Metastatic Tumours

Any malignant tumour may metastasise (spread) to the brain, but this is much more typical of some types of tumour than others. Malignant melanoma is the most likely to behave in this way, but other relatively common sites of origin include bronchus, breast and kidney. Metastases commonly occur in multiple sites within the brain at the same time.

Patients can present with epilepsy but symptoms occurring from focal damage or raised intracranial pressure are also common. These symptoms can include:

Weakness of limbs

Tingling or numbness

Headache

Speech disturbance

Treatment methods
Steroids sometimes have a dramatic and very rapid effect, producing clinical improvement in many patients. However, they do not destroy the tumour, but rather exert their effect by alleviating the local brain swelling that can occur in the vicinity of such a tumour. Steroids are often given in conjunction with surgery, radiotherapy or gamma knife.

Very active treatment options such as surgery and gamma knife are usually reserved for patients who have a solitary brain metastasis, or at most a fairly low number of such deposits. The primary malignancy should be well controlled, as should any other metastatic disease elsewhere in the body. For solitary lesions that lie in an easily accessible site complete excision usually provides good results, but It has been suggested that these results may be further improved when surgery is followed by radiotherapy or gamma knife. For patients with 1-3 small brain metastases and whose systemic cancer is under control, gamma knife alone is an option we would recommend. Gamma knife is ideally suited to the treatment of more than one lesion at a time (often impractical for a surgical approach), and can be repeated if necessary.

Where whole brain radiotherapy has failed and further recurrent disease is present, then gamma knife treatment can be used selectively as a boost therapy. This treatment regimen may also be considered suitable when one brain metastasis is disproportionately larger and/or more critically situated than any other.