Background Flashcards
What is the most common intracranial tumor?
Brain met is the most common intracranial tumor (outnumber primary brain tumors 8:1)
What is the annual incidence of brain mets in the United States?
170,000–200,000 cases/yr of brain mets in the United States, with development in up to 30% of pts with systemic cancer.
Why is the incidence of brain mets increasing?
The incidence is increasing due to advancements in systemic therapy (improved extracranial control) with limited penetration of the blood–brain barrier in conjunction with increased utilization of MRI/surveillance imaging.
What cancers are associated with hemorrhagic brain mets?
Hemorrhagic brain mets are most commonly associated with melanoma, RCC, and choriocarcinoma.
What do the terms solitary and single brain met connote?
A solitary brain met is only 1 brain lesion and no other sites of Dz progression.
A single brain met is only 1 brain lesion in addition to other sites of met Dz.
What cancers are most likely to metastasize to the brain?
Cancers associated with brain mets: lung (40%–50%), breast (15%), melanoma (10%)
In what % of pts are brain mets the 1st manifestation of Dz?
5%–20% of pts present with brain mets from an unknown primary. Pts presenting with brain mets without a prior Dx of cancer most often have a lung primary.
Should Bx or resection be recommended if a new Dx of brain mets is suspected?
Yes. Bx should be considered in pts with a new Dx of brain mets as 11% of pts (6/54) enrolled in the 1st Patchell trial were found to have a primary brain tumor (3 pts) or inflammatory/infectious process (3 pts) despite MRI or CT findings consistent with metastatic Dz. (Patchell R et al., NEJM 1990)
What is the more common type of brain mets: single or multiple?
Most pts have multiple brain mets rather than a single lesion, with increased detection of small, multifocal lesions on MRI typically not appreciated on CT.
How do pts with brain mets present?
Presentation of pts with brain mets: Sx of ↑ ICP (HA, n/v), weakness, change in sensation, mental status changes, and seizure
What is carcinomatous meningitis?
Carcinomatous meningitis is a clinical syndrome caused by leptomeningeal met with widespread involvement of the cerebral cortex. The Dx is associated with a poor prognosis.
Where do most brain mets occur?
Most brain mets arise in the gray/white matter junction due to hematogenous dissemination with narrowing of blood vessels. (Delattre J et al., Arch Neurol 1988)
Are most brain mets infra- or supratentorial?
The majority of brain mets are supratentorial.
What is the distribution of brain mets within the brain?
The distribution of brain mets correlates with relative weight and blood flow:
Cerebral hemispheres: 80%
Cerebellum: 15%
Brainstem: 5%
(Delattre J et al., Arch Neurol 1988)
What is the overall median time from initial cancer Dx to development of brain mets?
The median overall time from initial cancer Dx to development of brain mets is 1 yr.
