When cancer that began somewhere else in the body spreads to the brain and causes a mass or brain tumor, 它被称为转移性脑癌. 由此产生的肿瘤被称为脑转移瘤或脑转移瘤.” Johns Hopkins neurosurgeon Chetan Bettegowda 提供对转移性脑癌和治疗方案的见解.

当癌症扩散到大脑时会发生什么?

癌细胞可以脱离原发肿瘤，转移到大脑, usually through the bloodstream. They commonly go to the part of the brain called the cerebral hemispheres or to the cerebellum, where they form a mass.

一些转移性脑瘤在原发癌发生多年后才出现. 另一些转移速度很快，在原发癌症之前就被发现了.

当癌细胞到达大脑并形成肿瘤时, it may lead to a variety of symptoms that can be shared by nonmetastatic brain tumors as well.

脑转移的症状是什么?

脑转移的常见体征和症状包括:

• Headaches
• Seizures
• Weakness in the arms or legs
• Loss of balance
• Memory loss
• 言语障碍/说话困难

Other symptoms may include:

• Behavior and personality changes
• Blurred vision/vision disturbance
• Numbness
• Hearing loss

谁有患转移性脑癌的风险?

About one-third of patients with another type of cancer will develop one or more metastatic brain tumors. 45岁以后，患转移性脑瘤的风险开始增加, and is highest in those over 65.

如何诊断转移性脑瘤?

转移性脑和脊柱肿瘤通常在症状出现之前无法诊断. 以下是医生诊断转移性脑瘤的一些方法:

• Physical exam: After gathering information about your symptoms and personal and family health history, 医生进行了身体检查、视力和反射测试.
• Neurological exam
• Computed tomography (CT or CAT scan)
• Magnetic resonance imaging (MRI)
  • Diffusion tensor imaging (DTI) is a type of MRI that visualizes how water molecules pass through parts of the brain. 它揭示了组织结构的微观差异, 包括早期癌细胞的浸润.
• Biopsy: Collecting a piece of the tumor through surgery may be necessary when the diagnosis is unclear based on the other tests.

转移性脑癌的治疗

It is important to know that metastatic brain tumors are often treatable, and can be well-controlled. Generally, the faster you start treatment, 杀死或控制疾病的机会就越大.

脑转移瘤的治疗方案包括:

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted drug treatments
• Immunotherapy
• Clinical trials

In many cases, surgery or radiation therapy can improve — or entirely get rid of — symptoms. 阅读更多关于脑肿瘤治疗的信息.

Metastatic Brain Tumor Surgery

Surgery provides fast relief of “mass effect” — pressure inside the skull resulting from a growing metastatic tumor and swelling of the brain. Some patients may find improvement of symptoms as early as within hours of surgery if mass effect is what is causing your symptoms.

手术的目的是通过缩小肿瘤来减少肿瘤占用的空间, which means removing as much of the tumor as possible while maintaining neurological function.

一般来说，医生建议在以下情况下对转移性脑癌进行手术治疗:

• 这些症状和肿瘤的位置有明显的联系.
• 原发性癌症是可以治疗和控制的.
• The tumor can be safely removed.

切除转移性脑肿瘤的最常见的手术类型被称为a craniotomy, which can be performed through a variety of approaches, including the keyhole craniotomy.

了解更多关于脑肿瘤手术和康复的知识.

转移性脑肿瘤的放射治疗

Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation (light energy) to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.

这些无痛的治疗方法包括将辐射束穿过大脑, 哪一种方法可以治疗手术无法触及的癌症部位. 程序可以包括以下任何一种或几种:

• External beam radiation therapy 从机器输送辐射，通过身体到达转移性肿瘤.
  • Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
  • Stereotactic radiosurgery (e.g., 射波刀)将高剂量的辐射对准肿瘤的特定形状, 使周围的健康组织免受不必要的辐射.
  • Proton therapy 使用质子(而不是x射线)来治疗转移性脑肿瘤. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
• Brachytherapy is radioactive material implanted within a tumor to prevent further growth.

These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.

Choosing radiation therapy is complex, and often involves working closely with your care team. 对某些人来说，立体定向放射治疗可能比手术提供更好的预后. 其他人可能会接受全脑放疗或两种疗法的结合. You will have a risk-benefit conversation with your radiation team to weigh the potential benefits against the possible risks and side effects.

Because radiation therapy has been so successful in treating brain metastases — and because many live long lives after treatment — studies are now looking at how to manage the long-term effects of treatment.

转移性脑肿瘤的化疗

因为传统的化疗不能穿过血脑屏障, newer treatments called targeted therapy are used as the primary type of chemotherapy for treating metastatic brain tumors.

These drugs identify and attack cancer cells (the target) with minimal harm to normal cells while preventing the growth and spread of cancer cells. Targeted therapy can be administered after surgery or in conjunction with radiation therapy to destroy remaining cancer cells.

用于治疗转移性脑肿瘤的靶向疗法包括:

• 曲妥珠单抗治疗已经扩散到脑部的乳腺癌
• Erlotinib for the most common type of lung cancer (non-small cell lung cancer) that has spread to the brain

转移性脑肿瘤的免疫治疗

癌症免疫疗法是一个快速发展的研究领域，旨在开发药物, vaccines and other therapies that trigger the immune system’s natural abilities to fight cancer. 许多用于转移性脑肿瘤的免疫治疗药物起着“检查点抑制剂”的作用.” Normally, tumor cells can evade attack by activating certain proteins (called checkpoint proteins) that disarm your immune system. 检查点抑制剂阻止肿瘤细胞利用这一过程.

治疗转移性脑肿瘤的免疫治疗药物包括:

• Atezolizumab
• Ipilimumab
• Pembrolizumab
• Nivolumab

新疗法的临床试验

研究人员一直在寻找治疗转移性脑瘤的新方法. These new methods are tested in clinical trials. Talk with your health care provider to find out if there are any clinical trials you should consider.

你如何决定哪种转移性脑癌治疗方法适合你?

Your neurosurgeon will discuss the most appropriate treatment approach with you by considering these and other factors:

• 原发癌症的类型，你对治疗的反应和目前的状况
• 脑或脊柱内转移肿瘤的位置和数量
• 您的总体健康状况和对潜在治疗方案的偏好
• Your current symptoms

Along with benefits, doctors also consider the potential risks and side effects of any treatment. 许多推荐十大正规网赌平台担心辐射的影响. 其他人对手术的想法犹豫不决. 告诉你的医生你的担忧——这些都是值得考虑的重要问题.

Metastatic Brain Cancer Prognosis

转移性脑癌的预后差异很大. Keep in mind that each patient is unique, and with newer treatments, many patients live longer. Speaking with your care team about your unique diagnosis can provide an accurate prognosis.