Leptomeningeal disease (leptomeningeal metastases or LM) is cancer in your cerebrospinal fluid and leptomeninges, membranes that surround your brain and spinal cord. There isn’t a cure for leptomeningeal disease. Instead, healthcare providers focus on treatment to keep the cancer from spreading, ease symptoms and maintain quality of life.
Leptomeningeal disease (also known as LMD, leptomeningeal metastases, or LM) is cancer in your cerebrospinal fluid and in your leptomeninges, the membranes that surround your brain and spinal cord. It happens when an advanced cancer spreads from part of your body to your cerebrospinal fluid and leptomeninges. Leptomeningeal disease isn’t common, but healthcare providers are seeing more cases as more people live longer with cancer. There isn’t a cure for leptomeningeal disease; instead, healthcare providers focus on treatment to keep the cancer from spreading, ease symptoms and maintain quality of life.
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Approximately 5% of all people who have cancer develop leptomeningeal disease. The condition most commonly affects people who have the following kinds of cancer:
Brain metastases (metastatic brain tumors) and leptomeningeal disease happen when cancer spreads. The difference is that brain metastases are tumors that have traveled to your brain tissue itself. Leptomeningeal disease is cancer that travels to your cerebrospinal fluid and membranes surrounding your brain and spinal cord. Brain metastases and leptomeningeal disease can happen independently or together.
Leptomeningeal disease has many symptoms, but the most common are:
Leptomeningeal disease happens when a growing cancer spreads from its original site in your body to your cerebrospinal fluid and leptomeninges. This represents an advanced and aggressive pattern of cancer and is a significant event.
The leptomeninges are the inner part of your meninges (the three layers of membrane that cover and protect your brain and spinal cord). Cerebrospinal fluid is the clear fluid produced by your brain that surrounds your entire central nervous system and has direct contact with your leptomeninges. Normally, a network of veins drains this fluid unless something keeps the fluid from draining.
Cancer that spreads to your leptomeninges and cerebrospinal fluid can cause many neurologic symptoms and can block the normal flow of cerebrospinal fluid and create pressure on your brain.
Healthcare providers diagnose leptomeningeal disease with magnetic resonance imaging (MRI) of your brain and/or spine, as well as performing a spinal tap (lumbar puncture) to obtain cerebrospinal fluid that they can examine for the signs and presence of cancer cells. Sometimes, an MRI can appear normal if the tumor spread is only microscopic, which can make it challenging to diagnose.
Unfortunately, healthcare providers aren’t able to cure this condition. Instead, they focus on ways of slowing down the spread of cancer and easing symptoms. Treatments vary based on the kind of cancer that spread to your cerebrospinal fluid and leptomeninges, where the cancer is located and your overall health. Some common treatments include:
Unfortunately, there aren’t any ways to reduce the risk of leptomeningeal disease.
Leptomeningeal disease is a significant complication of advanced cancer. That means people who develop this condition are already in the more serious stages of cancer. In general, people who receive treatment for this condition live between three to six months after diagnosis. People who don’t have treatment live for about a month after diagnosis. That said, every person’s tumor and situation are unique. Your healthcare provider is your best resource for information about your situation.
If you have leptomeningeal disease, it’s important that you have a clear view of your prognosis. Leptomeningeal disease is a serious complication of advanced or late-stage cancer and can’t be cured. Ask your healthcare provider what you can expect, given your specific situation. That way, you can set priorities such as managing your symptoms so you’re as comfortable as possible.
These aren’t easy conversations for you or your healthcare provider, but they’re important. Your healthcare provider can help you understand what’s happening to your body and what might happen. They can help you to think about your options and suggest helpful resources.
Hospice care helps people who have advanced, life-limiting illnesses to spend their final days comfortably, with dignity, control and quality of life. When people are fighting a serious illness, their time and energy often focuses on treatment. Thinking about hospice shifts the focus from illness to how they want to spend the time they have. By talking with your healthcare provider and learning about how leptomeningeal disease is affecting your life, which treatments are available for your specific cancer type, and what you can expect from treatment itself, you’ll have more information to make the best decision possible for you as a team.
A note from Cleveland Clinic
If you have leptomeningeal disease, it’s likely that you have been living with some form of advanced cancer — cancer that’s growing throughout your body despite treatment. It may be devastating to learn your growing cancer has caused a serious complication for which there isn’t a cure. You may feel angry that after all you’ve gone through, you have another form of cancer that’ll likely affect your quality of life. You may feel frightened or you may feel overwhelmed and not sure what to do. If this is your situation, ask your healthcare provider for help. They understand what you’re going through and will be glad to help you in any way they can.
Last reviewed by a Cleveland Clinic medical professional on 04/12/2022.
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