Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - General Information About Adult Brain Tumors
The most common primary cancers metastasizing to the brain are lung cancer (50%), breast cancer (15%–20%), unknown primary cancer (10%–15%), melanoma (10%), and colon cancer (5%).[2,16] Eighty percent of brain metastases occur in the cerebral hemispheres, 15% occur in the cerebellum, and 5% occur in the brain stem. Metastases to the brain are multiple in more than 70% of cases, but solitary metastases also occur. Brain involvement can occur with cancers of the nasopharyngeal region by direct extension along the cranial nerves or through the foramina at the base of the skull. Dural metastases may constitute as much as 9% of total CNS metastases.
A lesion in the brain should not be assumed to be a metastasis just because a patient has had a previous cancer; such an assumption could result in overlooking appropriate treatment of a curable tumor. Primary brain tumors rarely spread to other areas of the body, but they can spread to other parts of the brain and to the spinal axis.
The diagnosis of brain metastases in cancer patients is based on the following:
- Patient history.
- Neurological examination.
- Diagnostic procedures, including a contrast MRI of the brain.
Patients may describe any of the following:
- Sensory defects.
- Gait problems.
Often, family members or friends may notice the following:
- Emotional lability.
- Personality change.
A physical examination may show objective neurological findings or only minor cognitive changes. The presence of multiple lesions and a high predilection of primary tumor metastasis may be sufficient to make the diagnosis of brain metastasis. In the case of a solitary lesion or a questionable relationship to the primary tumor, a brain biopsy (usually a stereotactic biopsy) may be necessary. CT scans with contrast or MRIs with gadolinium are quite sensitive in diagnosing the presence of metastases. PET scanning and spectroscopic evaluation are new strategies to diagnose cerebral metastases and to differentiate the metastases from other intracranial lesions.
Other PDQ summaries containing information related to adult and childhood brain cancer include the following:
- Breast Cancer Treatment
- Childhood Brain and Spinal Cord Tumors Treatment Overview
- Colon Cancer Treatment
- Non-Small Cell Lung Cancer Treatment
- Small Cell Lung Cancer Treatment
- Testicular Cancer Treatment
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