Cancer types

Brain metastases

Cancer spread to the brain.

- Cancer that started elsewhere and has spread to the brain. More common than tumours that start in the brain.
- Most often from lung cancer, breast cancer and melanoma, and sometimes kidney or bowel cancer.
- Symptoms: headache, seizures, weakness, unsteadiness, confusion. Some are found on a routine scan before any symptoms.
- Treatment has improved a lot: many patients now live well for years, especially when the cancer has a mutation that tablets can target.

Before starting chemotherapy, immunotherapy or targeted therapy, these tests check that you are fit for treatment, and give a starting point to compare with later.

Test	Why it is done
CBC (complete blood count)	Haemoglobin, white cells and platelets. Treatment can lower them.
RFT (kidney function)	Many medicines are cleared by the kidneys; the dose may need to change.
LFT (liver function)	Many medicines are processed by the liver.
Viral markers: HBsAg, anti-HCV, HIV	Hepatitis B can flare up during treatment. If positive, a tablet is given to prevent this.
Blood sugar (and HbA1c if diabetic)	Steroids given with chemotherapy can raise blood sugar.
ECG and 2D Echo	Check the heart rhythm and pumping before treatment, as some medicines affect the heart.

Before immunotherapy, also:

Test	Why it is done
Serum TSH (thyroid)	Immunotherapy can affect the thyroid gland.
Serum cortisol (morning sample)	Immunotherapy can affect the adrenal and pituitary glands.

Sometimes needed, depending on your treatment:

Pregnancy test for women who could be pregnant.
Calcium and magnesium: for example before cisplatin or bone-strengthening injections.
Dental check-up before bone-strengthening injections (zoledronic acid or denosumab), as they can rarely affect the jaw bone.
Hearing test before cisplatin, in some patients.
Clotting tests (PT/INR) before a biopsy or chemoport.

Your doctor will choose the tests that apply to you. Some of them are repeated during treatment.

- The number of deposits, the original cancer and its mutations decide between radiosurgery, surgery, whole brain radiotherapy and tablets.
- Steroids are started straight away if there is swelling, so symptoms can improve while we plan.

Treatment is planned with the neurosurgeon and radiation oncologist. Tap a situation on the map.
- 1. Stereotactic radiosurgery (SRS): a precise high dose to each deposit in 1 to 5 sessions, sparing the rest of the brain.
  2. Surgery for a large deposit causing pressure or symptoms, followed by radiosurgery to the cavity.
  3. Treatment of the cancer in the body continues.
  What the research shows
  - N0574: radiosurgery alone caused much less memory decline than radiosurgery with whole brain radiotherapy, with similar survival.
  - JLGK0901: radiosurgery worked as well for 5 to 10 deposits as for 2 to 4.
  Side effects: radiosurgery · steroids
- 1. Whole brain radiotherapy, usually avoiding the memory centre (hippocampus) and with memantine tablets to protect memory.
  2. Radiosurgery to many deposits in some centres.
  What the research shows
  - NRG CC001: sparing the hippocampus with memantine reduced memory decline compared with standard whole brain radiotherapy.
  - QUARTZ: in lung cancer patients who were very unwell, whole brain radiotherapy added little over steroids and good supportive care.
  Side effects: whole brain radiotherapy · steroids
- - Lung cancer with EGFR: osimertinib. With ALK: alectinib or lorlatinib.
  - HER2-positive breast cancer: tucatinib with trastuzumab and capecitabine, or trastuzumab deruxtecan.
  - Melanoma: nivolumab with ipilimumab.
  - In some patients with small deposits and no symptoms, these drugs are started first and radiotherapy is kept for later.
  What the research shows
  - HER2CLIMB: adding tucatinib helped patients with HER2-positive breast cancer and brain metastases live longer.
  - CheckMate 204: nivolumab with ipilimumab shrank melanoma brain deposits in about half of patients without symptoms.
Tap a treatment on the map.
- - Dexamethasone (steroid) reduces swelling around the tumour and quickly eases headache and weakness. It can raise blood sugar, increase appetite, disturb sleep and mood, and is reduced slowly; never stop it suddenly.
  - Seizure tablets are given only to those who have had a seizure.
  - If you have had a seizure, do not drive until your doctor says it is safe.
- - Usually well tolerated; mild headache or tiredness for a few days.
  - Months later, the treated spot can swell (radionecrosis); this may need steroids or bevacizumab and is not always growth of cancer.
- - Tiredness and hair loss.
  - Memory and concentration problems over months; hippocampal sparing and memantine reduce this.
- MRI brain every 2 to 3 months after treatment.
- If you have had a seizure, do not drive until your doctor says it is safe.
- Physiotherapy if there is weakness or unsteadiness.
- Mind and emotions

This information is general. Your own treatment plan may be different. Please discuss it with your doctor.

Written and medically reviewed by Dr Prathyusha Eaga, MD, DM (Medical Oncology). Last reviewed: 12 October 2026. Based on NCCN and ESMO guidelines.

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