Sometimes, cancer cells spread from where the cancer first started (the primary site) to other parts of the body. When the cells reach another part of the body, they may grow and form another tumour. This is called a secondary cancer or a metastasis.

Some types of primary cancer are more likely to spread to the brain. These include cancers of the lung, breast, bowel or kidney and a skin cancer called melanoma.

This information is about secondary brain cancer. You may find it helpful to read it with our information about the type of primary cancer you have. We have other information about tumours that start in the brain, which are called primary brain tumours.

Secondary brain cancer can cause the same symptoms as primary brain tumours.

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.

A doctor may suspect secondary brain cancer if:

• you have had cancer before, even a long time ago
• secondary cancer has also been found in other places, such as the liver or bones
• there is more than one tumour in the brain (primary brain tumours usually only affect one area of the brain).

Some people have no symptoms but secondary brain cancer is found during tests to diagnose the primary cancer.

Sometimes secondary brain cancer is found before the primary cancer has been diagnosed. In a small number of cases it may not be possible to find the primary cancer. This is known as secondary brain cancer from an unknown primary.

You may have a number of tests to diagnose secondary brain cancer. Your doctor will examine you thoroughly. They will test your reflexes and may test the power and feeling in your arms and legs. They may also look into your eyes using a special light and lens (ophthalmoscope), to see if the nerve at the back of the eye is swollen. This can be a sign of raised pressure on the brain caused by a tumour.

You will have a brain CT or MRI scan. Sometimes you will have a biopsy, if a tumour is found by the scans.

CT (computerised tomography) brain scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the brain. The scan takes only a few minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with.

You may be given an injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It’s important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection. You’ll probably be able to go home as soon as the scan is over.

Brain MRI (magnetic resonance imaging) scan

This scan uses magnetism to build up a detailed picture of your brain and central nervous system.

Before the scan, you’ll be asked to remove any metal belongings including jewellery. You will be given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you’ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Biopsy

Sometimes, a sample of cells from the tumour (biopsy) is taken and examined under a microscope. This can help work out if the tumour started in the brain or has spread from somewhere else. This test involves an operation. The surgeon will discuss with you whether this is needed and exactly what the operation involves. Often your symptoms and other test results give enough information to plan treatment and a biopsy is not needed.

It's not usually possible to get rid of secondary brain cancer, but treatment can shrink the tumours, slow their growth or control symptoms. Your treatment will depend on your general health, the size and number of brain tumours, and the type of primary cancer. Treatment may include steroids, radiotherapy, surgery, anti-cancer drugs and anticonvulsants.

Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about treatment benefits and disadvantages. They will also explain the risks and side effects.

You will have time to talk this through with them before you make any treatment decisions. You may be given a choice of treatment options. Let your specialist know if you need more information or time.

Steroids

Doctors prescribe steroid drugs to reduce the swelling around brain tumours. They reduce the symptoms caused by increased pressure and make you feel better. They may be given before or after surgery, and during or after radiotherapy.  For some people, steroids are the main treatment.

It’s important to take the steroids exactly as your doctor has explained. Your pharmacist or nurse will give you a steroid card. You should carry the card at all times so that in an emergency a doctor will know you are having steroid treatment. A card is not necessary if you are only having a short course of steroids.

Never stop taking your steroids suddenly, as this can make you very ill. Your doctor will gradually reduce the dose.

Possible side effects include:

• Indigestion. Take them with food and tell your doctor if you have stomach problems. They can prescribe a drug to help with this.
• Increased appetite and weight gain. This is more common when steroids are taken over a longer time. It will improve when your steroids are reduced.
• Difficulty sleeping. Avoid taking your steroids after 6pm.
• Feeling restless or agitated. Let your doctor know if this is a problem.
• A higher level of sugar in the blood. You will have blood or urine tests for this.

Taking higher doses of steroids for a longer period of time may cause more side effects. These can include mood changes or feeling low, swollen feet and legs, and raised blood pressure. It can make you more likely to get an infection too. Your muscles may also get weaker, so it is important to do some regular, gentle exercise.

Talk to your doctor or specialist nurse if you’re worried about any side effects. These will go away gradually as your doctor reduces your steroid dose.

Radiotherapy

Radiotherapy treatment uses high-energy rays to destroy the cancer cells. You may have this to slow the tumour growth and control symptoms.

You normally have radiotherapy in the hospital radiotherapy department as a series of short daily sessions. Treatment is usually given from Monday to Friday, with a rest at the weekend. The length of your treatment may vary from a couple of days to up to two weeks.

Radiotherapy has to be carefully planned to make sure it’s as effective as possible. On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. Your radiotherapy team use this scan to plan your treatment.

At the beginning of each treatment session, you lie in the same position but under the radiotherapy machine. The treatment itself only takes a few minutes. You’ll be left alone in the room but you can talk to the radiographer who will watch you from the next room. Radiotherapy is not painful, but you have to be very still for a few minutes during the treatment.

Stereotactic radiotherapy and radiosurgery

Stereotactic radiotherapy is a specialised type of radiotherapy sometimes used to treat secondary brain cancer. Several beams of radiation are given from different angles, overlapping at the tumour. This gives a high dose to the tumour and very low doses to surrounding healthy tissue so helps to reduce side effects.

Sometimes, people with fewer than four small brain tumours have stereotactic radiotherapy in one session of high-dose treatment. This is called stereotactic radiosurgery, which is also known as gamma knife treatment. Stereotactic radiosurgery doesn’t involve any surgery.

Stereotactic radiotherapy is only available in some hospitals and may not be suitable for everyone. Your cancer doctor can give you more information and talk to you about possible side effects and risks.

Side effects of radiotherapy

You may develop side effects over the course of your treatment. These usually disappear gradually over a few weeks or months after treatment finishes. Your doctor, nurse or radiographer will discuss this with you so you know what to expect. Let them know about any side effects you have during or after treatment so they can help.

Side effects of radiotherapy may include hair loss, skin reactions, feeling sick, tiredness and feeling drowsy. Your hair will usually grow back after treatment and the other side effects should gradually improve. Always tell your doctor or nurse about your side effects and let them know if any side effects get worse.

Surgery

In some cases, surgery may be used to treat secondary brain cancer. This is usually when there is only one secondary tumour and you are feeling well except for any symptoms caused by the tumour.

You will be referred to a neurosurgeon (brain surgeon) to see whether surgery is suitable for you. Surgery aims to remove all of the tumour or as much as possible. After the operation, you may have radiotherapy to treat any remaining cancer cells or to reduce the risk of the tumour returning.

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

It can take a while to recover after surgery, so it’s important to take good care of yourself. Get plenty of rest, try to eat well and follow the adviceyour doctor and specialist nurse give you.

Anti-cancer drugs

Depending on the type of primary cancer, you may be given anti-cancer drugs such as:

• chemotherapy – drugs that destroy cells including cancer cells
• targeted (biological) therapy – drugs that interfere with how cancer cells grow and survive
• hormonal therapy – drugs that change the effect of hormones on cancer cells.

Your cancer doctor will be able to tell you more about the types of drugs that are suitable for you. They will explain the side effects you may have and how they can be managed.

Anticonvulsants

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

You must stop driving straight away if you are diagnosed with a secondary brain tumour. You may not be allowed to drive for a period of time after your treatment finishes. This will depend on:

• the number of tumours you have
• where the tumours are in the brain
• whether you have had any seizures
• your treatment
• your type of driving licence.

If you drive, this change to your daily life can be upsetting. But it’s important to follow the advice you are given.

If you live in England, Scotland or Wales, you will need to contact the Driver and Vehicle Licensing Agency (DVLA) to tell them about your illness. Have a look at their information about medical conditions and driving or call 0300 790 6806 for more information. If you live in Northern Ireland, you can contact the Driver and Vehicle Agency (DVA) on 0845 4024 000 or have a look at their online information. These agencies will advise you of any restrictions on your right to drive.

If you’re not sure what you should do, check with your cancer doctor or specialist nurse. They will explain things to you.

You will be seen at the clinic to have regular check-ups and sometimes further scans. Always tell your specialist doctor and nurse if you have symptoms or side effects that don’t improve. There are different ways in which symptoms can be managed.

Being diagnosed with secondary cancer in the brain can be overwhelming. It’s common to feel shocked and frightened, or angry. Talking about your feelings to family and friends can often help you to feel supported.

There are different types of support available to help you cope if you are finding it difficult talk to you cancer doctor or nurse. We have more information about coping with advanced cancer that you may find helpful.