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Metastasis is the spread of the cancer to other parts of the body separate from where the cancer originated. Sometimes this happens before patients are even diagnosed. For others, it may never happen. Many patients with mesothelioma will die before this happens, because the spread of the cancer within the chest cavity is typically very aggressive.
The most common sites for metastatic tumors in mesothelioma patients are the liver, kidneys, and the second lung. A small percentage of patients experience brain metastasis. A brain tumor is particularly difficult to treat and can cause serious problems. Treatment may include radiation and surgery. 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 its original location to other parts of the body. Metastatic cancer is stage IV, the most advanced stage for most cancer types. Mesothelioma is no exception and stage IV is defined by metastasis, although not all mesothelioma patients live long enough to experience this stage.
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 rather than brain cells. The ability of cancer to spread through the body is one characteristic that makes it dangerous and potentially fatal. Cancer spreads when cells from the original tumor break off and travel through the walls of blood vessels or lymph nodes. From there, the cells can move through the blood or lymphatic system to lodge in other parts of the body.
Metastatic Brain Tumors
When the spread of cancer results in one or more brain tumors, it is called metastatic mesothelioma. The tumors are referred to as metastatic brain tumors because they were the result of metastasis. This is sometimes called secondary brain cancer. Cancer that originates in the brain is referred to as primary brain cancer. Secondary brain cancer is much more common than primary brain cancer.
Metastases to the brain occur in a few common areas. These areas are the cerebral cortex, the cerebellum, and the brain stem. Most metastatic brain tumors develop in the cerebral cortex. The cerebral cortex 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, including kidney, bladder, breast, and lung cancers, as well as leukemia.
Examples of Brain Tumors in Mesothelioma Patients
Overall, it is rare for mesothelioma to spread to the brain. Because the numbers are so low, the majority of these are presented as case reports. For example, one study looked at 150 patients with malignant mesothelioma from 1993 to 2014. Only eight patients, or 5.3% of patients had developed brain metastasis. Patients may be offered surgery or radiation, although there is not enough research or volume to have clear guidelines for treatment. Overall, those patients that developed brain metastasis had a poorer outcomes. Another 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. However, a confirmed diagnosis requires imaging scans. CT scans or MRIs of the brain can locate tumors and confirm 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, palliative treatment is important. Treatment strategies during stage IV cancer can help patients feel better and enjoy a greater quality of life. It is important for patients and doctors to understand the possibility of brain metastasis and recognize the symptoms. This is important for adequate treatment .
Symptoms of metastatic brain tumors include poor coordination, headaches of increasing frequency or severity, memory loss and other cognitive difficulties like problem solving. Other symptoms include tingling and numbness, personality changes, fatigue, seizures, vomiting, speech difficulties, vision changes, and unusual behaviors. The pressure that tumors put on the brain is the main reason that symptoms are so varied.
Treatment and Palliative Care
Treatment for metastatic brain tumors in patients with late-stage mesothelioma is largely palliative, helping the patient feel more comfortable. Treatments to reduce the tumor size can reduce pressure on the brain and potentially relieve symptoms. Chemotherapy, a highly effective cancer treatment, is typically not used for metastatic brain tumors. These brain tumors do not respond well to most chemotherapy drugs.
Better treatments for reducing metastatic tumors are surgery or radiation. Sometimes both are used together. Surgery is most often used if there is one large tumor in the brain. Removing mutiple small tumors can prove too difficult and risky. If there are multiple tumors spread throughout the brain, radiation to the entire brain is the most likely treatment strategy. Also, surgery followed by radiation is sometimes an option for treatment.
Patients with metastatic brain tumors may also benefit from treatments that target symptoms. For example, anticonvulsant drugs can be used to control seizures. Pain medications help with headaches. Also, 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 incurable. Metastasis will likely continue. Efforts to reduce tumors may extend the patient’s life and relieve symptoms for a time. However, these measures will not cure the cancer or eliminate the tumors.
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, there is no cure. However, if you have metastatic brain tumors, there are treatment options available. Talk to your medical team to find out what treatments are best suited for your particular symptoms and needs.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.