Brain metastases refer to the spread of cancer from its original site to the brain. This can occur with many types of cancer, including lung, breast, melanoma, and colon cancer. Brain metastases can cause a variety of symptoms, such as headaches, seizures, cognitive changes, and weakness or numbness in the limbs. Treatment options may include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of these approaches. The specific treatment approach will depend on the type and extent of cancer, as well as the individual's overall health and preferences. It is important to work closely with a healthcare professional to manage brain metastases and prevent potential complications, such as neurological deficits or impaired quality of life.

Brain metastases occur when cancer cells break away from their original location. The cells may travel through the bloodstream or the lymph system and spread (metastasize) to the brain where they begin to multiply.

Metastatic cancer that spreads from its original location is known by the name of the primary cancer. For example, cancer that has spread from the breast to the brain is called metastatic breast cancer, not brain cancer.

Treatment for brain metastases can help ease symptoms, slow tumor growth and extend life. Even with successful treatment, brain metastases often recur, so your doctor will recommend close follow-up after treatment.

Treatment options for people with brain metastases often include medication, surgery, stereotactic radiosurgery, whole-brain radiation therapy or some combination of these. In certain situations, your treatment team may consider drug treatments for brain metastases.

What treatments are best for you will depend on the type, size, number and location of the tumors, as well as your signs and symptoms, overall health, and preferences. Talk with your doctor about your goals for treatment.

Medications to control symptoms

Medications can help control signs and symptoms of brain metastases and make you more comfortable. Options might include:

• Steroid drugs. High-dose corticosteroids may be used to ease swelling around the brain metastases in order to reduce signs and symptoms.
• Anti-seizure drugs. If you experience a seizure, your doctor may recommend medicine to prevent additional seizures.

Surgery

If surgery is an option for you and your brain metastases are located in places that make them accessible for an operation, your surgeon will work to remove as much of the cancer as possible. Even removing a portion of the tumor may help reduce your signs and symptoms.

Surgery to remove brain metastases carries risks, such as neurologic deficits, infection and bleeding. Other risks may depend on the part of your brain where your tumors are located.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays and protons, to kill tumor cells. For brain metastases, your treatment may involve one or both of the following radiation therapy methods:

• Whole-brain radiation. Whole-brain radiation applies radiation to the entire brain in order to kill tumor cells. People undergoing whole-brain radiation usually require 10 to 15 treatments over two to three weeks.
• Side effects may include fatigue, nausea and hair loss. Long-term, whole-brain radiation is associated with cognitive decline.
• Stereotactic radiosurgery. With stereotactic radiosurgery (SRS), each beam of radiation isn't particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells. SRS is typically done in one treatment, and doctors can treat multiple tumors in one session.
• Side effects may include nausea, headache, seizures, and dizziness or vertigo. The risk of long-term cognitive decline after SRS is thought to be less than that with whole-brain radiation.

In recent years, doctors and researchers have made significant advances in their understanding of whole-brain radiation, stereotactic radiosurgery and how these two methods affect people's survival, cognitive ability and quality of life. In deciding which type of radiation therapy to use, you and your doctor will consider many factors, including what other treatments you're undergoing and the potential for you to experience cancer recurrences after treatment.