When breast cancer spreads to the brain, Breast cancer stands as the most prevalent form of cancer among women in the United States, comprising approximately 30 percent of all new cancer diagnoses in women annually, according to the American Cancer Society (ACS).
When breast cancer spreads to the brain
Metastasis, the spreading of cancer to distant parts of the body from its origin, occurs in all cancers, including breast cancer. At this advanced stage, often referred to as stage 4 cancer, the disease can extend to various locations, with the brain being a commonly affected site alongside the bones, lungs, and liver.
Brain metastasis specifically refers to the migration of cancer cells from their initial site, such as the breast, to the brain. A study from 2017, involving 4,932 individuals with metastatic breast cancer, indicated that 8.8 percent of them developed brain metastasis.
In many cases, metastases are initially identified in other common sites before reaching the brain. However, Breastcancer.org suggests that approximately 17 percent of individuals with metastatic breast cancer experience the brain as the sole site of metastasis.
Symptoms of brain metastasis vary depending on the region of the brain affected and may include headaches, dizziness, nausea, vomiting, limb weakness or numbness, vision changes like blurry or sudden loss of vision, speech difficulties, balance issues, memory impairment, alterations in personality, and seizures.
Other common symptoms indicating breast cancer metastasis include fatigue, malaise, reduced appetite, and unintentional weight loss.
Metastasis occurs when cancer cells detach from the primary tumor and travel through the circulatory or lymphatic systems to establish secondary tumors in distant areas of the body, such as the brain. While it’s challenging to predict the likelihood of brain metastasis, certain factors may heighten the risk.
According to a 2020 review, risk factors for brain metastasis resemble those for metastatic breast cancer in general. These factors include having specific breast cancer subtypes like triple-negative breast cancer or HER2-positive breast cancer, a tumor with high histological grade indicating rapid growth and spread, breast cancer spread to nearby tissues or lymph nodes, and an early breast cancer diagnosis.
However, having these risk factors doesn’t guarantee the development of brain metastasis but elevates the risk compared to individuals without such factors.
To diagnose brain metastasis, various tests may be employed if symptoms suggest its presence. Initially, blood tests are conducted to evaluate overall health and organ function, along with specific breast cancer tumor marker tests. A head MRI with contrast solution via intravenous injection is typically performed to confirm the diagnosis, providing clear images of brain abnormalities.
Treatment for brain metastasis depends on several factors, including the number and location of metastases, cancer subtype, metastasis to other body areas, genetic alterations, age, health status, and personal preferences. Treatment options are categorized as local or systemic, with a combination often used. Local treatments target the metastatic tumor site directly, while systemic treatments affect the entire body.
Local treattreatment
Local treatments for brain metastasis include surgical removal, stereotactic radiosurgery, and whole-brain radiation therapy.
Surgical removal of brain metastases is considered for individuals in good overall health with a limited number of accessible metastases. Following surgery, radiation therapy is often administered to target any remaining cancer cells.
Stereotactic radiosurgery delivers a concentrated dose of radiation to specific brain areas hosting metastases. This precise technique minimizes damage to surrounding healthy tissue.
Whole-brain radiation therapy involves administering radiation to the entire brain over multiple sessions. It is typically utilized when numerous brain metastases are present, and other local treatment options are not feasible.
Treatments that affect the entire body
Hormone therapy impedes the influence of hormones such as estrogen and progesterone on cancer cells characterized by estrogen receptor (ER) positivity. This inhibition aims to reduce the proliferation and division of cancer cells and is commonly employed alongside targeted therapy.
Targeted therapy functions by disrupting the activity of specific proteins found on or within cancer cells. Examples of targeted proteins include HER2 and cyclin-dependent kinases (CDK), which play crucial roles in cell growth regulation.
Immunotherapy enhances the immune system’s ability to combat cancer. Immune checkpoint inhibitors, a type of immunotherapy, may offer benefits for triple-negative breast cancer, a subtype that is less responsive to targeted therapy and lacks hormone receptor expression.
Other
Individuals with brain metastases often experience swelling around the brain, which can be managed with the use of steroids like dexamethasone to alleviate discomfort.
Seizures may also manifest as a symptom of brain metastasis. In such cases, doctors typically prescribe antiseizure medications to mitigate their occurrence.
Metastasis to the brain occurs when cancer cells detach from the primary tumor site and travel through the circulatory or lymphatic systems to establish secondary tumors in the brain. While the likelihood of developing brain metastasis cannot be definitively predicted, certain factors may heighten an individual’s risk.
Factors that elevate the risk of brain metastasis
According to a 2020 review, the risk factors associated with brain metastasis are akin to those for metastatic breast cancer in general. These factors encompass:
- Specific characteristics of breast cancer, such as triple-negative breast cancer or human epidermal growth factor receptor 2 (HER2)-positive breast cancer
- Tumors with a high histological grade, indicating irregular cell appearance under a microscope and a propensity for rapid growth and spread
- Breast cancer that has already metastasized to nearby tissues or lymph nodes
- A diagnosis of breast cancer occurring at a younger age
However, it’s important to note that having any of these risk factors does not guarantee the development of brain metastasis; rather, it signifies an increased risk compared to individuals without such factors.
How is brain metastasis diagnosed?
If symptoms indicate the presence of brain metastasis, your doctor will employ various tests for diagnosis.
Initially, blood tests will be conducted to assess overall health and organ function, including:
- A metabolic panel, evaluating liver and kidney function along with electrolyte levels in the blood
- A complete blood count, measuring different blood cell levels
- Tests for breast cancer tumor markers, proteins produced by breast cancer cells
Confirmation of brain metastasis diagnosis typically involves a head MRI scan using a contrast solution administered intravenously. This contrast enhances MRI images, aiding in diagnosis.
How is brain metastasis treated?
The choice of treatment for brain metastasis depends on several factors, including:
- The number and location of metastases in the brain
- The HER2-positive and ER-positive status of your cancer
- Whether cancer has metastasized to other areas of the body
- The presence of specific genetic changes in your cancer
- Your age, overall health, and personal preferences
Treatment options for brain metastasis can be categorized into local and systemic approaches. Local treatments target the metastatic tumor site directly, while systemic treatments affect the entire body. Depending on individual circumstances, a combination of local and systemic treatments may be recommended.
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