When a metastatic brain tumor is diagnosed, it means that cancer cells from another organ have spread to the brain.

Sometimes called secondary brain tumors, metastatic tumors are the most common type of brain cancer. They are about 10 times more common than tumors—known as primary brain tumors—that originate in the brain. Metastatic brain tumors can occur in both children and adults, and an estimated 200,000 new cases of brain metastases are diagnosed in the U.S. every year. 

A decade and a half ago, people diagnosed with a brain metastasis survived, on average, less than 6 months. Treatments have improved in the intervening years, and today, people with brain metastases are living longer than ever before.

At Yale Medicine, a team of dedicated oncologists and neurosurgeons focus specifically on the management of brain metastases. These world-renowned experts use state-of-the-art equipment to provide patients the best possible care.

"Today we are very much a part of first-line treatment for many of these patients," says Veronica Chiang, MD, director of stereotactic radiosurgery in the Department of Neurosurgery.

When a metastatic brain tumor is diagnosed, it means that cancer cells from another organ have spread to the brain. Up to 20% of people who have cancer will develop a metastatic brain tumor. The cells that form metastatic brain tumors can originate from any organ, but most often they come from lung, breast, skin, ovarian, and intestinal cancers.

Some people with brain metastases do not experience any symptoms. However, in some cases in which a tumor has had time to enlarge and press against other parts of the brain, symptoms such as these may appear:

• Daily, constant headaches that become worse and more frequent over time, associated with vomiting or changes in vision
• Weakness or numbness on one side of the body
• Seizures
• Clumsiness, trouble walking, or decreased coordination
• Difficulty with speech comprehension or expression
• Emotional or personality changes

Brain tumors are usually detected with an imaging test, typically computed tomography (CT) scans and magnetic resonance imaging (MRI) scans.

If a tumor is found in the brain on CT or MRI and there is no pre-existing diagnosis of cancer, the doctors will typically get scans of the rest of the body to determine if the cancer came from outside the brain. If a source is found in the body, a biopsy will be obtained from that site rather than from the brain.

If the only tumor found is the one in the brain, a biopsy in the brain may be required to determine whether it is cancer and, if so, where it originated.

Doctors do not yet know why some cancers spread to the brain and others do not. What is known, however, is that brain metastases can occur in any long-term cancer survivor.

In addition, certain cancers, such as melanoma, or some subsets of other cancers—such as EGFR-mutant lung cancer and HER2-positive breast cancer—also seem to be more likely to spread to the brain.

Patients with these cancer types should undergo brain scans on a regular basis.

Treating a brain tumor is usually only one step in treating metastatic cancer. At Yale Medicine, treatment is carefully coordinated among the neurosurgery, radiation oncology, and medical oncology teams.

Treatment for brain metastases usually involves radiation and surgery, since chemotherapy has limited ability to penetrate the brain. Patients may also be given corticosteroids to reduce swelling, as well as anti-seizure medications.

Patients whose brain scans reveal only a few metastases can be considered for a targeted radiation treatment called radiosurgery. At Yale Medicine, this treatment is delivered using a machine known as the Gamma Knife. If this procedure deemed appropriate, imaging required for treatment, treatment planning, and radiation delivery can all be done in one day. 

For those with larger or more widespread brain tumors, Yale Medicine also offers the more comprehensive treatment options, including:

• Hippocampal sparing whole brain radiation therapy with memantine
• Surgical resection or laser ablation—guided by MRI in the operating room
• Microsurgical resection of tumor

Yale Medicine is the only consortium providing comprehensive brain cancer care in southern New England. This gives patients access to the full range of treatment options, from medical therapy to cutting-edge radiosurgery.

At Yale Medicine, treatment is personalized to the patient's needs, and is evidence-based, acquired through national research and experience. Discussion of challenging cases occurs at a weekly tumor board, and recommendations are communicated back to the involved physicians to ensure a seamless coordination of care.