Symptoms and Diagnosis of Brain Metastases

Recognize the Signs, Talk to Your Doctor ^{[1, 2]}

• Headaches and/or pressure in your brain—these headaches are usually ‘progressive’ and different from a typical headache or migraine, get worse, continue for days and don’t go away
• Nausea or vomiting—cancer by itself can cause vomiting and frequent vomiting can cause dehydration and risk of choking or other respiratory issues
• Changes in mental status—changes in behavior can signal a brain tumor; symptoms are wide ranging and may affect language / communication, emotion / personality, learning / memory, attention / concentration
• Seizures—this can be small, like a lip or hand twitch or more serious like falling to the floor or difficulty speaking; anything perceived as a seizure should not be ignored, even if it is partial and/or you remain awake during the episode
• Specific neurological symptoms—things like tingling and motor skills issues which affect one side of the body or balance problems
• Weakness—severe weakness, that is not associated with pain, in any extremity such as the arm or leg is cause for concern

Patients often have symptoms from their primary cancers that can mask symptoms of brain metastases. In addition, patients can experience complications from both the primary cancer and the brain mets at the same time. It is important not to ignore warning signs and symptoms because early detection can mean a better chance at preserving normal brain function that can be affected by the brain metastases.

Symptoms will differ and depend on the size and location of the metastatic brain tumor(s). If you are experiencing one or more symptoms, let your doctor know how long you have been having them and how often they occur. Taking into consideration your existing condition and treatment regimen, your doctor will ask a series of questions designed to understand your symptoms. They may send you for images, or scans, to help diagnose whether you have metastases to the brain.

If you have these or other symptoms, discuss them with your doctor in the context of your primary cancer, overall health and medical history. In-office tests may be done, including assessment of reflexes, cognition (thinking / thought processing), sensations, muscle strength, alertness, etc. If these assessments require more testing, your neuro-oncologist or neurosurgeon may then send you for diagnostic imaging of the brain and additional parts of the body to figure out whether the primary cancer has spread elsewhere.

There are different scans that may be needed and a patient may need more than one scan to diagnose the tumor size and location and type. A few different types of scans and imaging techniques may be used to diagnose metastatic brain tumors.

Most Common Imaging Techniques

• Computed Tomography (CT)—special X-Ray equipment that creates detailed pictures, or scans of your brain
• Magnetic Resonance Imaging (MRI)—a powerful machine with a magnetic field, radio frequency pulses and a computer that produces detailed pictures of your brain

Other Potential Imaging Techniques

• Magnetic Resonance Spectroscopy (MRS)—noninvasive diagnostic test for measuring biochemical changes in the brain, especially the presence of tumors
• Position emission tomography (PET)—system that uses a radioactive substance called a tracer to look for disease in the brain

You have likely already undergone body scans for your primary condition. Discuss with your doctor or nurse, in detail, how the brain scans are similar and different from previous scans. Knowing where and when to go and how the scan works will help reassure you and better prepare you for the experience. Your doctor may even prescribe additional CT scans of your chest, abdomen and pelvis as well as a bone scan to detect any primary cancer elsewhere in the body.

If you are diagnosed with brain metastases, this will likely be the first of many brain scans that will happen during your treatment. It is wise to keep a history and a digital copy of all your scans to better inform the different medical teams that you may work with during your treatment.

^[1] American Association of Neurological Surgeons
^[2) American Brain Tumor Association

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