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About Brain Mets

Donna G

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Mary again wrote a column in our local hospital sheet in her "Cancer Corner" I will paraphrase for some is good info for us.

We have seen an increased number of patients with Brain Metastases in the last 2 months, so I thought this would be a good topic for the month.

Brain metastases occur in 20-40 % of individuals with cancer. The incidence is increasing as patients are living longer with their primary disease and our advances in neuroimaging are made. Brain mets generallly occurs in individuals with systemic disease , although as the primary cancer are better controlled, brain mets may be the only symptomatic site of the cancer. The majority of brain mets occur at 3 sites: The brain parenchyma itself, the skull and dura and the leptomeninges ( a term describing a diffuse seeding of cancer cells thoughout the meninges and CSF) The majority of brain metastastes are a result of hematogenous spread from the primary tumor. The cancer that most commonly spread to the brain are : melanoma, lung, breast , kidney, colon and thryoid. The lung is the most common site of origin.

Brain metastasis is characterixed by peritumoral edema, which contributes to the neurological symptoms. The presenting signs and symptoms are dependent upon the location of the lesion. Most brain metastases occur in the cerebral hemisphere. Symptoms include: signs of Increased Intracranial Pressure ( headache, nausea, and vomiting) , change in level of consciousness and diminished cognitive function, personality changes, hemiparesis, language problems, and seizures. Thus if a cancer patients presents with any of these symptoms think possible new brain mets and if this is confirmed by MRI , steroids should be started immediately to help decrease the swelling. Usually decadron is given every 6-8 hours around the clock. The next step is a Radiation Therapy consult. With early diagnosis and management, brain metastases often responds to therapy and an increasing number of patients are experiencing a prolonged remission.

The main side effect of brain radiation is fatigue. It will improve once radiation is completed. Assess for any changes as memory , gait, nausea vomiting and/or progression of symptoms. Often just with the initiation of decadron the patient will see some improvement in symptoms.

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