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The diagnosis of brain metastases in cancer patients is based on patient history, neurological examination, and diagnostic procedures. Patients may describe headaches, weakness, seizures, sensory defects, or gait problems. Often, family members or friends may notice lethargy, emotional lability, or 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 tumor may be sufficient to make the diagnosis of metastases. 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. In one study, the diagnosis of single brain metastasis was changed in 6 of 54 patients after the lesion was biopsied. The six patients had primary brain tumors or infectious and inflammatory lesions.[22] 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.[23]

References:

  1. American Cancer Society.: Cancer Facts and Figures 2010. Atlanta, Ga: American Cancer Society, 2010. Also available online. Last accessed June 16, 2011.
  2. Levin VA, Leibel SA, Gutin PH: Neoplasms of the central nervous system. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 2100-60.
  3. Trends in SEER incidence and U.S. mortality using the joinpoint regression program 1975-2000 with up to three joinpoints by race and sex. In: Ries LAG, Eisner MP, Kosary CL, et al.: SEER Cancer Statistics Review, 1975-2000. Bethesda, Md: National Cancer Institute, 2003., Section 3: Brain and Other Nervous System Cancer (Invasive), Table III-1. Also available online. Last accessed October 6, 2009.
  4. Parkin DM, Bray F, Ferlay J, et al.: Estimating the world cancer burden: Globocan 2000. Int J Cancer 94 (2): 153-6, 2001.
  5. Preston-Martin S: Descriptive epidemiology of primary tumors of the spinal cord and spinal meninges in Los Angeles County, 1972-1985. Neuroepidemiology 9 (2): 106-11, 1990.
  6. Behin A, Hoang-Xuan K, Carpentier AF, et al.: Primary brain tumours in adults. Lancet 361 (9354): 323-31, 2003.
  7. Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000.
  8. Moss AR: Occupational exposure and brain tumors. J Toxicol Environ Health 16 (5): 703-11, 1985.
  9. Hochberg FH, Miller G, Schooley RT, et al.: Central-nervous-system lymphoma related to Epstein-Barr virus. N Engl J Med 309 (13): 745-8, 1983.
  10. Schabet M: Epidemiology of primary CNS lymphoma. J Neurooncol 43 (3): 199-201, 1999.
  11. Hutter A, Schwetye KE, Bierhals AJ, et al.: Brain neoplasms: epidemiology, diagnosis, and prospects for cost-effective imaging. Neuroimaging Clin N Am 13 (2): 237-50, x-xi, 2003.
  12. Cloughesy T, Selch MT, Liau L: Brain. In: Haskell CM: Cancer Treatment. 5th ed. Philadelphia, Pa: WB Saunders Co, 2001, pp 1106-42.
  13. Ricci PE: Imaging of adult brain tumors. Neuroimaging Clin N Am 9 (4): 651-69, 1999.
  14. Buckner JC: Factors influencing survival in high-grade gliomas. Semin Oncol 30 (6 Suppl 19): 10-4, 2003.
  15. Louis DN, Cavenee WK: Neoplasms of the central nervous system. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 2091-100.
  16. DeAngelis LM: Brain tumors. N Engl J Med 344 (2): 114-23, 2001.
  17. Ueki K, Nishikawa R, Nakazato Y, et al.: Correlation of histology and molecular genetic analysis of 1p, 19q, 10q, TP53, EGFR, CDK4, and CDKN2A in 91 astrocytic and oligodendroglial tumors. Clin Cancer Res 8 (1): 196-201, 2002.
  18. Giordana MT, Ghimenti C, Leonardo E, et al.: Molecular genetic study of a metastatic oligodendroglioma. J Neurooncol 66 (3): 265-71, 2004.
  19. Patchell RA: The management of brain metastases. Cancer Treat Rev 29 (6): 533-40, 2003.
  20. Wen PY, Black PM, Loeffler JS: Treatment of metastatic cancer. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 2655-70.
  21. Posner JB, Chernik NL: Intracranial metastases from systemic cancer. Adv Neurol 19: 579-92, 1978.
  22. Noordijk EM, Vecht CJ, Haaxma-Reiche H, et al.: The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 29 (4): 711-7, 1994.
  23. Schaefer PW, Budzik RF Jr, Gonzalez RG: Imaging of cerebral metastases. Neurosurg Clin N Am 7 (3): 393-423, 1996.
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Last Updated: May 16, 2012
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