Treatment for secondary brain cancer

Treatment for secondary brain cancer aims to control the cancer and your symptoms. It can also prevent problems from developing.

Deciding about treatment

Deciding about treatment can be difficult. You need to understand:

• what treatment can do for you
• any side effects of the treatment
• how many visits to hospital the treatment involves

You can stop whenever you want if you find it too much to cope with.

Talk through your options with your doctor or specialist nurse. You may find it helpful to talk things over with a close relative or friend or a counsellor if one is available.

Your treatment will depend on several factors, including:

• your type of primary cancer

• the treatment you have already had

• how many tumours are in the brain

• where the cancer is in the brain and how big it is

• whether your cancer has spread to other parts of the body

• your general health

• your symptoms

Types of treatment

You are likely to have a combination of treatments. Some to control the cancer and others to control specific symptoms.

Radiotherapy

Radiotherapy treatment uses high energy x-rays to kill cancer cells. Radiotherapy can help to control cancer growth and symptoms. You usually have this as external radiotherapy. This is where the therapy radiographer uses a machine outside the body to direct radiation beams at the cancer to destroy it.

Stereotactic radiotherapy (SRT) is one type of external radiotherapy. It's a targeted treatment and gives radiotherapy from many different angles around the body. The beams meet at the cancer site, so it receives a high dose of radiation. The tissues around the cancer get a much lower dose of radiation. This lessens the risk of side effects to the rest of the brain. Your doctor might use this to target one or two small areas of cancer in the brain.

For some people with secondary brain cancer, you might be able to have the full dose of radiotherapy as a single fraction. This is also called stereotactic radiosurgery.

For several areas of secondary brain cancer (multiple brain metastases), you might have whole brain radiotherapy. This might be when you haven’t had the following treatments before:

• stereotactic radiosurgery
• stereotactic radiotherapy
• surgery

You usually have this course of external radiotherapy over 1 or 2 weeks. The total dose of the course of radiotherapy is split into several smaller doses called fractions. Splitting the dose up allows the healthy cells to recover in between treatments. You usually have one treatment (fraction) a day, from Monday to Friday and a rest at the weekend.

Whole brain radiotherapy is also given to help prevent secondary brain cancer from developing. You might have this if you have small cell lung cancer (SCLC). This treatment is also called prophylactic cranial irradiation (PCI).

Steroids

Secondary brain cancer and its treatment, such as surgery or radiotherapy, can increase the pressure in the brain.

Your skull is hard and made up of bone, so there's a fixed amount of space for the brain. If there's a cancer or swelling it increases the pressure inside the skull. This is called raised intracranial pressure. Symptoms of raised intracranial pressure might include:

• headaches

• feeling or being sick

• seizures (fits)

• behaviour changes

• changes to your vision

Steroids can help to reduce swelling. This can help improve symptoms and keep them under control.

You usually take steroids for short periods of time ranging from a few days to a few weeks. Your specialist will reduce your steroid amount (dose) slowly, as stopping them suddenly can make you unwell.

Surgery

Your doctor may offer you surgery if you have a single or small number of secondary brain cancers that look removable. Surgery might not be possible if the tumours are widely spread within the brain. Brain surgery is not suitable for everyone. It’s a major operation and you have to be well overall.

For brain surgery, your surgeon will also want to make sure your primary cancer (and any other areas of cancer spread) is stable. By this they mean the cancer has stayed the same size, so it hasn’t got any better or worse.

Your surgeon removes secondary brain tumours in the same way as they remove a primary brain tumour.

Chemotherapy

Chemotherapy uses anti cancer drugs to kill cancer cells. The type of chemotherapy you have depends on the type of primary cancer. 

It can be difficult to treat brain tumours with some chemotherapy drugs. This is because the brain is protected by the blood brain barrier. This is a natural filter between the blood and the brain which protects the brain from harmful substances. 

Your doctor will talk to you about what chemotherapy is best for your situation.

Hormone therapy

Some cancers including breast and prostate cancer depend on hormones to survive and grow. So lowering hormone levels in the body can help to control them.

Hormone treatment may be tablets or injections. Hormone treatment is a common treatment for advanced breast cancer and advanced prostate cancer.

Targeted cancer drugs

Targeted cancer drugs are treatments that target the differences that help a cancer cell to survive and grow.

Your doctor may suggest a targeted cancer treatment if it is suitable for your primary cancer. There are different types of targeted cancer drugs including:

• monoclonal antibodies (MABs)

• cancer growth blockers

• PARP inhibitors

• drugs that block blood vessel growth (anti angiogenics)

Targeted cancer treatment can help to shrink and control secondary brain cancer for the following cancers:

• lung
• breast 
• melanoma

Immunotherapy

Immunotherapy uses your immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.

You might have immunotherapy if, for example, you have lung cancer or melanoma skin cancer.

Controlling symptoms

Secondary brain cancer can cause symptoms. The treatments above might help to control your symptoms by shrinking or removing the brain tumours. You might have other treatment to help control them if they’re still troublesome. Here are a few other ways of controlling secondary brain cancer symptoms.

Drugs to help control seizures

Your doctor might give you anti epileptic medicines to help prevent seizures (fits). Seizures are sudden bursts of electrical activity in the brain. These can be quite scary for you and the people around you when they happen.

Painkillers

Secondary brain cancer can cause pain such as headaches. It’s important to tell your treatment team if you have any pain so they can get on top of it early. They will work with you to find the right painkiller and strength to help ease the pain.

Research into secondary brain cancer

Research is going on all the time into improving treatments for secondary brain cancer and helping understand more about how the cancer develops and why treatment stops working. Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.