What Causes Breast Cancer To Metastasize To The Brain
Metastasis happens when cancer cells break away from the original tumor site. These cells use the circulatory or lymphatic system to travel to a more distant part of the body, such as the brain, and establish a new tumor.
Its not possible to predict with certainty whether or not a person will develop brain metastasis. However, some factors can increase a persons risk.
How Will I Know If My Breast Cancer Spreads
Your doctor will use specific kinds of tests to find out if your cancer has gone to other places in your body. First, your doctor will want to know how youâre feeling. They will ask you about any symptoms youâre having and your overall health. They might also look at the size of your tumor and check your lymph nodes.
After that, the doctor may give you:
Blood tests. They look for signs of anything abnormal thatâs happening in your body. For example, results from a liver function test can let your doctor know that breast cancer may have gone to your liver. High levels of some substances in your blood hint that the cancer has spread to your bones.
Imaging scans. These tests make detailed pictures of the inside of your body. They help your doctor pinpoint any cancer spread. These tests include:
- X-ray
A Window Of Opportunity
In addition to pinpointing the cellular mechanics of dormant tumor cells in brain tissue, the researchers also learned that the mechanism is unique.
âOne of the major points of the study is that this process is very specific to the brain,â Ghajar said. âThe mechanism does not seem to exist anywhere else.â
The bottom line? Now that theyâve located this vulnerability, they can work on ways to target the seeds of brain mets before they have a chance to sprout.
âTumor cells need to invade, to get into the bloodstream, get out of the bloodstream, to survive in the organ theyâre trying to colonize,â Ghajar said. âPeople have always focused on the ability of these cells to survive. They thought their ability to survive was the rate-limiting step.â
This data, Ghajar said, shows that the bottleneck to brain metastasis is not cells gaining entry to the brain or surviving once there. Instead, the research definitively points to escape from dormancy as the rate-limiting step.
And that presents a window of opportunity.
âWhat we want to do ultimately is target the dormancy phase,â Ghajar said. âWe have real evidence that this is what limits metastasis. If we could keep things in this state, or if we could eliminate them while theyâre in the state, that would help prevent metastasis. Now we just have to figure out the precise way to do this. Stay tuned!â
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Natural History Of Cns Metastasis
Of the nearly 1.3 million people diagnosed with cancer in the United States each year, 100,000 to 170,000 will develop brain metastases, for an annual incidence of 4.1 to 11.1 per 100,000 population .1 Large autopsy studies suggest that between 20% and 40% of all patients with metastatic cancer will have brain metastases .14 Given their overall greater frequency, lung and breast cancer are by far the most common tumors to present with brain metastases.2,4 The incidence of symptomatic brain metastases among women with metastatic breast cancer ranges from 10 to 16%.5 On average, the median latency between the initial diagnosis of breast cancer and the onset of brain metastasis is 2 to 3 years.1,2 In most cases, breast cancer patients develop brain metastases after metastases have appeared systemically in the lung, liver, and/or bone.6 For the purposes of this review, central nervous system and brain are used interchangeably.
H& O Could You Discuss The Use Of The Diagnosis
CA Initially, the GPA score depended on the patients age, the patients performance status, and the presence or control of extracranial disease. These 3 factors were used to determine the prognosis of a particular patient. For example, a 35-year-old patient with an excellent performance status and no evidence of extracranial disease would have a better prognosis than an elderly patient with a performance status of 2 or 3 and uncontrolled lung metastases. This score helped us to tailor therapies and counsel patients on what to expect.
Since the original GPA was published, we have come to recognize that histologic subtype among patients with breast cancer also plays a role in prognosis, and the scale has been adjusted.
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Radiation Therapy For Metastatic Brain Tumors
Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.
These painless treatments involve passing beams of radiation through the brain, which can treat cancers in areas that are difficult to reach through surgery. Procedures may include any one or a combination of the following:
- External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
- Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
- Stereotactic radiosurgery directs a high dose of radiation targeted to the specific shape of the tumor, sparing surrounding healthy tissue from unnecessary radiation exposure.
- Proton therapy uses protons to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.
Because radiation therapy has been so successful in treating brain metastases and because many live long lives after treatment studies are now looking at how to manage the long-term effects of treatment.
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Treatment For Metastatic Breast Cancer
There are a number of different approaches to treating metastatic breast cancer. Every cancer is unique and treatment can be tailored to your specific circumstances.
Doctors usually treat metastatic breast cancer in any part of the body with systemic medications, which treat cancer throughout the entire body. Chemotherapy, hormonal therapy, targeted therapies, and immunotherapy are all systemic medications. Local treatments that target a specific part of the body, such as surgery or radiation, are sometimes recommended.
Most treatment decisions depend on where in the body the cancer has spread, the cancers characteristics , and any cancer treatments youve had in the past.
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Breast Cancer Metastasis To The Brain
Breast cancer sometimes metastasizes to the brain. This condition is commonly referred to as “secondary breast cancer in the brain.” Brain metastases occur in approximately 10%-15% of women with stage 4 breast cancer. In some cases, the breast cancer metastasizes directly to the brain in others, the breast cancer metastasizes to another area of the bodysuch as the lungs, liver or bonesbefore it reaches the brain.
Some people assume that a brain metastasis is brain cancer. However, thats not the case. The distinction between brain cancer and brain metastases lies in where the cancer originatedbrain cancer involves tumors made up of cancerous brain cells, while brain metastases involve tumors made up of cancerous cells from elsewhere in the body .
If Your Breast Cancer Has Spread
Even if your breast cancer has spread to other parts of your body, it does not necessarily mean its not treatable. If the cancer cannot be removed, the goal of treatment is to improve symptoms, improve quality of life and extend survival.
Some women live with breast cancer for several years as they learn to adjust and accept that theyll be on treatment for an indefinite period of time, explains Dr. Roesch. Your cancer team will help you learn and cope with what you can expect on this journey.
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Indications For Surgical Treatment
Surgical resection continues to play an important role in patients with a limited number of brain metastases and a relatively good performance status. In the early 1990s, three randomized trials on single brain metastasis were conducted to evaluate the efficacy of surgical resection followed by whole-brain radiation therapy compared with whole-brain radiation therapy alone, and the data indicated that surgical resection significantly prolonged overall survival in patients without active systemic disease and with a higher Karnofsky performance status . According to the JCOG0504 trial, surgical resection followed by salvage stereotactic radiosurgery has been established as a standard therapy for patients with fewer brain metastases . SRS is also the effective alternative to surgical treatment for a single metastasis , but the higher doses of SRS increase the risk of the late effect of radiation necrosis . In addition, brain edema caused by metastatic brain tumors resolves significantly faster after surgical resection than after SRS . Moreover, in patients with neurological symptoms caused by brain lesions of > 3 cm with a mass effect or associated hydrocephalus, surgical resection can immediately alleviate these symptoms . Instead, surgical resection followed by SRS can be considered as standard treatment in patients with a few brain metastases, mainly with lesions of > 3 cm in diameter .
Potential New Therapeutic Target For Brain Metastases From Breast Cancer
Metastatic breast cancer is breast cancer that has spread to another part of the body, most commonly the liver, brain, bones, or lungs. There are many treatment options that are available for metastatic breast cancer including surgery, chemotherapy, radiation therapy, and now there may be a new treatment that will offer hope. Researchers led by CU Cancer Center member Diana Cittelly, PhD, report a potential new treatment option for breast cancer that spreads to the brain.
Their findings are published in the journal Clinical Cancer Research, in a paper titled, IL13R2 promotes proliferation and outgrowth of breast cancer brain metastases.
The researchers investigated the role of interleukin 13 receptor alpha 2 , a protein that is found in increased rates in cancer cells that metastasize to other locations in the body.
We found that patients expressing high levels of IL13Ra2 in their brain metastases have worse survival than those expressing low levels of IL13Ra2, but we could not see this correlation when examining the primary tumors. That was important because it suggested that there is an adaptation of the cancer cells when they spread to the brain, and we could eventually target it, Cittelly said. We were able to identify a role for this receptor as a tool in promoting the proliferation and outgrowth of metastasis in the brain.
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How Common Are Brain Mets
Approximately 200,000 Americans with all types of cancer develop brain mets every year.
Brain mets affect approximately 1 in 10 women with metastatic breast cancer. For about 17% of these women, cancer spreads only to the brain. More commonly, metastatic breast cancer goes to bones or other organs first, and then may eventually affect the brain.
Metastatic Brain Cancer Prognosis
Prognosis for metastatic brain cancer varies greatly. Keep in mind that each patient is unique, and with newer treatments, many patients live longer. Speaking with your care team about your unique diagnosis can provide an accurate prognosis.
Palliative Care at Johns Hopkins
Palliative care is specialized medical care that helps patients facing serious illnesses and their families by adding an extra layer of support.
Palliative care teams can help with the symptoms and the stress of living with a serious illness, including controlling pain, providing support for the mental and emotional effects of an illness, and managing other symptoms.
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Surgery Followed By Radiotherapy
The use of surgery is most often reserved for patients with good performance status, few lesions or large symptomatic lesions . Surgery followed by radiation therapy has been shown to improve OS and symptom control vs radiation therapy alone., Patchell et al. demonstrated that, in patients with a single BM , WBRT after complete surgical resection reduced the rate of recurrence at both the initial metastatic site and other brain sites , and reduced death due to intracranial progression . However, OS was similar between the WBRT and the control arm. In addition, WBRT has short- and long-term toxicities, including neurocognitive side effects and decreased quality of life.,
Two randomised clinical trials compared post-operative WBRT to post-operative stereotactic radiosurgery , a precise form of radiotherapy that delivers highly conformal high-dose radiation to restricted areas to kill small groups of cells with minimal damage to the surrounding normal tissues., One of these studies included patients with up to three lesions. In both studies, local control was equivalent or better with SRS and there was a lower risk of cognitive impairment no differences in OS were seen between the radiotherapeutic approaches. Therefore, after surgical resection, the use of SRS is the recommended option whenever feasible.,
Treatment Of Brain Metastases
Steroid medicines, such as dexamethasone, are often used to reduce swelling in the brain around the metastases. This can often help with symptoms right away while further treatment is planned.
Anti-seizure medicines may also be used if a patient has had a seizure. This can help prevent more seizures.
Radiation therapy is often used to manage brain metastases and control symptoms. For people with several brain metastases or meningitis from cancer, whole brain radiation can be used. This can help improve symptoms and prevent them from getting worse.
Surgery is also sometimes used to treat brain metastases, especially if there are no more than three spots. For some people, a specialized procedure called stereotactic radiosurgery may be used. Either procedure is most often followed by whole brain radiation therapy for the best results.
Chemotherapy is not usually a treatment for brain metastases because these medicines have a hard time getting into the brain. However, for people with meningitis from cancer, chemotherapy may be injected right into the fluid that surrounds the brain and spinal cord. This can be done during a lumbar puncture or through a device called an Ommaya reservoir.
An Ommaya reservoir is a dome-like device that is placed under the skin of the head and accessed with a needle. If the patient has an Ommaya reservoir, they can get chemo into the fluid that surrounds the brain and spinal cord without having to get repeated lumbar punctures.
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What Are Metastatic Brain Tumor Symptoms
Metastatic brain tumor symptoms differ based on your tumors location. Those symptoms can mimic stroke symptoms. But while stroke symptoms come on suddenly, metastatic brain tumor symptoms appear and get worse over time, from days to weeks. These symptoms include:
- Headaches caused by a tumor putting pressure on your brain. Your headaches may also stem from fluid leaking from your tumors blood vessels.
- Seizures that happen when your tumor interferes with your brains normal electrical activity.
- Cognitive problems, meaning you have trouble processing information or how you think. You may have trouble remembering things that just happened.
- Changes in how you behave or in your mood.
- Weakness on one side of your body, or not being able to use your arm or leg on one side of your body.
- Problems hearing, swallowing or seeing.
- Nausea and vomiting.
- Difficulty speaking or understanding speech.
Do I have metastatic brain cancer if I have any of these symptoms?
Many of these symptoms such as headaches, nausea and vomiting, or mood changes are also caused by other less serious conditions. Generally speaking, any change in your body that lasts more than a few weeks is something you should discuss with your healthcare provider.
I Have Brain Metastases How Do I Take Care Of Myself
Brain metastases can create a new set of medical conditions and issues when youre already dealing with cancer treatment:
- Depending on your brain tumors location, you may be at increased risk for seizures, which may affect your ability to work or drive. Your healthcare provider may prescribe medication to reduce your risk.
- You may need surgery to remove your brain tumor. If so, youll need support while you recover.
- You may need help managing side effects from different or additional cancer treatments. You may want to consider palliative care to help you manage your symptoms and treatment side effects.
- Your brain metastases diagnosis is another step in your cancer journey. Metastatic brain cancer treatment focuses on slowing cancers spread and helping you maintain your quality of life. This may be time for you to talk to your healthcare provider about next steps if your cancer cant be cured.
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Immunotherapy For Metastatic Brain Tumors
Cancer immunotherapy is a fast-growing field of research that seeks to develop drugs, vaccines and other therapies that trigger the immune systems natural abilities to fight cancer. Many immunotherapy drugs for metastatic brain tumors act as checkpoint inhibitors. Normally, tumor cells can evade attack by activating certain proteins that disarm your immune system. Checkpoint inhibitors prevent tumor cells from exploiting this process.
Immunotherapy drugs to treat metastatic brain tumors include:
- Atezolizumab
What Is A Metastatic Brain Tumor
A metastatic brain tumor is one of several types of metastatic cancer. Brain metastases, or metastatic brain tumors, happen when cancer in one part of your body spreads to your brain. Most metastatic brain tumors spread from primary cancers in your lungs, your breasts or your skin, specifically melanoma.
Researchers are finding more ways to predict who might develop brain metastases so healthcare providers can monitor for signs of metastatic brain tumors. Healthcare providers treat metastatic brain tumors by managing your symptoms through surgery and other treatments and helping you maintain your quality of life.
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