Metastatic brain tumours are cancers that grow in the brain through a primary cancer growing in another part of the body. The primary cancer may be lung, colon, breast, lymphoma, leukaemia etc. They frequently occur in the cerebrum (80%), the cerebellum (13-16%) and the brainstem (3%). Fifty percent of the time, multiple metastatic brain tumours are present. Most are diagnosed after their primary cancer has been diagnosed and treated. About one-third of people with metastatic brain tumours have not been previously diagnosed with cancer, and their central nervous system symptoms are the first indication of cancer. In about half of these people, the primary site will never be found.
The diagnosis is based on the medical history, neurological examination and computed tomography (CT) or magnetic resonance imaging (MRI) scans. If there is no history of cancer, it is necessary to undergo more extensive testing to determine the primary cancer such as blood, urine and stool tests, chest x-ray, colonoscopy, chest/abdominal CT scan and mammography.
Treatment goals depend on the patient and other factors. The goal may be cure or relief of symptoms.
Radiation kills cancer cells directly or interferes with their growth. Two types of radiation therapy are available.
Chemotherapy is recommended for spinal fluid metastases and is still under investigation for use against metastatic brain tumours. If the primary tumour is hormone dependent, hormones or hormone-blocking drugs may be used. Breast cancers that are oestrogen-receptor-positive are treated with tamoxifen which may also shrink the metastatic tumours. Prostate cancer metastases may also be treated by hormones. Steroids may be effective in patients with lymphoma.
Steroids such as Dexamethazone, act rapidly to decrease the symptoms of raised intracranial pressure due to brain swelling that accompanies metastatic brain tumours but do not kill the tumour cells. Improvement is noticeable within six to twenty four hours. This therapy is effective in sixty to eighty percent of patients with metastatic brain tumours. Steroids are frequently prescribed during the course of radiation therapy to reduce the swelling caused by radiation.
Steroid use is monitored by the doctor because of its potential side effects e.g., gastric pain and haemorrhage, aggravation of diabetes mellitus and reduced ability of the body to fight infection etc.
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