Brain metastases are growths that spread to the brain from a cancer in another part of the body. They are distinct from primary brain tumors, which start in the brain.
Brain metastases are also much more common. An estimated 150,000 to 200,000 people are diagnosed with a brain metastasis each year, compared to about 17,000 diagnoses for primary brain tumors.
The number of brain metastasis diagnoses has actually risen recently. Many doctors believe this is due to better early detection of brain metastases, as well as better treatments for primary cancers. As more people live longer with a primary cancer, the disease has more time to spread to the brain. This has led to a renewed focus on treating brain metastases.
Any cancer can spread to the brain, but the three most likely to do so are breast cancer, lung cancer and melanoma. Other cancers that often spread to the brain include colon cancer, gynecologic cancers and renal cell carcinoma.
A cancer can metastasize (or spread) to a single location or to multiple locations in the brain. It can also spread to the cerebrospinal fluid or to the leptomeninges, the outer lining of the brain and spinal cord. This type of metastasis is known as leptomeningeal disease (LMD), or leptomeningeal carcinomatosis.
Since LMD cancer cells float in the cerebrospinal fluid, they can quickly spread throughout the central nervous system. As a result, LMD has a poor prognosis.
Brain function and anatomy
The brain processes all our senses and is the starting point of our emotions and movements. It sends and receives messages throughout the body via the spinal cord and nerves in the head. The network of the brain and spinal cord is called the central nervous system (CNS).
The brain is protected by the skull, while the vertebrae of the spine protect the spinal cord. Extra protection is provided by a liquid called cerebrospinal fluid, which surrounds both the brain and the spinal cord.
The brain has four main parts:
Cerebrum: The cerebrum is outer and largest part of the brain. It has two halves that are called hemispheres. Each hemisphere has four lobes: a frontal lobe, parietal lobe, temporal lobe and occipital lobe. The cerebrum is responsible for our senses of sight, hearing, smell and touch, as well as emotional reasoning language and movement.
Basal ganglia: These structures are found deeper inside the brain. They play a part in control of movement.
Cerebellum: This structure is at the back of the brain. It helps control and coordinate movement, such as walking and balance.
Brainstem: Located just in front of the cerebellum at the juncture of the cerebrum and the spinal cord, the brainstem relays sensory and motor messages between the cerebrum and the rest of the body. This small area is very important and even plays a life-supporting role in functions such as breathing and regulation of your heart rate.
Learn more about brain metastases:
Learn more about clinical trials for brain metastases.
Metastatic melanoma patient grateful for leptomeningeal disease clinical trial
I was 40 when I was diagnosed with stage IB melanoma. Five years after I had surgery to remove the tumor on my back, I was diagnosed with stage IV melanoma.
My local oncologist in Oklahoma City reviewed my PET scan and told me to come back in three months to recheck the suspicious spots found on my lungs. My wife and I felt like they were treating me as ¡®just another cancer patient.¡¯
Before I had even gotten into the car to leave, my wife had made an appointment at MD Anderson.
Finding hope at MD Anderson
My wife¡¯s father was treated at MD Anderson years ago for melanoma. I knew I was in the right place for treatment, but when I arrived for my first appointment, I was overwhelmed by the size of the campus. My mother and grandmother had also had melanoma and died within five months of each other. So, I was thinking the worst. I had three young kids. I wanted to see them graduate.
As my wife and I walked through the hospital, I noticed a bunch of children in wheelchairs. One looked at me and mouthed the words, ¡°It will be alright.¡± Then she waved at me.
I was overwhelmed with emotion. These kids hadn¡¯t even got to experience life yet. But they were so optimistic. I knew then that I was going to beat this.
Beginning metastatic melanoma treatment
At MD Anderson, I met with melanoma medical oncologist , who reviewed my PET scan and sent me to have a brain MRI. I was told I could head home, and the doctors would follow up with my results and a treatment plan.
The next day, my wife and I were halfway home when an MD Anderson nurse called and said, ¡°Mr. Stone, we found several tumors on your brain, and we need you to come back to meet with the neurosurgeon to develop a plan.¡±
I returned to MD Anderson and met with the neurosurgeon, who told me I had 15 tumors on my brain. I immediately began 10 rounds of radiation therapy. It didn¡¯t get rid of the tumors. So, I had Gamma Knife? stereotactic radiosurgery, which uses precise beams of gamma rays to target brain tumors in hard-to-reach places. This shrunk or eliminated all the tumors on my brain. Dr. Patel told me about a clinical trial she had completed that had shown some promise for patients with melanoma. She recommended I receive immunotherapy treatment with four rounds of a drug called ipilimumab and an oral chemotherapy called temozolomide at home. The tumors in my lungs completely resolved.
My melanoma was in remission for almost three years, but a follow-up visit in 2017 revealed a new tumor on my brain. I had another round of Gamma Knife? stereotactic radiosurgery, then my next follow-up appointment revealed new tumors on my lungs. I started immunotherapy again, but I only received one dose before my condition worsened.
I had a shooting pain through my back and couldn¡¯t move. My wife rushed me to a local hospital, and an MRI showed six more tumors on my spine. I received 10 rounds of radiation to my spine.
Side effects from metastatic melanoma treatment
My melanoma treatments caused nausea, vomiting and fatigue.
After the spinal radiation, I suffered from constipation. I returned to the emergency room and learned I had an ileus in my intestines. This caused my bowels to stop working. I couldn't eat for weeks. The pain was unbearable. It took weeks before my intestines began to function like normal and I could eat again.
My leptomeningeal disease diagnosis
After completing my spinal radiation locally, I returned to MD Anderson for a follow-up appointment. That¡¯s when I was diagnosed with leptomeningeal disease (LMD). This occurs when cancer cells from primary tumors enter the leptomeninges, the outer lining of the brain and spinal cord.
My wife and I had never heard of LMD, so we did some research. My doctors were kind and gave us information, but they were honest in sharing that patients with my diagnosis typically make it just a few months with treatment. Dr. Patel transferred my care to melanoma LMD specialist .
An LMD clinical trial at MD Anderson saved my life
Dr. Glitza Oliva told me about a new clinical trial for metastatic melanoma patients with LMD. I qualified for the trial, but my wife and I were concerned. We¡¯d be taking a chance since I would be the first patient to receive this treatment. But I was determined not to let cancer beat me. I trusted my doctors and nurses at MD Anderson, so I agreed to participate in the clinical trial in hopes it would extend my life.
As part of the clinical trial, I had an Ommaya port placed for treatment. I received the immunotherapy drug nivolumab directly into my spinal fluid as well as into my veins. My wife and I drove to Houston every two weeks for the first year. Then we started flying.
About a year ago, I started going just once a month. One month, I receive treatment and do bloodwork. The next month I get MRIs and scans along with my treatment.
I haven¡¯t had any major changes for a full year now. I still have some tumors that are stable, but there¡¯s no new growth.
Why I¡¯ll never give up
I recently celebrated five years on the clinical trial. Going from being told I had just a few months to live to now is truly a blessing from God. I feel like I don¡¯t have cancer anymore. Sure, I have a little fatigue and suffer from dizziness, but I¡¯m able to do most of the things I enjoy. I golf and go to football games to watch my daughters cheer. I even went to Disney World with my family and walked 42 miles. At home, you can catch me mowing the lawn, working in the flower beds or working on my truck.?
My motto is to never give up. I work with the cards I am dealt and stay as positive as I can.
I¡¯m thankful for my wife, who¡¯s been by my side through everything, and for my family¡¯s support. Everybody at MD Anderson, from the nurses to the doctors, is special to me. They¡¯re so kind. I love them all. In nine years, I¡¯ve never had one bad experience at MD Anderson. I¡¯m forever grateful.
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Why choose MD Anderson for your brain metastasis treatment?
When a patient is diagnosed with a brain metastasis, treating that growth becomes a top priority. At MD Anderson, your case can be reviewed by our central nervous system metastases tumor board. This group includes physicians who specialize in primary cancers (the tumors that spread to the brain) as well as experts in neurosurgery, neuro-oncology, radiology and radiation oncology for the central nervous system.
Members of this team have spent decades treating patients with brain metastases. They often find ways to treat tumors that other care providers have declared untreatable. This combination of experience and expertise helps them deliver a personalized treatment plan offering the best possible outcome.
As a patient at a top-ranked cancer center, you will also benefit from advanced imaging techniques that can identify and track your brain metastasis over time. Your care may include some of the most advanced surgeries and therapies available. These include complex procedures many providers do not offer, such as awake craniotomies, which allow doctors to map the brain during surgery to avoid damaging vital spots.
You can also benefit from advanced treatments such as Gamma Knife? stereotactic radiosurgery, stereotactic radiosurgery to the spinal cord, image-guided radiation therapy and laser interstitial thermal therapy (LITT). These treatments allow precise treatment of metastases while minimizing the effects on nearby healthy tissue. Doctors might also offer you the opportunity to participate in clinical trials that may not be available anywhere else.
And since brain metastases and their treatments can impact how you think and behave, we have experts who can evaluate symptoms related to your disease and help find ways to minimize those effects.
Usually going to a hospital is a bad feeling, but for me coming back to MD?Anderson is a great feeling. It¡¯s a feeling of security, that I¡¯m getting the correct treatment.
Treatment at MD Anderson
Brain metastases patients can receive treatment from the following care centers and clinics.
MD Anderson's Brain and Spine Center
Physician-scientist focused on improving brain metastases treatment
Metastatic cancer: What happens when cancer spreads?
How I¡¯ve survived metastatic brain cancer
Metastatic melanoma survivor: 'Coming back to MD Anderson is a great feeling'
