Brain Mets
Posted 8/2/2012
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I do know this is a terrifying topic, but there is actually some "good" news. Most of us are aware the breast cancer can spread to the brain, that some breast cancers (most frequently those that are Her2 positive or triple negative) are more likely to do so, and that there IS treatment. What you may not know is that the treatment is actually quite effective, and it seems fair to suggest that, although scarier, brain mets are not so different than liver or lung or other serious mets in terms of prognosis. This is a change, and a very welcome one.
Until fairly recently, a diagnosis of brain mets inevitably signaled the beginning of the end. Women were treated with radiation, but there were side effects, and it did not seem to be very helpful. For most of us, the idea of cancer in our brains is more upsetting than thinking about cancer in other parts of our body. We live in our brains; our brains are central to who we are, and surely good brain functioning is necessary to continue to manage our lives. Symptoms of possible brain mets may be vague, and can include headaches that persist (and what else is accompanying those headaches such as nausea, a sense of general malaise), changes in vision, or even changes in balance or other motor function. When we report one of these things to our doctors (and we should), it is always taken seriously and usually followed up by a brain MRI.
Now we get to the better news: brain mets can be treated either with very targeted radiation (called CyberKnife at BID although different large institutions that have this expensive, special machine may call it something different) if there is a single met or with whole brain radiation if the concern is that the problem is more widespread. Either treatment happens over a period of days, does bring some temporary side effects, and may result in longer term problems. The longer term problems with memory and cognition are much more likely with whole brain radiation, but are MUCH less common than they used to be. Treatment has improved. One unfortunate side effect is that hair usually does not regrow in the spots that were radiated. I know some women who sport "reverse Mohawks."
Now some better news and hopeful examples: I have a marvelous group for women with Stage IV/metastatic breast cancer, and several women in the group have been treated for brain mets. One woman continued to go to work daily while she received whole brain treatment. Others took a little time off, but then returned to work or their other usual routines. They are all doing fine.
Here is a summary from Oncology Stat about this issue. I give you the beginning and a link (registration, which is free, is required). I do recommend that you read it, because, although it is scary, knowledge is always power.
Brain Mets in Breast Cancer: Breaking Through the Barrier IMNG Medical Media. 2012 Jul 23, D Mahoney
BOSTON (IMNG) - Although brain metastasis is a notoriously formidable foe in the battle against breast cancer, recent breakthroughs in some patient subgroups suggest a challenge to its reign of terror.
As the ranks of women living with advanced breast cancer have swelled, thanks to treatment advances that alter the natural history of the disease, so has the incidence of tumor progression in the brain, according to Dr. Nancy U. Lin. The brain is a particularly hospitable sanctuary for cancer cells because few of the current chemotherapy agents penetrate the blood-brain barrier.
Current strategies for managing brain metastases have not substantially altered patient outcomes, Dr. Lin told attendees at a breast cancer program sponsored by Harvard Medical School in Boston.
But improved understanding of the biology of primary tumors and the specific sensitivities of tumor subtypes to various therapies (along with the identification of mediators of CNS progression) promises to usher in a new era in the treatment - and possibly prevention - of brain metastases in breast cancer, predicted Dr. Lin of the Dana-Farber Cancer Institute and Harvard Medical School, both in Boston.
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