Metastatic Brain Tumors

Overview

What is a metastatic brain tumor (brain metastases)?

A metastatic brain tumor is one of several types of metastatic cancer. Brain metastases, or metastatic brain tumors, happen when cancer in one part of your body spreads to your brain. Most metastatic brain tumors spread from primary cancers in your lungs, your breasts or your skin, specifically melanoma.

Researchers are finding more ways to predict who might develop brain metastases so healthcare providers can monitor for signs of metastatic brain tumors. Healthcare providers treat metastatic brain tumors by managing your symptoms through surgery and other treatments and helping you maintain your quality of life.

What are the differences between a metastatic (secondary) brain tumor and a primary brain tumor?

There are several differences between a metastatic or secondary brain tumor and a primary brain tumor. Some differences are:

  • A primary brain cancer is a tumor that develops in your brain. A metastatic or secondary brain tumor happens when cancer spreads to your brain from another area of your body.
  • A metastatic brain tumor is malignant, and most primary brain tumors are benign. However, benign brain tumors can affect how your brain functions if they grow large enough to press on nearby nerves, blood vessels and brain tissue.
  • Metastatic brain tumors are more common than primary brain tumors.

Who’s affected by metastatic brain tumors?

Metastatic brain tumors are the most common brain tumor in adults. An estimated 200,000 to 300,000 people are diagnosed with metastatic cancer each year. Most people with cancer develop metastatic brain cancer between ages 45 and 65, with most cases developing in people age 65 and older.

How do brain metastases affect my body?

Different parts of your brain control different body functions, so the impact brain metastases have on your body depends on where your primary cancer ended up when it traveled to your brain. About 85% of brain metastases develop in your cerebrum, which is the top and largest part of your brain, with 15% developing in your cerebellum, the lower part of your brain.

Your cerebrum has four lobes or sections. Each section manages different body functions. For example, if you have a metastatic brain tumor in your frontal lobe, it could affect your behavior, reasoning and thinking. If you have metastatic brain tumors in the left frontal lobe, it could affect your speech.

How long does it take for my primary tumor to spread to my brain?

Brain metastases happen when cells from your primary tumor spread to your brain. Cancer cells travel via your blood or lymphatic system. It’s difficult to pinpoint how long that journey takes. Just like taking the freeway to your destination might be faster than taking side roads, cancer cells that have easy access to your blood or lymphatic system can spread more quickly than cells that don’t have that access.

Symptoms and Causes

What are metastatic brain tumor symptoms?

Metastatic brain tumor symptoms differ based on your tumor’s location. Those symptoms can mimic stroke symptoms. But while stroke symptoms come on suddenly, metastatic brain tumor symptoms appear and get worse over time, from days to weeks. These symptoms include:

  • Headaches caused by a tumor(s) putting pressure on your brain. Your headaches may also stem from fluid leaking from your tumor’s blood vessels.
  • Seizures that happen when your tumor interferes with your brain’s normal electrical activity.
  • Cognitive problems, meaning you have trouble processing information or how you think. You may have trouble remembering things that just happened.
  • Changes in how you behave or in your mood.
  • Weakness on one side of your body, or not being able to use your arm or leg on one side of your body.
  • Problems hearing, swallowing or seeing.
  • Nausea and vomiting.
  • Difficulty speaking or understanding speech.

Do I have metastatic brain cancer if I have any of these symptoms?

Many of these symptoms such as headaches, nausea and vomiting, or mood changes are also caused by other less serious conditions. Generally speaking, any change in your body that lasts more than a few weeks is something you should discuss with your healthcare provider.

What causes metastatic brain tumors?

Metastatic brain tumors happen when cells from your existing tumor spread to your brain. Researchers aren’t sure why some primary cancers are more likely to metastasize. Here are the most common forms of brain metastases:

  • Lung cancer metastasis to your brain. About half of all metastatic brain cancers spread from your lungs.
  • Breast cancer metastasis to your brain. Approximately 10% to 15% of all people with metastatic breast cancer develop brain metastases.
  • Melanoma metastasis to your brain. Melanoma is the third most common form of cancer that spreads to your brain.
  • Prostate cancer metastasis to your brain. Less than 1% of all people with prostate cancer develop metastatic brain tumors.

Diagnosis and Tests

How do healthcare providers diagnose metastatic brain tumors?

Your healthcare provider may start the diagnosis process by asking about your symptoms such as headaches, blurred vision and nausea. They may ask how long you’ve had the symptoms and how your symptoms affect you.

For example, if you have headaches, they may ask if your headaches persist even after you’ve taken medication. They may ask if your headaches are so intense they interrupt your daily routine or if you wake up with headaches that gradually get better as the day goes on.

If you’re being treated for cancer, your healthcare provider will ask about that cancer. Cancer cells don’t change during metastasis. For example, if you have breast cancer that’s spread to your brain, your healthcare provider may treat the cancer in your brain the same way they treat your breast cancer. Here’s the sort of information your healthcare provider will use to diagnose your metastatic brain cancer:

  • What type of cancer you have.
  • When your cancer was diagnosed.
  • Your cancer’s status, meaning the specific stage and grade.
  • Your current treatment and how your cancer is responding to that treatment.

What tests do providers use to diagnose metastatic brain tumors?

Your healthcare provider may do the following tests to learn more about your tumor(s):

  • Neurological exam. During a neurological exam, your healthcare provider will look for changes in your balance, coordination, mental status, hearing, vision and reflexes. These changes can point to the part of your brain that may be affected by a tumor.
  • Blood test. To check for tumor markers (substances secreted into blood by tumors) that are linked to certain types of tumors.
  • Magnetic resonance imaging (MRI.) This test uses a large magnet, radio waves and computer to develop detailed images inside your body so healthcare providers know your tumor(s) size and location.
  • Biopsy. Your healthcare provider may perform a biopsy to make a final diagnosis. They do that by removing a small amount of tissue from your tumor so it can be examined under a microscope. Your healthcare provider may perform a biopsy as part of surgery to remove all or part of your tumor.

Management and Treatment

How do healthcare providers treat brain metastases?

Your healthcare provider may begin by treating your immediate symptoms. For example, if you have edema from your brain tumor, your healthcare provider might prescribe steroids. If you’ve had seizures, they might prescribe anticonvulsant medication.

The overarching treatment for metastatic brain tumors is to stop or slow the tumor’s growth in your brain and minimize your symptoms while treating the cancer that’s spread to your brain.

What’s the treatment for breast cancer metastasis to my brain?

Healthcare providers may combine ongoing breast cancer treatment with the following treatments:

  • Stereotactic radiosurgery/GammaKnife radiosurgery. This is the most common way healthcare providers in the United States treat brain metastases. Healthcare providers target brain tumors with high doses of radiation.
  • Brain surgery to remove your brain tumor(s).
  • Whole brain radiation therapy. Your healthcare provider may use this treatment if you have several brain tumors or if the cancer has spread to your brain’s membranes. This is called leptomeningeal disease.
  • Chemotherapy. Healthcare providers use chemotherapy on a case-by-case basis. That’s because many chemotherapies can’t pierce your blood-brain barrier, which keeps toxic substances in your blood from getting to your brain. Instead of chemotherapy that interferes with tumor cell reproduction, your healthcare provider may recommend targeted therapies that may interfere with other tumor cell functions.
  • Immunotherapy. This treatment uses your immune system to combat your tumor.

What’s the treatment for lung metastasis to my brain?

Healthcare providers use radiosurgery and/or brain surgery to treat lung metastasis to your brain. Recent research shows small cell lung cancer in the brain may be sensitive to targeted therapies and immunotherapy.

What’s the treatment for melanoma metastasis to my brain?

Healthcare providers may use radiosurgery and/or surgery and immunotherapy to treat melanoma metastasis to your brain.

What’s the treatment for prostate metastasis to my brain?

Metastatic brain tumors stemming from your prostate are very rare, accounting for about 1% of all metastatic brain cancers. Prostate cancer that has spread to your brain may be treated with radiosurgery and/or surgery.

Prevention

Can I prevent metastatic brain tumors?

Most metastatic brain tumors stem from existing lung and breast cancers and melanoma. Treating those cancers is the first step toward reducing the chance you’ll develop brain metastases. Understanding your risk for developing brain metastases is another step. Ask your healthcare provider about your individual risk for developing metastatic brain tumors.

Outlook / Prognosis

What is the metastatic brain tumor prognosis?

Your prognosis or expected outcome depends on several factors that are specific to you and your medical condition. Healthcare providers base prognoses on factors such as your age and your overall health. They also consider how your primary cancer responded to treatment, if you have more than one brain tumor and your brain tumor’s size. Your healthcare provider is your best resource for information about your personal prognosis.

Living With

I have brain metastases. How do I take care of myself?

Brain metastases can create a new set of medical conditions and issues when you’re already dealing with cancer treatment:

  • Depending on your brain tumor’s location, you may be at increased risk for seizures, which may affect your ability to work or drive. Your healthcare provider may prescribe medication to reduce your risk.
  • You may need surgery to remove your brain tumor(s). If so, you’ll need support while you recover.
  • You may need help managing side effects from different or additional cancer treatments. You may want to consider palliative care to help you manage your symptoms and treatment side effects.
  • Your brain metastases diagnosis is another step in your cancer journey. Metastatic brain cancer treatment focuses on slowing cancer’s spread and helping you maintain your quality of life. This may be time for you to talk to your healthcare provider about next steps if your cancer can’t be cured.

When should I see my healthcare provider?

You should see your healthcare provider if your metastatic brain cancer symptoms get worse or you have symptoms that you think may be related to your primary cancer or your brain metastases.

When should I go to the emergency room?

Brain tumors increase your risk of neurological problems such as seizures or not being able to move your arms and legs. You may need emergency medical care if you have symptoms that get worse.

What questions should I ask my doctor?

If you have metastatic brain tumor(s), you’re already coping with one kind of cancer, and you may wonder what your new diagnosis means. Here are some suggested questions to help you understand your situation:

  • What is a metastatic brain tumor?
  • Why did I develop this tumor or tumors?
  • How will brain metastases affect me?
  • What treatments do you recommend?
  • What are these treatment side effects?
  • Does having brain metastases mean I will have cancer in more areas of my body?
  • What is my prognosis?

A note from Cleveland Clinic

If cancer is a journey, learning your cancer has spread to your brain may feel like a huge step into unknown territory. There’s no cure for the different types of metastatic brain tumors. But researchers are making progress toward predicting who may develop brain metastases. Being able to predict who may develop brain metastases means healthcare providers can watch for symptoms that might indicate your cancer has spread to your brain. Early diagnosis and early treatment, including surgery and other treatments, may be another turning point in your cancer journey. Talk to your healthcare provider if you have metastatic brain tumors or wonder if you’ll develop brain metastases. They’ll help you through this next part of your journey and stay with you every step of the way.

Last reviewed by a Cleveland Clinic medical professional on 12/02/2021.

References

  • American Cancer Society. Brain Metastases. Accessed 12/2/2021.
  • Amsbaugh, Mark J, Kim, Catherine S. Brain Metastasis. (https://www.ncbi.nlm.nih.gov/books/NBK470246/#_NBK470246_pubdet_) StatPearls. Accessed 12/2/2021.
  • D'Antonio C, Passaro A, Gori B, et al. Bone and Brain Metastasis in Lung Cancer: Recent Advances in Therapeutic Strategies. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987652/) Ther Adv Med Oncol. Accessed 12/2/2021.
  • Mantovani C, Gastino A, Cerrato M, et al. Modern Radiation Therapy for the Management of Brain Metastases From Non-Small Cell Lung Cancer: Current Approaches and Future Directions. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8593461/) Front Oncol. Accessed 12/2/2021.
  • National Cancer Institute. Metastatic Cancer: When Cancer Spreads. (https://www.cancer.gov/types/metastatic-cancer) Accessed 12/2/2021.
  • Rastogi K, Bhaskar S, Gupta S, et al. Palliation of Brain Metastases: Analysis of Prognostic Factors Affecting Overall Survival. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069611/) Indian J Palliat Care. Accessed 12/2/2021.
  • Stelzer KJ. Epidemiology and prognosis of brain metastases. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656565/) Surg Neurol Int. Accessed 12/2/2021.

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