Understanding breast cancer brain mets

Though some brain metastases can have no symptoms at all, others often do. Symptoms that suggest cancer has spread to the brain can vary depending upon location, but the common symptoms include:

• Headache
• Changes in cognition and mental status (ability to think, understand and use words correctly)
• Weakness or numbness on one side of the body
• Dizziness
• Visual changes (seeing lights, seeing double, or narrowing of vision)
• Problems with balance
• Seizures
• Nausea and vomiting
• Sensory changes (changes in smelling, taste, hearing)
• Difficulty speaking

Many of these symptoms can have other causes, including side effects from chemotherapy. When any of these symptoms persist for days with no relief from over-the-counter medications, consult your oncology team. A seizure would warrant urgent attention from a clinician, especially if it is the first time that a seizure has occurred.

Magnetic resonance imaging (MRI) with gadolinium (an image enhancer that provides better contrast) is the standard technology for diagnosing breast cancer brain metastasis. MRIs can distinguish a single metastasis from multiple metastases, which is an important factor in determining what kind of treatment a patient needs.

If the diagnosis is uncertain, a brain biopsy may be done. This is a procedure typically reserved for patients who appear to have a limited number of large or symptomatic brain lesion(s). If a brain biopsy is required, a neurosurgeon will remove a sample of tissue to determine if it is a metastasis. Sometimes it is helpful to remove the entire lesion, especially if it appears to be the only one in the brain. Increasingly, brain biopsies for diagnostic purposes only, are being avoided. Usually the diagnosis of brain metastasis can be made non-invasively (i.e., using MRI alone, or if there is doubt, using serial imaging). However, surgery for therapeutic purposes (i.e., to remove a large or symptomatic brain metastasis) is routinely used.

At this time, healthcare providers do not normally screen for brain metastasis before symptoms develop, however this is under investigation in a clinical trial. There is increasing support from the patient advocate and medical communities to include brain imaging at the time of a MBC diagnosis, especially in patients at higher risk of developing brain metastasis. If you suspect you may have brain metastasis, ask your doctor about ordering a brain MRI.

Risk factors for brain metastasis include hereditary mutations in the BRCA1 gene, prior metastases in other organs, and your subtype of cancer. The chance of developing breast cancer brain metastasis varies and occurs in up to 25-50% of those with TNBC, approximately 30-50% of those with HER2+ breast cancers, and 14% in HR+ disease.

Our curated list of National Cancer Institute (NCI)-designated cancer centers with programs dedicated to the treatment of CNS metastasis can help you find a second opinion

The prognosis of patients with breast cancer who develop brain metastasis has substantially improved over the past 20 years, but can vary widely depending upon your breast cancer subtype and your age.

Historically, survival of patients with breast cancer brain metastasis was very poor, ranging from 3-6 months. However, with the development of new treatments that effectively control cancer outside of the brain, patients with BCBM are living longer. The overall survival for breast cancer patients with brain metastasis (all types combined) is now closer to just over 2 years, with a life expectancy of 3 years for those with HER2+ tumors. These statistics do not reflect the results of the many clinical trials that are still ongoing. Therefore overall survival in patients with breast cancer brain metastasis may improve over time.

It is important to remember that each patient is unique, and that statistics cannot possibly account for all the variations that exist in a person and their cancer. There are some patients who far exceed the averages provided above. We share the stories of several BCBM patients who have lived well beyond what the statistics show.

Studies have also shown that specialized care known as palliative or supportive care, which addresses the symptoms and stress of an advanced disease, can improve quality of life. In some cases, it can even extend survival. For patients with brain metastasis, palliative radiation therapy is often prescribed to control tumors or relieve symptoms such as headaches.

Palliative care is provided by a special team of doctors, nurses, social workers, and other specialists who work together to provide an extra layer of support beyond simply keeping the patient alive. Palliative care specialists can help patients get relief from symptoms that include:

• Pain
• Fatigue
• Sleep disturbance
• Depression
• Anxiety
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Other symptoms that affect quality of life

Specialists can also assist with psychosocial support by recommending a licensed therapist or offering resources for relaxation techniques including yoga, meditation, music therapy, art therapy, and others. Spiritual support may also be offered to patients who are seeking to be connected with hospital chaplains or local religious and spiritual leaders to help with loss of faith or hope. Lastly, palliative care specialists can assist with explaining complicated medical information, which can reduce confusion or concern around making important treatment decisions.

Ask your treating physician about being connected to a palliative care team

Treatment options for breast cancer patients with brain metastasis often include oral or IV medication, surgery, stereotactic radiosurgery, whole-brain radiation therapy or some combination of these.

Learn more about treatment options for brain metastasis