Metastatic Brain Tumors in New Jersey

Metastatic brain tumors (also known as secondary brain cancer) are cancer cells that spread from other body organs to the brain. Brain metastases are the most common form of brain cancer. Usually, metastatic brain tumors grow and exert pressure on the brain leading to altered brain functions. Signs and symptoms of brain metastases include headaches, seizures, personality changes, and memory loss. Anyone experiencing these symptoms should visit the board-certified neurosurgeons of Centers for Neurosurgery, Spine & Orthopedics (CNSO) in New Jersey for their experienced medical care.

Symptoms

Brain metastases form when cancerous cells from the primary tumor travel to the brain through the bloodstream or lymphatic system. In some cases, a metastatic brain tumor is discovered before the primary cancer is detected. In other instances, a brain tumor forms years after a primary cancer was diagnosed. Depending on where within the brain a tumor grows, it will affect the specific functions of the brain causing the corresponding focal neurological symptoms as well as non-focal symptoms.  Upon physical neurological examination by a CNSO neurosurgeon, they will be able to detect whether the symptoms experienced could indicate the presents of a brain tumor. 

The common non-focal signs of a brain tumor, regardless of whether it is primary or a metastatic brain tumor include:

• Seizures
• Headaches
• Vomiting
• Loss of balance
• Weakness on one side effecting both the arms and legs
• Memory loss
• Speech disruption

Brain tumors can also cause a wide range of changes in a patient’s mental status and personality. These changes range from subtle personality changes and mood swings to, if not treated, lethargy, comatose then death. The cause for the progression is a rapidly growing metastatic brain tumor will increase in size, and invade other parts of the brain which will affect physical and cognitive function. This damage to essential brain structures might not be fully restored regardless of how expediently treatment is provided but the sooner a brain tumor is detected, the greater the likelihood the patient will experience a full recovery.

Causes & Risk Factors

The risk of developing metastatic brain tumors depends on the type of primary cancer, the stage at which it is first diagnosed, and the patient’s age. Any systemic cancer may spread to the brain, but some types of cancer pose a significantly higher risk of doing so. Malignancies such as breast, lung, skin, kidney, and colon cancers are most likely to metastasize in the brain.

The type of primary malignancies leading to brain metastasis differs between men and women. Lung cancer metastasis is more likely to cause brain tumors in men, whereas breast cancer is a leading cause of brain tumors in women. Metastatic brain tumors are more common in adults than in children. The risk of developing tumors is also related to age. It increases after the age of 45 but is highest in people over 65 years old.

Diagnosis

Patients should seek medical advice once the symptoms become apparent. However, some signs of metastatic brain tumors can be ambiguous and unclear. Whichever the case, many doctors can determine a diagnosis through various testing methods.

After a patient describes their signs and symptoms, the physician may order a workup to establish the presence or absence of the tumors. Common ways to test and detect metastatic brain tumors include:

• Neurological exams: The exam checks a patient’s hearing, balance, vision, strength, coordination, memory, cognitive skills, and reflexes. Challenges in one or more areas may indicate which parts of the brain are impacted.
• Computed axial tomography (CT or CAT Scan): This diagnostic imaging procedure uses special X-ray measurements to provide detailed brain information, including injuries and diseases. The doctor may perform a CT scan with or without contrast – a dye to study an area more clearly. Contrast examination may require the patient to fast for several hours before the procedure.
• Magnetic resonance imaging (MRI): This procedure produces detailed brain images using radio waves and magnets. It’s often paired with an intravenous contrast agent to provide detailed information about the tumor, including its size, characteristics, location, and pressure effects. 
• Biopsy: At the time of the brain surgery, the CNSO neurosurgeon will prepare a specimen (sample) of the brain tumor to be analyzed by a pathologist. If a tumor resection is not necessary, a small tissue sample may be all that is required. In either instance, the pathologist will further prepare the specimen via histologic staining, plus examined it under a microscope to determine the type of brain tumor, whether it is primary or metastatic cancer, and whether it is benign (noncancerous) or malignant (cancerous).

Treatment

Treatment options depend on the type of brain tumor, its size, location, and stage (spread within the body). Other critical factors include the patient’s health, comorbidities, and medical history. The neurosurgeon, oncologist, and radiation oncologist, need a precise brain tumor diagnosis to determine whether surgical resection alone, with chemotherapy, or with radiation therapy is the optimal treatment. Also taken into consideration is whether the patient is clinically stable plus the stage and grade of the cancer.

A further discussion about primary and metastatic brain tumor treatment options fall into three broad categories – medications, surgical procedures, and types of radiation.

Medication

Prescribed medication helps to control some of the most problematic symptoms of a brain tumor and makes the patient more comfortable. Medication typically includes:

• Anti-seizure medication: Prevents seizures from occurring thereby preventing the associated trauma.
• Pain Medication: Minimizes headache pain.
• Steroids: Reduces brain swelling (edema) caused by the growth of the brain tumor. 
• Chemotherapeutic drugs: Attacks and kills rapidly dividing cancer cells. These medications can simultaneously treat both brain and other tumor sites throughout the body. 

Surgery

The specific location of the brain tumor growth determines whether a minimally invasive surgery, endoscopic surgery, craniotomy or radiation type surgery is best. Neurosurgeons use magnetic resonance imaging (fMRI) to determine the precise tumor location and plan the appropriate surgery. The neurosurgeons at CNSO use advanced intraoperative neuronavigational systems to visualize the tumor and their vantage point which allows them to perform minimally invasive brain surgery that is highly successful and provides for a rapid recovery. 

Surgery provides tissue for biopsy to confirm the type of brain tumor, eliminates troubling symptoms, halts further progression of worsening symptoms, arrests cancerous invasion, and returns the patient to their baseline ability to function without the tumor. CNSO surgeons only recommend surgery if it will provide great relief to the patient’s symptoms, increase life expectancy, and improve the quality of life.

Radiation Therapy or Treatment

Radiation therapy kills tumor cells using high-energy beams from the excitation of protons or electrons. Neurosurgeons prescribe the type of radiation treatment. Radiation oncologists prescribe the specific dose of one or more types of radiation therapy and the method of administration to treat brain metastases. Below are examples of the methods of administering radiation to a patient:

• Whole-brain radiation: This treatment therapy is applied to the whole brain to kill the cancer cells. The treatment regimens are comprised of 10 to 15 treatment sessions spread over two or three weeks.
• Stereotactic radiosurgery (SRS): This method kills cancer cells by directing multiple beams in a very targeted technique that delivers a large dose of radiation to the brain tumor. It may be administered after brain surgery to kill residual malignant cells in the resection bed. SRS is often done in one treatment and can target multiple tumors in a single session. Linac and GammaKnife use SRS to administer radiation
• Proton Therapy: Can target very small areas of the brain thereby limiting the about of exposure to the surrounding location.

Prognosis

The effectiveness of treatment for brain metastases depends on the severity of spread to the brain and controlling primary cancer. The prognosis of a metastatic brain tumor depends on the time-lapse between primary cancer and brain metastasis, state of primary cancer, and neurological deficit. Other critical factors include the type and size of the primary tumor and the effect of the metastatic lesion. A routine, systematic aftercare, complete with regular imaging studies, is crucial in order to monitor whether there is any progression of the cancer.

The New Jersey CNSO Neurosurgeons Can Help

The professional team of experienced neurosurgeons at Centers for Neurosurgery, Spine & Orthopedics specialize in treating metastatic brain tumors. Each of the board-certified neurosurgeons at CNSO team has successfully been extracting brain tumors and collaboratively working with radiation oncologists for over a decade. They are compassionate and will provide each patient with a comprehensive, personalized treatment plan including coordination with all specialists up to and including the physical rehabilitation specialists in order to support a quick recovery.

Contact the specialists at any one of the six CNSO locations in West Orange, Paramus, Jersey City, Morristown, and Wayne, New Jersey to learn more about brain tumor treatment and the best path forward.