Metastatic, or secondary, brain tumors arise from cancer that first develops elsewhere in the body. This type of tumor is more common in adults than primary brain tumors, and the incidence is growing, due to advances in cancer treatment that make it possible for people with cancer to live longer than ever before. When a metastatic tumor is detected in the brain, surgery to reduce or remove it can ease tumor-related symptoms and set the stage for further metastasis brain cancer treatment.
Understanding Metastatic Brain Tumors
A metastatic brain tumor behaves differently than a primary tumor, which originates in the brain rather than another organ. When cancerous cells from a tumor elsewhere in the body (such as in the lungs, breast, colon or kidneys) break free and travel to the brain, they typically develop into tumors that retain the characteristics of the original. Since metastatic brain tumors can arise from different types of primary tumors, their characteristics can help to identify the tumor and plan for treatment.
Depending on the affected area, metastatic brain tumors can cause a wide range of symptoms, including headaches, seizures, and problems with vision, coordination and speech. The appearance of tumor symptoms may be the first indication of possible metastasis brain cancer, and surgery to remove the tumor or reduce its size can relieve or possibly, eliminate these symptoms.
Surgical Options for Metastatic Brain Tumors
Standard treatments for metastatic brain tumors include surgery, radiation therapy, and chemotherapy – or a combination of these, based on a patient’s overall health, as well many other factors such as the nature, size and location of the tumor(s) in the brain. Although surgery is not appropriate for every patient with metastasis brain cancer, many treatments begin with a procedure to reduce the size of the tumor or remove it completely, or obtain a tissue diagnosis/biopsy.
To determine whether surgery is appropriate for an individual patient, neurosurgeons typically consider factors such as the behavior and number of tumors involved, the status of a patient’s original cancer, and that person’s age and overall health. Surgery to remove a brain metastasis is often recommended for those with a single tumor in an accessible location when the primary cancer is being managed with appropriate treatment and radiation therapy alone is not sufficient.
Preparing for Surgery
In general, preparing to have surgery to remove a metastatic brain tumor is much like preparing for other types of surgical procedures. In the days or weeks before surgery, you can expect to undergo a variety of tests, including blood tests and MRI or CT scans. A complete health history is taken, which includes questions about any prescribed and over-the-counter medications, as well as any herbal supplements or other natural remedies you may be taking. You may be asked to stop taking some medications and supplements for certain periods before surgery or to change the dosage.
Before surgery, patients typically will have a special type of MRI for intraoperative stereotactic navigation. This scan recognizes the patient’s face and head, and it helps the surgeon navigate through the brain’s tissues to locate the tumor. Patients typically receive general anesthesia, with a breathing tube and other forms of monitoring for the duration of the surgery.
In the Operating Room
Once on the operating table, the patient’s head is positioned in a head holder for stability, and the incision site is cleaned and prepped. Incisions are made behind the hairline, so scarring will not be visible. Generally, there is no need to shave the hair.
Surgery typically takes two to three hours and begins with a craniotomy – a procedure to open the skull. A small piece of bone is removed from the skull, and the dura, the tissue covering the brain, is opened to expose the brain. With the help of stereotactic navigation and ultrasound imaging to pinpoint the precise location, surgeons remove the brain tumor from surrounding tissues. The dura is then closed, and the skull bone is replaced and secured with titanium screws. After the incision is closed and dressed, the patient is moved to the hospital’s intensive care unit.
The hours immediately after surgery, as well as the first night in the hospital, are spent in intensive care, where specialized staff conducts careful monitoring of vital signs and responsiveness. Since the trauma of surgery can cause swelling in the brain, some people might experience temporary deficits in speech or movement, but these deficits typically resolve over time.
With no complications, patients recuperate in the hospital for about three days and return home with a set of discharge instructions for wound care and other aspects of recovery. Fatigue is common after surgery, but most people are able to return to normal life within a week or two, returning for post-surgery follow-ups as recommended.
Surgery may be part of a larger treatment plan that will include radiation therapy, certain kinds of chemotherapy, or both. Some patients might also need physical or occupational therapy to help regain normal functioning. In the days and weeks after surgery, doctors monitor progress and conduct imaging tests to plan the next steps.
Surgery for metastasis brain cancer is a generally safe procedure that can reduce the symptoms caused by the tumor, improve quality of life and support other types of treatments. Your doctors and healthcare team will work with you to determine whether brain tumor surgery should be a part of your cancer care plan.