Secondary brain tumours
This information is about secondary brain tumours. We hope that it will answer any questions that you may have. If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment.
What is a secondary brain tumour?
A secondary brain tumour is a tumour within the brain that has occurred because cancer cells have spread into the brain from a cancer in another part of the body.
Some cancers can spread from their original site. The place in which the cancer first started is known as the primary tumour. When cancer cells have spread to another part of the body, they are referred to as secondaries or metastases.
Cancer cells can break away from the primary tumour and travel through the blood or through the lymphatic system. The lymphatic system is a complex system made up of a network of lymph nodes (or lymph glands) that are found all over the body. The lymph nodes are connected by tiny lymphatic vessels.
Some types of cancer are more likely to spread to the brain. The most likely types to spread to the brain are cancers of the lung, breast, bowel, colon, kidney (renal) and skin (malignant melanoma).
It is important to know if the tumour is a primary or secondary brain tumour as the two are treated differently. It's usually possible to know if a tumour within the brain is a secondary rather than a new primary cancer of the brain itself, because there is often a history of cancer elsewhere in the body, even from a long time ago.
Also, when the rest of your body is scanned, other secondaries may be found in other places – for example, in the liver or in the bones.
If there is more than one tumour in the brain, it is likely that these are secondary tumour growths because cancers which start off in the brain usually remain and enlarge in one place. More than one secondary tumour in the brain is sometimes called multiple brain secondaries.
Occasionally, if there is only one growth in the brain (a solitary brain tumour) and if there has never been a diagnosis of cancer elsewhere in the body, it may be difficult to tell whether the growth is a primary or a secondary one. In such situations, a sample of cells from the tumour (biopsy) will need to be taken and you will be referred to a neurosurgeon for this.
When the cells from the biopsy are examined under a microscope, they may look like the cells from a cancer from another part of the body. For example, if a lung cancer has spread to the brain, the affected cells would look like lung cells rather than brain cells.
Signs and symptoms
Some of the symptoms for a secondary brain tumour are similar to those for a primary brain tumour.
The most common symptoms are headaches, weakness in areas of the body, changes in behaviour, fits (seizures), symptoms of raised pressure in the brain (raised intracranial pressure), nausea and vomiting, confusion and listlessness.
A doctor may suspect a metastatic brain tumour if there has been a previous diagnosis of cancer and you have any of the above symptoms. Sometimes, secondaries or metastases are found before the primary cancer has been diagnosed. In some cases, even after numerous tests, it may not be possible to find the original cancer. In this situation, the tumour is known as a secondary brain tumour from an unknown primary.
Diagnosis
To diagnose a secondary brain tumour, the doctor will examine you thoroughly.
A CT scan or an MRI scan can sometimes show the difference between secondary and primary tumours.
CT (computerised tomography) scan A CT scan takes a series of x-rays which build up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10–30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
Most people who have a CT scan are given a drink or injection to allow particular areas to be seen more clearly. This may make you feel hot all over. Before having the injection or drink, it is important to tell the person doing this test if you are allergic to iodine or have asthma.
MRI (magnetic resonance imaging) scan This test is similar to a CT scan, but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. During the scan you will be asked to lie very still on the couch inside a long tube for about 30 minutes. It is painless but can be uncomfortable, and some people feel a bit claustrophobic during the scan. It is also noisy, but you will be given earplugs or headphones.
Some people are given an injection of dye into a vein in the arm, but this usually does not cause any discomfort.
Biopsy Occasionally it is necessary to take a sample of cells from the tumour (biopsy) to confirm the diagnosis. The biopsy will then be looked at under a microscope. The biopsy operation is done by a neurosurgeon. Your doctor will discuss with you whether this is necessary in your case, and exactly what the operation involves.
Other tests Your doctor will look into the back of your eyes, using an ophthalmoscope. They can see if the nerve at the back of the eye is swollen. This can be caused by oedema (swelling of the tissues within the brain), which may occur due to an increase in the amount of fluid in the brain.
The doctor may also do an examination to test the power and feeling in your arms and legs, and will test your reflexes.
Treatment
Being told that you have secondary cancer in the brain will be a tremendous shock. It is important to discuss any questions, fears and treatment options with your doctor. It is not usually possible to get rid of a secondary brain tumour completely, but treatment can sometimes shrink the tumour, slow its growth and control symptoms.
Consent
Before you have any treatment, your doctor will give you full information about what the treatment involves and explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.
Benefits and disadvantages of treatment
Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. If you have been offered treatment that aims to cure your cancer, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the cancer for a period of time, it may be more difficult to decide whether to go ahead.
If you feel that you can't make a decision about the treatment when it is first explained to you, you can always ask for more time to decide.
You are free to choose not to have the treatment and the staff can explain what may happen if you do not have it. You don't have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.
Steroids are generally given to help to control symptoms. They can temporarily improve headaches, weakness of the limbs, and nausea.
Radiotherapy is the most common treatment, but sometimes chemotherapy may also be given. If chemotherapy is given, it has to be a type that is able to cross the membranes that protect the brain and spinal cord (the blood brain barrier). In certain cancers which have spread to the brain, hormonal therapy or immunotherapy may be used.
In some cases, especially if the scans show that there is only one secondary tumour in the brain, it may be possible to remove it by surgery. You will be referred to a neurosurgeon to see whether it is possible to remove it. Following the operation, radiotherapy treatment may be given to reduce the chances of the tumour returning.
Your feelings
You may find the idea of a secondary cancer affecting your brain extremely frightening. The brain controls the body, and not being in control can be very worrying. You may have many different emotions including anxiety and fear. These are all normal reactions and are part of the process that many people go through in trying to come to terms with their condition.
Many people find it helpful to talk things over with their doctor or nurse, or with one of our support service nurses. Close friends and family members can also offer support.
Additional information
Driving
The Drivers and Vehicle Licensing Association (DVLA) will not allow you to drive for between one to two years after diagnosis of a secondary brain tumour, depending upon the grade of the tumour. If you have also had an epileptic fit the DVLA will not allow you to drive for a year after your last fit.
It may be recommended that you do not drive some vehicles, such as a LGV (large goods vehicle) or a PCV (passenger carrying vehicle).
The hospital will not contact the DVLA, but it is your responsibility to do so and your doctor will advise you how to do this.
