Brain cancer, secondary

Secondary brain cancer can cause similar symptoms to primary brain tumours.

As a tumour grows, it can press on or grow into nearby areas of the brain. This can cause symptoms because it stops that part of the brain from working normally.

The first symptoms may be due to the tumour causing a build-up of pressure inside the skull. This is called raised intracranial pressure.

Symptoms depend on where the tumour is in the brain. They can include:

• headaches
• feeling or being sick
• seizures (fits)
• changes in personality or being confused
• numbness or weakness on one side of the body
• problems with speech
• problems with eyesight.

Some people might not have any symptoms. Instead, the tumour may be found during tests to find out more about the primary cancer.

Treatment for secondary brain cancer can help shrink the tumours, slow their growth and control symptoms. But secondary brain cancer cannot usually be cured. Your treatment will depend on: your

• general health
• the size, position and number of brain tumours
• the type of primary cancer
• the size of the primary cancer and how many places it has spread to.

Treatment for brain metastases (secondary brain cancer) may include radiotherapy and sometimes surgery. You will also have treatment to help control the symptoms, such as steroids and drugs to control seizures (anticonvulsants). Depending on the type of primary cancer, you may also have other anti-cancer treatments such as chemotherapy or targeted therapy.

A team of specialists will plan your treatment. Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about the benefits and risks of different treatment types. They will also explain the side effects.

You may be given a choice of treatment options. You will have time to talk this through with your hospital team before you make any treatment decisions.

You will need to give your consent for the hospital staff to give you the treatment. Ask any questions about anything you do not understand or feel worried about. Tell your specialist if you need more information or more time to decide on a treatment.

Doctors prescribe steroids to help reduce symptoms of tumours in the brain. The symptoms are caused by swelling in the brain, which may cause increased pressure inside the skull. Steroids help to reduce the swelling, which can help you feel better. It can also help with other symptoms such as weakness.

Radiotherapy uses high-energy rays to destroy cancer cells and control the tumour. It can slow tumour growth and control symptoms. The type of radiotherapy you have will depend on the size, position and number of tumours. Your doctor will explain what treatment is best in your situation.

A type of radiotherapy called stereotactic radiosurgery (SRS) can be used to treat some secondary cancers in the brain. SRS aims to give a higher dose of treatment to the tumour. It may be given when there is only 1 tumour, or a few small tumours, and the primary cancer is under control. SRS is given in 1 session and does not involve any surgery.

You may be offered radiotherapy to the whole brain if:

• there are a higher number of brain tumours
• they are large
• they affect the meninges (the covering of the brain).

This is usually given in daily sessions over 1 to 2 weeks.

Your specialist doctor or nurse will explain your treatment and possible side effects. Most side effects are short-term and will improve gradually when the treatment is over. We have more information about coping with the side effects of radiotherapy for a primary brain tumour.

In some cases, surgery may be used to treat secondary brain cancer. This is usually when there is only 1 secondary brain tumour.

Sometimes if there is more than 1 tumour, it may be possible to have surgery to remove the larger tumour and have targeted radiotherapy to the smaller tumours. This will depend on:

• the size and number of tumours
• how well you are
• if the primary cancer is well-controlled.

Surgery may also be used if you have pressure inside the skull.

Any brain surgery is a major operation. You need to be well except for any symptoms caused by the tumour. The operation is similar to the type of operation used to treat a primary brain tumour.

You will be referred to a brain surgeon, called a neurosurgeon. They will decide whether surgery is suitable for you. Surgery aims to remove all of the tumour. If it is not possible for your surgeon to remove all of the tumour, they will remove as much as they safely can. After the operation, you may have radiotherapy to treat any remaining cancer cells.

Your surgeon will explain what your operation will involve. They will talk to you about the possible complications and risks.

Depending on the type of primary cancer you have, you may have anti-cancer drugs. Your cancer doctor will be able to tell you more about the types of drugs that might be suitable for you.

You may have:

• chemotherapy – drugs that destroy cancer cells
• targeted therapies – drugs that interfere with how cancer cells grow and survive
• immunotherapy – drugs that use the immune system to attack cancer cells
• hormonal therapies – drugs that change the effect of hormones on cancer cells.

Your doctor will explain any side effects you may have and how they can be managed.

If you have had seizures (fits), you may be given drugs called anticonvulsants to help reduce the risk of having seizures. Side effects will depend on the type of drug you take.

Your doctors and nurses will ask about any other symptoms or side effects you may have. It is important to talk to them about these so they can give you the right help. They may refer you to a palliative care team. They are experts in managing symptoms. There are palliative care teams based in hospitals and the community. Your GP or cancer specialist can refer you to a palliative care team. We have more information about advanced cancer.

Following diagnosis and treatment for a brain tumour, most people will not be allowed to drive for a period of time. If you drive, it is important to discuss with your doctor how your diagnosis and treatment for a secondary brain cancer affects your right to drive.

If you have a driving licence, you must tell the licencing agency (DVLA or DVA) that you have been diagnosed with a brain tumour. Talk to your doctor or specialist nurse about your individual situation. We have more information about how a brain tumour may affect your right to drive.