its treatment and significantly improve quality of life. Information and support for people with lung cancer and their families is available at the Go2 Foundation for Lung Cancer, the American Cancer Society, and the Global Resource for Advancing Cancer Education (GRACE). Looking Ahead: After Brain Metastases TreatmentAfter surgery, radiation, 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 continue to follow up every few months with another MRI. 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 poor for people with NSCLC and brain metastases traditionally, 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 notes, “but thankfully, more and more studies are focused on exactly this problem.” Additional reporting by Erica Patino If lung cancer isn’t caught early, there’s a high risk of it spreading to other parts of your body, including the brain. When cancer cells travel to the brain, doctors call it brain metastases (or brain mets). This can cause one or more tumors to form in the brain, which can lead to serious symptoms like blurry vision, slurred speech, headaches, and seizures. Brain mets are common in lots of different types of cancer, but they’re especially
common in lung cancer. About 50% of those who have lung cancer will develop brain mets. And around 25% already have them at the time of diagnosis. If you have metastatic lung cancer, odds of survival are poor. But for those who develop brain mets, the outcome might be worse. On average, most people with brain mets survive less than 6 months after diagnosis. If lung cancer isn’t caught
early, the cancer cells can spread through lymph nodes and the blood supply to different parts of the body, including the brain. In fact, most brain mets start out as lung cancer. What’s the link? Experts don’t fully understand it. Some recent research on mice shows that when lung cancer cells travel to the brain, they quickly build blood vessel branches.
This gives them the blood supply to survive and multiply. Some studies point out that nicotine from cigarette smoke might play a role. But experts say they need to research and study the link more. The lung cancer with the highest risk of brain mets is small-cell lung cancer (SCLC). You can also develop brain mets with some forms of non-small-cell lung cancer (NSCLC) caused by changes (or mutations) in certain genes, such as: According to research, about 50% to 60% of people with EGFR- or ALK-positive lung cancer go on to develop brain mets. Why is this? Doctors aren’t sure. But those who have NSCLC tend to live for several years after they’re diagnosed. Experts believe that this might allow the cancer more time to spread to
the brain. Other theories suggest that targeted treatments for lung cancer might not properly reach the tumors within your brain. Or these mutation-based cancer cells might have a genetic tendency to travel to the brain. Brain mets that grow inside your brain matter are the most common type. But in some cases, cancer might spread to the fluid around your brain.
This is called leptomeningeal disease (LMD). Brain mets can be microscopic and cause no symptoms initially. Symptoms related to brain mets depend on the location and size of the tumors in the brain. Symptoms also reflect how quickly a tumor is growing and if there is actual increased pressure within the brain. Symptoms may reflect the impact of brain mets on the local
brain tissue (focal) or affect brain function (global) from increased pressure and swelling inside the brain. You’re also more likely to have global symptoms if you have leptomeningeal disease as well. Focal symptoms result from direct pressure or destruction locally in the brain. This is often from tissue destruction from the tumor, or from a stroke into the tumor, or from a seizure caused by the tumor. They can include: Global symptoms include: The symptoms may suddenly change if you have a bleed (hemorrhagic stroke) from the tumor. Bleeding inside the brain is a medical emergency that often
requires surgery to control. This may not be possible in the case of bleeding from brain mets. Your doctor will run a few tests and exams, such as: Neurological exam. Your doctor will check for many brain-related functions such as:
Imaging tests. A MRI scan with contrast dye might help your doctor find brain tumors. The dye is an injectable ink that’s given into your arm. During the scan, the dye will make the tissues and blood vessels in your brain show up more clearly and have a lot more detail. Other imaging tests may include:
If your doctor finds brain mets, you’ll likely be followed regularly with repeat imaging studies. The time period between studies will vary and depends on the size and growth of the tumor. Biopsy. If your doctor finds a mass or a tumor, they may recommend taking a small sample with a needle to make sure that it is metastatic lung cancer. This is called a biopsy. A lab technician will see the sample under a microscope to check whether the cells are cancerous (malignant) or noncancerous (benign). They can also tell whether cancer cells came from some other part of your
body (brain mets) or grew in your brain (the primary tumor). If leptomeningeal disease (LMD) is suspected, your doctor will insert a long needle between two vertebrae in the lower part of your spine and take a fluid sample. This procedure is called a lumbar puncture. They then check the fluid to see if it has cancer cells from the lung. If your lung cancer spreads to your brain, there are several
treatment options. These include: Medications. Some cancer drugs come in pills that you can take by mouth, while others are given intravenously (IV) in a vein. The type of medications your doctor recommends will depend on the locations of your brain lesions and your individual situation. Medications include: Chemotherapy. This kills cells that grow quickly, including cancer cells. If you have LMD, your doctor might inject
chemo into your arm or directly into your spinal fluid. They can also give it through a device that’s inserted under your scalp called an Ommaya reservoir. Targeted therapy. If you have brain mets caused by lung cancer that have certain genetic biomarkers like ALK and EGFR, then you might get this therapy. Targeted pills focus on flaws within cancer cells and block them. This causes cancer cells to die. But you might have to wait a few weeks before your doctor can confirm whether your cancer has biomarkers. If you need to start treatment as soon as possible, you might have to rule out this option. Focused radiation to the brain. Also called stereotactic radiosurgery, this therapy uses radiation beams in a specific way to kill cancer cells in the brain. For the procedure, your doctor may use machines called Gamma Knife and Cyberknife to attack cancer cells. Whole-brain radiation therapy (WBRT). This therapy uses radiation beams on your entire brain. But sometimes, your doctor might shield the hippocampus – the part of the brain that controls memories – during the procedure to prevent memory problems. This is called “hippocampus sparing.” WBRT may also be done if you have SCLC before cancer can spread to your brain because SCLC has a high risk of brain mets, including microscopic brain mets. This procedure is called
prophylactic cranial irradiation. But because this can cause serious side effects, your doctor might just closely monitor your brain for metastatic tumors with regular MRIs. Neurosurgery. If the brain met is too large or starts to cause symptoms, your doctor might perform surgery to remove the affected area. They may follow this up with radiation in the same area after surgery. If
your lung cancer spreads to the brain, research shows that the outlook is poor. On average, those who develop brain mets tend to live for less than 6 months after diagnosis. Because brain tumors can affect areas of the brain that control your motor skills, speech, hearing, balance, or memory, after treatment you might need rehabilitation as part of your recovery process. This can include therapies like physical therapy, occupational therapy, and speech therapy. Your
doctor might refer you to an expert after you finish treatment. If treatment options are not able to work well enough to fight back cancer, your doctor might suggest supportive care like hospice and palliative care. These therapies are provided by a team of experts who work with you and your loved ones to support you physically, emotionally, and spiritually to help improve your quality of life as you live with advanced lung cancer and brain mets. How long can you live when lung cancer spreads to the brain?Only about one-fifth of people with lung cancer will live for five years after diagnosis. But for those who develop brain metastases, the already grim outlook is even worse. They will survive, on average, for less than six months. When lung cancer reaches the brain it can cause headaches, seizures and paralysis.
Can lung cancer that has spread to the brain be cured?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.
How long can you live when cancer spreads to the brain?Among the study's findings: Median survival of brain metastases has improved over the years, but varies by subset: lung cancer, 7-47 months; breast cancer, 3-36 months; melanoma, 5-34 months; gastrointestinal cancer, 3-17 months; and renal cancer, 4-36 months.
What is the survival rate for small cell lung cancer that has spread to the brain?Small cell lung cancer that metastasizes to the brain is highly aggressive, as it multiplies quickly. Evidence indicates that once metastasis occurs, the median survival time is 6 months.
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What is the survival rate for lung cancer that has spread to the brain
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