Secondary brain tumours
Secondary brain tumours occur when cancer cells have spread to the brain from a cancer that has started in another part of the body.
What is a secondary brain tumour?
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The place in the body where a cancer first starts is called a primary tumour.
A secondary tumour occurs when cancer cells break away from the primary tumour and travel through the blood system to another part of the body. When cancer cells spread to another part of the body they are called secondaries or metastases.
Some types of cancer are more likely to spread to the brain. The most likely are cancers of the lung, breast, bowel, kidney (renal) and skin (malignant melanoma).
Secondary brain tumours can cause the same symptoms as primary brain tumours. It's important to know if a tumour in the brain is a primary or secondary cancer as the two are treated differently.
Signs and symptoms of secondary brain tumours
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The most common symptoms of secondary brain tumours are:
weakness in areas of the body
mood swings and changes in behaviour
feeling or being sick
A doctor may suspect a secondary brain tumour if:
You have a history of cancer elsewhere in the body, even from a long time ago, which could have spread to the brain.
When the rest of your body is scanned, secondaries are also found in other places, such as the liver or bones.
Tests show that there is more than one tumour in the brain - primary brain tumours usually remain and grow in one place. If there is more than one secondary tumour in the brain, these are sometimes called multiple brain secondaries.
Some people with secondary brain tumours have no signs or symptoms and their secondaries are discovered during investigations of their primary tumour.
Sometimes secondaries are found before the primary cancer has been diagnosed. In a small number of cases it may not be possible to find the original cancer. In this situation, the tumour is known as a secondary brain tumour from an unknown primary.
Diagnosis of secondary brain tumours
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To diagnose a secondary brain tumour, the doctor will examine you thoroughly. They will test your reflexes and may test the power and feeling in your arms and legs.
Your doctor will look into the back of your eyes using an ophthalmoscope to see if the optic nerve at the back of the eye is swollen. This can be caused by swelling of the tissues within the brain, due to increased fluid in the brain (oedema).
CT or MRI scans can sometimes show the difference between secondary and primary tumours.
CT (computerised tomography) scan
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10-30 minutes. CT scans use small amounts of radiation, which will be very unlikely to harm you or anyone you come into contact with.
You may be given an injection of dye which allows particular areas to be seen more clearly on the scan. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
MRI (magnetic resonance imaging) scan
This test is similar to a CT scan, but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it's safe for you to have an MRI scan.
Before having the scan, you'll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan show up more clearly. During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It's also noisy, but you'll be given earplugs or headphones.
If there is only one tumour in the brain, and tests have shown there has never been cancer elsewhere in the body, the doctors may need to take a sample of cells (biopsy) from the tumour. You will be referred to a neurosurgeon for this and they will discuss what is needed in your case and what the operation involves. An excision biopsy may be considered.
The cells from the biopsy are examined under a microscope. The appearance of the cells will help the doctors know whether the tumour started in the brain or elsewhere. For example, if a lung cancer has spread to the brain, the tumour cells would look like lung cells, and it would be diagnosed as a secondary brain tumour.
Treatment for secondary brain tumours
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It's not usually possible to get rid of a secondary brain tumour completely, but treatment can sometimes shrink the tumour, slow its growth and control symptoms.
Being told you have secondary cancer in the brain can be a huge shock, even if doctors have prepared you for this possibility. It's important to discuss any questions, fears and treatment options with your doctor.
Before you have any treatment, your doctor will give you full information about the aims of the treatment and what it involves. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.
Benefits and disadvantages of treatment
Treatment can be given for different reasons and the potential benefits will vary for each person. When a cure is not possible and the treatment is to control the cancer for a period of time, it may be difficult to decide whether or not to go ahead.
If you feel that you can’t make a decision about the treatment when it is first explained to you, you can always ask for more time to decide.
You are free to choose not to have the treatment and the staff can explain what may happen if you decide not to have it. You don’t have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.
There are various treatments that can be used for secondary brain tumours.
Steroids are chemicals naturally produced in the body that help control and regulate how the body works. Steroids can be given as tablets or by injection, and can reduce the swelling that often surrounds secondary brain tumours. Although steroids do not treat the tumour itself, they can improve symptoms and make you feel better. They may be used before, during or after radiotherapy or before or after surgery.
Radiotherapy is the use of high-energy x-rays and similar rays (such as electrons) to treat disease. Beams delivered from outside the body (external radiotherapy) is the most common treatment for secondary brain tumours. It's normally given as a series of short, daily treatments using equipment similar to a large x-ray machine.
The length of your treatment can vary from a couple of days to up to two weeks.
Side effects of radiotherapy to the head include hair loss, skin reactions, tiredness and feeling drowsy. Your hair will usually grow back after treatment and the other side effects should gradually improve.
We have more information about how radiotherapy is planned and given.
In some cases, surgery may be used if the scans show that there is only one secondary tumour in the brain and the person is generally well enough, apart from symptoms caused by the pressure from the tumour.
You will be referred to a neurosurgeon (brain surgeon) to see whether surgery is suitable for you. After the operation, radiotherapy may be given to reduce the chances of the tumour returning. Surgery isn't usually recommended when there are two or more brain secondaries, although it may be used to relieve pressure in the head.
Some people with only one or two secondary tumours may have stereotactic radiosurgery. This is a radiotherapy technique that delivers a very accurate high dose of radiation targeted to the tumour which causes less damage to surrounding tissue. One to three sessions of radiotherapy may be needed. This treatment may also be used for a secondary tumour that persists after previous radiotherapy to the whole brain.
Stereotactic radiosurgery is available only in specialist hospitals and is only suitable for some people. You can discuss with your clinical oncologist whether it is appropriate for you.
If chemotherapy is given, it has to be a type that is able to cross the membranes that protect the brain and spinal cord (the 'blood-brain barrier').
In certain cancers that have spread to the brain, hormonal therapy or immunotherapy may be used.
Your doctor will be able to tell you more about the appropriate treatments for you.
Medicines for seizures
If you have seizures (fits) you may be given a medicine called an anticonvulsant to help prevent them.
The idea of a secondary cancer affecting your brain can be very frightening. You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions, and are part of the process many people go through in trying to come to terms with their condition.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.
The Drivers and Vehicle Licensing Association (DVLA) will not allow you to drive for 1-2 years after diagnosis of a secondary brain tumour, depending on the grade of the tumour. If you have also had epilepsy, the DVLA will not allow you to drive for a year after your last seizure.
You may not be allowed to drive certain vehicles, such as a large goods vehicle or a passenger-carrying vehicle.
The hospital will not contact the DVLA. It is your responsibility to do this and your doctor will advise you on how to go about this. You can contact the DVLA by phone on 0300 790 6806 or at dvla.gov.uk
This information has been compiled using information from a number of reliable sources, including:
Bernstein & Berger. Neuro-oncology – the essentials. 2nd edition. 2008. Thieme.
Souhami, Hochhaser. Cancer and its management. 6th edition. 2010. Wiley-Blackwell.
Wen, Loeffler. Overview of the clinical manifestations, diagnosis, and management of patients with brain metastases. www.uptodate.com (accessed January 2014).
Drappatx, Wen. Systemic therapy for brain metastases. www.uptodate.com (accessed Jan 2014).
With thanks to Dr Lucy Brazil, Consultant Clinical Oncologist who reviewed this information.
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