Management of Large Cell Neuroendocrine Carcinoma
What To Know About Lung Cancer That Has Spread To The Brain
How Brain Metastases From Lung Cancer Are TreatedIf diagnosed and treated early, brain metastases usually respond to therapy. Your treatment plan will depend on your tumors (size, number, location in the brain, and genetic characteristics); the extent of disease outside the brain; and your overall health. Treatment may include:
Surgery Surgery may be an option for people with only one or two brain metastases that are easy to access and remove. It may also work for people who have a larger tumor that's causing compressive symptoms, and removing even a portion of the tumor may help alleviate symptoms. According to a review, surgery is commonly followed by radiation therapy.
Radiation This therapy uses X-rays or other high-energy beams to kill cancer cells. Different methods of radiation are used to treat brain metastases.
People who have smaller brain tumors or tumors that are not surgically accessible or are too advanced for neurosurgery may be good candidates for stereotactic radiosurgery, in which MRIs, CT scans, and computer guidance are used to deliver large doses of radiation directly to tumors.[5] "This approach can effectively treat metastases with little radiation exposure to other parts of the brain and with minimal side effects," says Dr. Goldman.
If you have many tumors throughout your brain or a large tumor deep in the brain, your doctor may recommend whole-brain radiation, in which radiation is applied to the entire brain to kill tumor cells.[6] "This method," Goldman explains, "treats the whole area but, unfortunately, comes with more side effects, such as headache, fatigue, nausea, hair loss, and some slowed cognition."
Systemic Therapy With systemic therapies, including chemotherapy, immunotherapy, and targeted therapy, drugs travel through the bloodstream to reach cancer cells throughout the body.
Because many chemotherapy drugs are unable to cross the blood-brain barrier — a network of capillaries that keeps certain substances from reaching the brain — targeted therapy is the primary form used to treat brain metastases, according to a journal article.[7]
Targeted therapies can identify and attack specific cancer cells with minimal harm to normal cells. For people with lung cancer cells that have specific mutations (such as EGFR and ALK), these therapies can be highly effective.
But if your lung cancer doesn't carry these specific mutations or has spread elsewhere in the body, your doctor may consider other systemic therapies, such as immunotherapy (which uses medicine to activate your own immune system to recognize and kill cancer cells) or chemotherapy.
Palliative Care This type of specialized medical care can include pain management, mental health counseling, spiritual support, and stress management techniques. It's a key component of treatment for patients with metastatic NSCLC.[8]
Palliative care can help mitigate the side effects of both the cancer and its treatment and significantly improve quality of life. Information and support are available for people with lung cancer and their families at Go2 for Lung Cancer, the American Cancer Society, and the Global Resource for Advancing Cancer Education (GRACE).
Looking Ahead: After Brain Metastases TreatmentAfter radiation, surgery, or systemic treatment for brain metastases, your doctor will most likely order an MRI to determine how much of the tumor is gone and then follow up with MRIs every few months.
The prognosis for people with NSCLC that's metastasized to the brain is highly variable, so it's important to keep in mind that statistics don't necessarily pertain to your situation. While the outlook was traditionally poor for people with NSCLC and brain metastases, advancements in treatment are continually improving survival rates.
Clinical trials are regularly being conducted to find ways to improve treatment for people with NSCLC that's metastasized to the brain. Ask your doctor whether you may be a candidate for such a trial. You can also search for a clinical trial in your area at ClinicalTrials.Gov.
"Brain metastasis has traditionally been an area that was difficult to study," Goldman says. "But, thankfully, more and more studies are focused on exactly this problem."
Additional reporting by Erica Patino.
This Remarkable MSK Patient Is Living With Two Kinds Of Stage 4 Cancer
To see Michael Simien darting in and out of New York City streets on his bike, you'd never guess he is 70 years old — let alone that he is living with two kinds of metastatic cancer: lung cancer that was diagnosed 10 years ago and a rare, aggressive type of non-Hodgkin lymphoma called mantle cell lymphoma that was diagnosed five years ago.
Michael is keenly aware that he has beaten the odds. When a persistent cough led him to the emergency room of another hospital, a physician told him in the waiting room his scans suggested he had lung cancer. "There goes a bone fide walking dead man," he heard another patient say as Michael left the ER, stunned.
Michael wept and prayed, and then he got to work. His research led him to Memorial Sloan Kettering Cancer Center (MSK) for treatment, where he met with thoracic medical oncologist Helena Yu, MD. The cancer was inoperable, so Dr. Yu prescribed him chemotherapy for eight months. The side effects were rough.
"It hit me hard," remembers Michael. "My hands and feet darkened. I kept comparing myself to a burnt match, trying to keep a sense of humor about this."
Dr. Gilles Salles, Chief of MSK's Lymphoma Service, found a drug to control Michael's cancer.
The next course of treatment was much easier: an immunotherapy called nivolumab, infused every two weeks. The tumors started shrinking, and in September 2019, Michael rang the remission bell to celebrate his last treatment.
"It felt great," remembers Michael. "I was walking up out of the valley of the shadow of death."
Life was good again. Michael was able to work odd jobs, after years as a New York City corrections officer and bus operator. He relished spending time with his sister and his son, Michael Jr., whom he calls "Slim."
A Shocking Second Diagnosis: Stage 4 Mantle Cell LymphomaSeven months after he thought he was done with cancer, Michael was shaving and noticed swelling near his left ear and a lump in the back of his throat. A biopsy at MSK revealed stage 4 mantle cell lymphoma. He couldn't believe it. How could he have a second cancer diagnosed at stage 4?
"This is it for me. I was thinking about where I was going to be buried," says Michael. "I really felt like giving up."
His MSK care team told him the two cancers were unrelated. They were just bad luck. But there was hope: MSK's unique diagnostic test, MSK-IMPACT®, found his cancer was caused by a mutation of the gene called TP53. It was a rare subtype of a rare kind of lymphoma. Then came the good luck: MSK's Chief of Lymphoma Service, Gilles Salles, MD, PhD, informed Michael that he qualified for an MSK clinical trial that was testing a combination of drugs including ibrutinib.
Since the clinical trial ended in July 2024, Michael has been taking a similar drug (zanubrutinib) that's keeping his cancer at bay with fewer side effects.
Full Speed Ahead
Michael Simien with his son, Michael Jr.
Now Michael is doing remarkably well. His cancer is not detectable and considered "dormant." Dr. Salles sees him at quarterly checkups, with scans every six months. He takes two zanubrutinib pills twice a day, and they're covered by Medicare. When Michael faced other financial challenges, such as covering his rent, the team at MSK patient financial services helped him apply for a grant to help pay for necessities.
Michael tries to spread hope whenever he can. He took the dire words he heard 10 years ago in the ER and turned them into the name of his poetry blog, "Walking Dead Man."
"People are coming to MSK thinking they are on their last legs," says Michael. "I remember talking to a patient one day, and I ended up reciting one of my poems. I had a little audience, and they all clapped. "
Michael says he's able to bike full speed ahead in life, thanks to the care he's received at MSK and his positive outlook.
"It took years," he says. "I used to think because of cancer I might not see this or I might not see that. But now I know it doesn't matter. Because I'm here now. "
Symptoms Of Late Stage Metastatic Breast Cancer
Breast cancer that has spread to other parts of your body may start to cause new symptoms, depending on the location of the metastases. As symptoms develop or progress, treatment and care may also need to change.
Metastatic breast cancer occurs when cancer that started in the breast spreads to another part of the body. It's also known as stage 4 breast cancer.
When breast cancer spreads beyond the breast, it tends to appear in one or more of the following areas:
Symptoms of metastasis may depend on where breast cancer has spread in your body.
There isn't currently a cure for metastatic breast cancer, but treatments can help relieve symptoms, improve quality of life, and help you live longer.
If the cancer is confined to the breast, it's capable of being treated and potentially cured with a therapy plan that combines more than one method of treatment.
If the cancer has spread, it can still be treated with different types of therapy but can no longer be cured. That's why early diagnosis and treatment of breast cancer are so important.
If breast cancer is diagnosed at a later stage, there may be symptoms that appear in addition to those present with earlier stage breast cancer, such as skin changes, nipple discharge, or a lump in the breast.
Metastasis in the bones
If breast cancer has spread to your bones, symptoms may include:
Metastasis in the brain
Metastasis in the lungs
If breast cancer has spread to your lungs, symptoms may include:
Metastasis in the liver
Late stage breast cancer may eventually stop responding to treatment. This means your care team will shift focus to keeping you comfortable and treating your symptoms.
At this time, you may also experience general symptoms that occur when a person approaches the end of their life. With advanced breast cancer, these symptoms include:
Treatments for metastatic breast cancer are becoming so advanced that many people can live for a long time after their diagnosis and still maintain a good quality of life.
Treating metastatic breast cancer might include some of the same techniques used to treat breast cancer in the earlier stages.
However, there are different drugs available depending on the type of cancer. Treatment will likely change as the cancer progresses or stops responding to treatment.
Pain management is often an important part of care for metastatic breast cancer. A doctor may prescribe a combination of pain medications, such as opioids and over-the-counter pain relievers. They may also recommend that you see a pain specialist.
Pain medications are often prescribed in a variety of methods:
A pain medication pump is sometimes needed to administer appropriate levels of medication.
You and a healthcare team can work together to manage your symptoms. Some factors, like lifestyle changes or changes to your environment, can be done at home with the help of loved ones, while others may require a healthcare professional's advice and supervision.
Talk with a doctor about the best options for easing symptoms and improving your quality of life.
Hospice or palliative care
Palliative care might be recommended from the start of treatment for metastatic breast cancer. It can also be added to your treatment plan at any point, and treatment may continue at the same time.
The following types of professionals might make up a palliative care team:
The type of support they provide will vary based on your needs.
Palliative care may eventually transition to hospice care. Hospice becomes an option when treatment stops fully, and comfort becomes the priority.
It's recommended when a doctor believes a person may die within 6 months. It might be provided:
Palliative care support may continue throughout hospice care.
Treatment for emotional symptoms
If you're experiencing a lot of emotional distress, it may be time to seek out support for your mental health. This could come from a variety of different people or groups, such as:
These groups allow you to share your experiences and feelings with others who are in the same situation and understand what you're going through.
A support group can provide connection and comfort, reduce your isolation, and help improve your well-being, among other benefits.
Find a support group near you via the following sites:
Eating and nutrition
You may also need to adjust your eating habits. You might experience a reduced appetite. Changes in your senses of smell and taste may also make you less interested in food.
Try to experiment with different foods or supplement your diet with protein drinks that are high in calories. This can help you strike a balance between a smaller appetite and maintaining enough strength and energy to get through the day.
It's best to avoid or limit foods like:
There are medications available to help ease symptoms of nausea and improve appetite. These might come with the side effect of drowsiness. Consider talking with a doctor if you feel this type of medication may help you eat or drink more.
Caregiving
If you care for someone with metastatic breast cancer, it's important to know that the support you provide can change as the disease progresses.
It's likely you'll be focused on keeping your loved one comfortable at this stage. This may look like:
As a caregiver, it's also vital to care for yourself. Be sure to check in with yourself often about how you're feeling and reach out for help when you need it.
The outlook for people with metastatic breast cancer and the length of time between a stage 4 diagnosis and the onset of end-of-life symptoms vary greatly.
Research suggests that about 31% of people who receive a metastatic breast cancer diagnosis live at least 5 years after their diagnosis.
Keep in mind that these statistics can't predict your personal outlook. Many individual factors play a role in survival rates.
Newer treatments are helping extend lives and improve the quality of life for people with metastatic breast cancer.
Metastatic breast cancer isn't curable, but it's treatable. The outlook for people with the disease isn't as life-limiting as it once was. Advanced treatments are extending lives, and more are being researched every day.
Once breast cancer has metastasized to other areas of the body, you may experience new symptoms. Metastases in the lungs, brain, bones, or liver might each cause different symptoms.
Becoming familiar with these symptoms can help you recognize any changes in your health and keep your care team informed.
Treatment will focus on managing your symptoms and extending your life. Doctors and other healthcare team members can better manage your care if you report your symptoms, concerns, and what is or isn't working.
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