Metastatic Brain Tumors: Introduction

by Roy Strowd, MD

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    00:01 So how do we think about brain metastases? What are the common tumors that travel and metastasize to the brain? Well, lung cancer is common.

    00:09 A lot of people get lung cancer and so lung cancer can metastasize to the brain and it should be something that we consider.

    00:16 Breast cancer, this is the same. It's a common cancer, it's a common tumor, and patients can live a long time from systemic therapy long enough for tumors to metastasize to the brain.

    00:26 Melanoma is not as common. It's a less common cancer, but it has a predilection for the brain.

    00:31 It likes to go to the brain.

    00:33 Melanoma cells.

    00:34 Melanocytes arise from neural crest cells, which are a nerve tissue of origin, and this may allow us to understand some of melanomas predilection for the brain.

    00:45 Renal cell carcinomas can go and travel to the brain and can bleed they're an important tumor to consider, and colorectal cancer.

    00:52 So that takes us from the common to the less common tumors that like to metastasize to the brain.

    00:57 Will remember in terms of primary brain tumors, we also consider them in terms of how common they are.

    01:01 Meningiomas are the most common, followed by gliomas, and pituitary adenomas, and vestibular schwannomas.

    01:09 How do patients with brain metastases present? Well, commonly, we see new focal neurologic deficits or seizures.

    01:17 And that tells us that there is a part of the brain, the focus, where there is a problem.

    01:21 And we should image it with a CT or an MRI.

    01:24 Headache is common.

    01:25 It's seen in a quarter to a half of patients, but many things cause headache.

    01:29 And so we're really looking for headache in the setting of nausea, vomiting, or that focal neurologic deficit.

    01:37 What do we do? A patient who has a systemic cancer, a lung cancer, a breast cancer, or a melanoma, and presents with a new focal neurologic deficit should undergo imaging.

    01:47 CT is good for evaluating hemorrhage.

    01:50 And MRI is really superior for looking at lesions that occur in the brain.

    01:55 Where do we see brain metastases on imaging? Well, the most common places the hemisphere.

    02:00 And you see here 80% of brain metastases are seen in the hemispheres.

    02:05 The lesions highlighted in green here are at the gray-white junction, that border between the cortical gray matter and the subcortical white matter where there are large blood vessels for cancers to hematogenously spread.

    02:19 We also see brain metastases in the cerebellum, and occasionally in the brainstem.

    02:25 They classically appear at the gray-white junction, a very important imaging signature for brain metastases.

    02:34 Which cancer patients or which type of cancer patients should undergo evaluation with MRI for brain metastasis? Well, there's three groups that I would like for you to think of.

    02:45 The first group are patients where MRI is recommended at the time of diagnosis because they're at such high likelihood of developing brain metastasis.

    02:54 And that includes small cell lung cancer, some non-small cell lung cancers, and advanced melanoma.

    03:00 And this gets back to both small cell lung cancer and melanomas predilection to travel to the brain.

    03:06 In fact, in some of those patients, we prophylactically treat the brain to prevent those tumors from developing.

    03:12 The second group are patients where MRI is recommended if the patient develops a focal neurologic deficit.

    03:19 And this includes breast cancer, renal cell carcinoma, and colorectal cancer.

    03:23 Cancers that we know can metastasize to the brain, but not as commonly as that first group.

    03:29 The last group are cancers where we uncommonly see brain metastasis, and this includes squamous cell carcinoma of the head, neck, pancreatic cancer, and prostate cancer.

    03:38 So the patient's type of cancer can help guide us in terms to our level of suspicion for a brain metastasis.

    About the Lecture

    The lecture Metastatic Brain Tumors: Introduction by Roy Strowd, MD is from the course CNS Tumors.

    Included Quiz Questions

    1. Lung
    2. Breast
    3. Skin (melanoma)
    4. Renal
    5. Colorectal
    1. Prostate cancer
    2. Small cell lung cancer
    3. Advanced melanoma
    4. Renal cell carcinoma
    5. Non–small cell cancer

    Author of lecture Metastatic Brain Tumors: Introduction

     Roy Strowd, MD

    Roy Strowd, MD

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