Manifestations of metastatic brain cancer

The article is professionally consulted by Dr. Le Tan Dat - Internal Medicine Oncologist, Oncology Center for Radiation Therapy, Vinmec Times City International Hospital, Vinmec Central Park.

Brain metastasis occurs when cancer cells travel through the bloodstream or lymphatic system from the original tumor, spreading (metastasize) to the brain. This is an extremely dangerous phenomenon that patients should pay attention to detect as soon as possible for timely treatment. What are the symptoms of brain metastases?

Metastatic brain cancer is the spread of a cancerous tumor that has spread to the brain, which is different from the primary brain tumor. The difference between these two types of brain damage is confusing for many people.
Primary brain tumors are tumors that originate in the brain, which can be benign or malignant. Benign tumors progress slowly, but affect brain function and when large, can cause compression leading to death. Malignant tumors in the brain progress rapidly. Fatal consequences of brain cancer are usually caused by tumor compression, hemorrhage, and brain edema, not by tumor metastasis to places other than the brain.
Metastatic brain tumor: Most cancers can metastasize to the brain, in which cancer often has brain metastases such as lung cancer, breast cancer, melanoma,... For example, a patient have lung cancer where the tumor first forms in the lung tissue, then cells from the tumor that separate from the original tumor travel through the blood or lymph system to other parts of the body, including whole brain. Tumor that has spread far is called “metastasis”. When lung cancer metastasizes to the brain, the “brain tumor” is actually lung cancer cells.

When symptoms of metastatic cancer occur, the symptoms and how often depend on the size, location, and number of metastases. Signs of brain metastasis to a certain stage can be seen visually such as vomiting, seizures (convulsions), decline in health, etc. But in many cases, there are absolutely no symptoms at all. Metastatic tumors are discovered incidentally only when a CT scan or MRI is indicated in the staging of a particular primary cancer. Possible symptoms of brain metastases include:
2.1 Headache Headache is the first and most frequent symptom. Most metastases to the brain damage the brain and put a lot of pressure on the skull. These headaches do not go away with either headache medicine or pain relievers. They usually appear early in the morning and increase in intensity and frequency.
2.2 Prolonged fatigue The body is getting weaker and weaker, even paralyzed on one side of the body. Tumors that metastasize to the brain greatly affect brain function, even paralyzing nerves and making one side of the patient's body weak or paralyzed. The patient's body always falls into a state of fatigue, loss of consciousness, dizziness, unsteady walking,...
2.3 Prolonged vomiting

This is a symptom that occurs in all patients with metastatic brain cancer. This symptom will appear with a headache, dizziness.
2.4 Loss of consciousness and behavior changes After a period of cancer metastasis to the brain, the patient will gradually lose consciousness and sometimes have loss of consciousness. There are also symptoms of memory loss, mood swings, behavioral changes, and psychosis. Therefore, the body is always sluggish, depressed, balancing is difficult and talking is difficult.
2.5 Visual impairment The patient's ability to see far and clearly will decline suddenly. There is the phenomenon of staring at something.
2.6 Epilepsy Seizures (convulsions) occur in about 35% of patients with metastatic brain cancer. The older you are, the more likely you are to have epilepsy, and the more dangerous the epilepsy is. The risk of epilepsy increases with people after age 45.
2.7 Persistent Cough It's because of the lingering headaches that make you cough and sneeze a lot. When bending over, it will be very uncomfortable because of the pressure of the tumor on the brain.
2.8 Voice Change One of the most visual signs of brain metastases is a change in voice, difficulty talking. Especially with declining health, patients are prone to sore throat. Although he tried his best to speak, his voice was still low, sometimes wheezing. And when you have a sore throat, your voice will get worse.
All of the above symptoms can be caused by causes other than a brain tumor. When seeing suspicious signs, it is best for the patient to go to the hospital for examination and diagnosis in the most accurate way.

Currently, the survival prognosis of cancer patients is increasingly improved thanks to new cancer drugs such as targeted therapy or immunotherapy.
The best treatment for a patient with metastatic brain cancer will depend on the size, number, and location of the tumor, as well as the signs and symptoms, general health, and wishes of the patient. . Among them, the main methods include:
Medical treatment: Using high doses of corticosteroids to reduce swelling and edema around the tumor and reduce neurological signs and symptoms.
Surgery: Surgery is an option when the metastases are unifocal and the metastatic brain tumor is in an accessible location during surgery, the surgeon will cut to remove as much of the cancer as possible.
Radiation therapy: Radiation therapy is the use of high-energy beams such as ionizing radiation to kill cancer cells. For metastatic brain tumors, treatment may include one or both of two types of radiation therapy: whole brain radiation therapy or high-dose SRS focused radiation therapy.
Whole brain radiation therapy has been used for decades, for multifocal or inoperable brain metastases. This method can reduce the tumor by 25-50%, improve symptoms but cannot increase the patient's survival. SRS radiation therapy is a great advancement of radiotherapy machinery and technology, which can increase the dose very high to the tumor with the most accuracy to control the tumor while also increasing the patient's survival. Research results show that SRS radiation therapy can cause tumor reduction response to 70-90% and increase survival time about 15 months compared to whole brain radiation therapy only 5 months. Today, the treatment of brain metastases with SRS brain radiosurgery is a new technique applied at the world's leading radiotherapy centers and is currently being routinely applied at Vinmec International General Hospital. .
The hospital is equipped with an Optical Surface Monitoring System (OSMS) to observe the patient's head movement accurately to each mm, without the need for cranial drilling to fix the head like Gamma Knife radiation in other units.
In addition, the Encompass dedicated head immobilization system of Qfix (USA) is also specially designed to be used specifically for this SRS radiation system, ensuring the most accurate head fixation of the patient. but still keep the comfort and lightness during radiotherapy to help the treatment process achieve optimal results.