Management of Cancer That Has Spread to the Brain - Episode 7

The Diagnosis of Brain Metastases

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Priscilla Brastianos, MD: Now we’ll move on to the next segment. Let’s talk about the diagnosis of brain metastases. Dr. Ahluwalia, tell us about how brain metastases are usually diagnosed and what do you look for? We already heard a little bit from Katie and Ivy about their diagnosis. Dr. Ahluwalia, do you want to expand on that?

Manmeet Ahluwalia, MD: Absolutely, and thanks to both Ivy and Katie for sharing their incredible journey, and thanks to Nick for being such a supportive caregiver. These are inspiring stories, and every time we take care of these patients, we are just in awe of how much they go through and how valiantly they encounter this disease. I always say to the patients that it’s a journey and that we all take together, right? We’re all in this as stakeholders and we all need to support the patient who is the center of the whole mission. Thank you for sharing your journeys, both of you. I’m so incredibly happy with you getting the outcomes you have been getting and best of luck to keep going strong.

With that, whenever we have patients who have lung cancer, and in Ivy’s case this was done, we do a screening MRI [magnetic resonance imaging] at diagnosis of a stage 4 lung cancer, and we like to do MRI unless it’s contraindicated, because we know MRIs are much more likely to pick out a small brain metastasis. As Ivy had mentioned, she had eight small metastases at diagnosis and she was asymptomatic. We all are humbled. We have seen a number of patients who are asymptomatic and have brain metastases which are small, and they’re picked up by MRI that may be missed by a CAT [computerized axial tomography] scan. Clearly, the morality of choice is an MRI whenever you need to screen for brain metastases.

Then we had worked with the American Cancer Society and we had put out a campaign, and kudos to Ralph and the ABTA [American Brain Tumor Association] for doing the survey, picking out these findings where, as Ralph outlined, as physicians and health care givers, we feel we are doing a good job informing our patients, but we are finding out from patients and caregivers that we can all do better. This is a nice wake-up call for us that we need to inform our patients in a better manner. We heard from both Ivy and Katie that it was discussed, but not to the degree that they would have liked. I clearly feel that we could all do better.

As a part of the campaign, we had brochures in our patient work rooms that informed patients of general symptoms to look for. Obviously, you can give a general overview and depending on where the brain metastases happens in the brain, they can lead to a neurological dysfunction the patient might have. Maintaining a high degree of awareness is helpful, especially in patients who may have a greater chance of developing a brain metastases — that’s stage 4 lung cancer, HER2-positive breast cancer, triple negative breast cancer, especially with stage 4 diseases in these — and then patients who have BRAF mutations in their melanoma, which is 50% of patients with melanoma. Talking about awareness, talking about telling patients and their caregivers what to be on the lookout for, is always helpful. Then there’s always a suspicion so ordering a brain MRI sooner rather than later is helpful and at least ruling out if someone has a brain metastasis or not.

Priscilla Brastianos, MD: Great, thanks so much. Again, you highlight the importance of patients being aware of letting their physicians know if they’re having new neurologic symptoms.

Transcript Edited for Clarity