Mesothelioma Brain Metastasis
One of the characteristics of stage IV mesothelioma is metastasis, the spread of the cancer to more distant parts of the body. Many patients with mesothelioma will pass away before this happens. The spread of the cancer within the chest cavity is often damaging enough. However, some patients do experience metastasis, including the spread of the cancer to the brain.
The most common sites for metastatic tumors in patients with mesothelioma are the liver, kidneys, and the second lung. However, brain metastasis is possible and occurs in a small percentage of patients. A brain tumor can cause serious symptoms, and treating it can be challenging. Treatment may involve radiation and surgery, but chemotherapy is typically not helpful. At this stage of the disease the goal of most treatments is palliative care.
What is Metastasis?
Metastasis is the spread of cancer beyond the local and regional areas of the body in which it originated, on to distant parts of the body. Metastatic cancer is typically also considered to be stage IV, or the most advanced stage of cancer for most types. Mesothelioma is no exception and stage IV is defined by metastasis, although not all patients with mesothelioma live long enough for metastasis to be an issue.
The cancer cells that make up metastatic tumors resemble those from the original tumor. So, when someone with mesothelioma develops metastatic brain tumors, the tumor cells actually resemble mesothelioma cells, not brain cells. The ability of cancer to spread throughout the body is what makes it so dangerous. It happens when cells from the original tumor break off and ultimately migrate through the walls of blood vessels or lymph nodes. From there the cells can move through the blood or lymphatic system to invade other parts of the body, like the brain.
Metastatic Brain Tumors
When the distant spread of cancer results in one or more tumors in the brain, it is called metastatic mesothelioma. The tumors are referred to as metastatic brain tumors to communicate that the tumors did not originate there, but were the result of metastasis. This type of cancer is sometimes referred to as secondary brain cancer, while cancer that originates in the brain is primary. Secondary brain cancer is much more common than primary brain cancer.
Metastases to the brain tend to occur in a few common areas: the cerebral cortex, the cerebellum, or the brain stem. The majority of metastatic brain tumors develop in the cerebral cortex, which is the largest part of the brain and is responsible for language, memory, senses, consciousness, and many other functions. Although metastatic brain tumors can result from mesothelioma, other types of cancer more commonly cause them. These include kidney, bladder, breast, and lung cancers, as well as mesothelioma and leukemia.
Examples of Brain Tumors in Mesothelioma Patients
Metastatic brain tumors caused by mesothelioma are not very common, but they do occur. One study investigated seven cases of children with mesothelioma and found that three of them had metastasis to the brain. Another case study looked at two patients with pleural mesothelioma who ended up with metastatic brain tumors. The researchers concluded that more research needed to be done to describe the condition and that early detection of symptoms of brain tumors in mesothelioma patients could help them get better palliative care.
Mesothelioma patients may be diagnosed with metastatic brain tumors because of characteristic symptoms. A confirmed diagnosis, though, must be done with imaging scans. CT scans or MRIs of the brain can help locate tumors and confirm that the cancer has spread to the brain. These scans can also help guide treatment. Research suggests that the earlier the metastasis is discovered and diagnosed, the more effective treatments will be in relieving symptoms.
Symptoms of Metastatic Brain Tumors
While there is no hope of curing mesothelioma once it has spread to other parts of the body, like the brain, palliative treatment is important. Treatment strategies, even during stage IV cancer, can help patients feel better and enjoy a greater quality of life with the time they have left. It is important for patients and doctors alike to be aware of the possibility of brain metastasis and to recognize the symptoms so that adequate treatment can be provided.
Symptoms of metastatic brain tumors include poor coordination, headaches of increasing frequency or severity, loss of memory and other cognitive difficulties like problem solving, tingling and numbness, changes in personality, fatigue, seizures, vomiting, speech difficulties, changes in vision, and unusual behaviors or rapidly changing emotions. The pressure that tumors put on the brain is the main reason that they cause so many potential and varied symptoms.
Treatment and Palliative Care
Treatment for metastatic brain tumors in patients with late-stage mesothelioma is largely targeted at palliative care, helping the patient feel more comfortable. Treatments are used that can reduce the size of the tumors in the brain, thereby reducing pressure on the brain and relieving symptoms. Chemotherapy, which is one of the most effective types of treatment for many types of cancer, is not often used for metastatic brain tumors. In most cases, the brain tumors do not respond well to chemotherapy.
Better treatments for reducing the size of metastatic tumors are surgery or radiation. Sometimes both of these are used together. Surgery is most often used when there is one large tumor in the brain. Trying to remove multiple smaller tumors may be too difficult. If there are multiple tumors spread throughout the brain, radiation to the entire brain is the most likely treatment strategy. A combination of surgery, followed by radiation to reduce more of a tumor is also sometimes an option for treatment.
Patients with metastatic brain tumors may also benefit from treatments that target the symptoms, without directly affecting the tumors. Anticonvulsant drugs, for instance, can be used to control seizures. Pain medications help with headaches. Corticosteroids or diuretics may be used to reduce swelling in the brain.
Unfortunately, the prognosis for metastatic brain tumors is not good. Cancer that has spread to the brain, whether from mesothelioma or another type of cancer, is considered incurable. Metastasis is likely to continue, and all efforts at reducing the tumors may extend the patient’s life and relieve symptoms for a time, but will not cure the cancer or eliminate the tumors entirely.
Living with mesothelioma in its advanced stages is difficult. It can be uncomfortable and painful, especially if the cancer has spread to the brain. Treatment at this stage is challenging, and while doctors may be able to reduce tumors, they will not be able to cure the cancer. If you have metastatic brain tumors, you have options for treatment, though. You should be able to get some relief from symptoms, so talk to your medical team about what you can do and what kinds of treatments may be best for your particular symptoms and needs.
Page edited by Dave Foster
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