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Brain metastases

Definition:

  • Brain metastases are cancerous growths that have spread (metastasized) to the brain from primary tumors elsewhere in the body.

Epidemiology:

  • More common than primary brain tumors.
  • Often seen in patients with advanced systemic cancer, particularly lung cancer, breast cancer, melanoma, renal cell carcinoma, and colorectal cancer.

Pathophysiology:

  • Cancer cells spread via the bloodstream or lymphatic system to the brain, where they grow and form secondary tumors.
  • Tend to be located at the junction between gray and white matter.

Clinical Features:

  • Symptoms depend on the location and size of the metastases but can include headaches, seizures, neurological deficits (e.g., weakness, numbness), and cognitive or behavioral changes.
  • Increased intracranial pressure can cause nausea, vomiting, and altered consciousness.

Diagnosis:

  • MRI with contrast is the preferred imaging modality for detection and characterization of brain metastases.
  • Whole-body imaging (e.g., PET-CT) to identify primary tumor and other metastases.
  • Biopsy for histological confirmation, if the primary cancer is unknown.

Management:

  • Treatment depends on the number of lesions, the type of primary cancer, the patient’s overall health, and symptoms.
  • Options include:
    • Surgical resection for accessible single lesions.
    • Radiation therapy, including whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS).
    • Systemic therapy based on the primary cancer type (e.g., chemotherapy, targeted therapy, immunotherapy).
  • Symptomatic treatment for edema (e.g., corticosteroids) and seizures (antiepileptic drugs).

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