23B. Nervous system metastases

Definition and epidemiology

Brain metastases are the most common form of adult brain tumour. 70% of brain metastases are multiple rather than solitary. Brain metastases is rare in paediatric cancers.

Etiology

  • Lung cancer
  • Breast cancer
  • Melanoma
  • Lymphoma

Clinical features

The symptoms are as for other brain tumours.

Diagnosis and evaluation

Contrast-enhanced MRi is the gold standard. Metastases are usually multifocal and have large perifocal oedema. Biopsy is performed in most cases.

Treatment

Steroids can be used to reduce the oedema. Radiosurgery (gamma knife) can be used with curative intent if there are few lesions. Otherwise, whole brain radiation therapy is usually used.

If the primary tumour is chemosensitive, chemotherapy may cure the brain metastases as well.

Other metastases

Meningeal carcinomatosis refers to metastasis to the meninges from any carcinoid tumour. This usually results in cranial nerve symptoms. Tumour cells are present in the CSF.

Metastases to the vertebral column can compress the spinal cord and cause back pain or lumboischialgia. The primary tumour may be any thoracic or abdominal cancer, most commonly prostate, lung, or breast.


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23A. Lumboischialgia and chronic back pain

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24A. Paraneoplastic nervous system diseases

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