What is a Metastatic Brain Tumour?
Metastatic brain tumours occur when cancer spreads to the brain from another part of the body. They are also called secondary brain tumours. These tumours are much more common than primary brain tumours and most often arise from cancers of the lung, breast, skin, kidney or bowel.
Although metastatic brain tumours originate from cancers elsewhere in the body, tumour cells within the brain may acquire additional genetic changes that differ from those present in the original cancer.
Metastatic brain tumours are more common in patients with advanced cancer, although they can sometimes be the first sign that a cancer has spread.
Common Sources of Brain Metastases of Metastatic Brain Tumour
The most common cancers that spread to the brain are lung cancer, breast cancer, melanoma, kidney (renal) cancer, and colorectal cancer. Among these, lung cancer is the most common primary tumour to metastasize to the brain, while breast cancer and melanoma are also common causes. Kidney and colorectal cancers spread to the brain less frequently.
Metastatic Brain Tumour Symptoms
As metastatic brain tumours grow, they can place pressure on nearby healthy brain tissue. This pressure may disrupt normal brain function and lead to a range of neurological and cognitive symptoms. Many symptoms result from increased pressure inside the skull (intracranial pressure), swelling around the tumour, or disruption of nearby brain structures.
Common symptoms of intracranial metastases include:
- Headaches
- Focal neurological deficits, such as weakness or numbness affecting specific parts of the body
- Seizures
- Impaired cognition or altered mental status, especially in patients with multiple brain metastases or significant intracranial pressure
- Sudden stroke-like symptoms caused by bleeding within the tumour, which is more common in melanoma, kidney cancer, and choriocarcinoma
- Vision changes, including blurred vision
- Difficulties with speech or language
- Weakness, poor balance, or difficulty walking
How Is Metastatic Brain Tumour Diagnosed?
MRI is the most important imaging tool for diagnosing metastatic brain tumours. Because metastatic brain tumours can appear similar to high-grade gliomas on imaging, doctors must carefully distinguish between these tumour types. In some cases, metastatic tumours may initially resemble primary brain tumours, which can affect treatment decisions.
Advanced MRI techniques, such as magnetic resonance spectroscopy (MRS) and perfusion-weighted imaging (PWI), help improve diagnostic accuracy. These techniques assess differences in tumour metabolism, cellular composition, and blood flow that may help distinguish metastatic tumours from other brain lesions . Radiologists also examine tumour boundaries, patterns of blood vessels, and surrounding tissue changes to help distinguish metastatic brain tumours from high-grade gliomas.
If doctors suspect that the primary cancer originated elsewhere in the body, they may order whole-body imaging, such as PET/CT, to help identify the original tumour site. However, PET scans cannot always distinguish cancer cells from areas of active inflammation.
When imaging findings are uncertain, or when confirmation is needed, pathologists may examine tumour tissue under the microscope to establish the diagnosis. They use specialised stains and cell-specific markers to identify tumour cells and distinguish metastatic tumours from primary brain tumours.
Living With Metastatic Brain Tumour
Metastatic brain tumours can significantly affect a patient’s quality of life. Both the cancer itself and its treatment may cause physical and cognitive difficulties that place considerable emotional, social, and financial strain on patients and their families.
Palliative care can help patients manage symptoms, cope with the illness, and improve emotional well-being. It may also provide support, comfort, and guidance while patients and families adjust to life after diagnosis and treatment.
After treatment, your multidisciplinary team may recommend regular MRI scans to monitor for tumour progression, recurrence of treated lesions, the development of new brain metastases, or treatment-related changes. The frequency of imaging depends on your individual situation and treatment plan.
Many patients find that seeking information, support, and counselling helps them better manage the challenges associated with the disease. Maintaining daily routines and gradually adapting to uncertainty may also help preserve a sense of normality for both patients and their families.
Patients often develop different coping strategies over time, and your healthcare team will continue to support you throughout every stage of care.
Treatment and Management Options for Glioblastoma
Treatment for metastatic brain tumours depends on several factors, including the type of primary cancer, the number, size and location of the brain metastases, symptoms, and the person’s overall health. Treatment aims to control tumour growth, relieve symptoms, preserve neurological function, and maintain quality of life. Your healthcare team will develop an individualised treatment plan, which may include one or more of the following treatment options.
For patients who develop symptoms from brain swelling, treatment often begins with corticosteroids such as dexamethasone to reduce swelling and improve neurological symptoms. Treatment then depends on the individual patient and the extent of disease.
Whole brain radiotherapy (WBRT) may be used when cancer has spread to multiple areas of the brain, particularly when stereotactic radiosurgery is not suitable. It treats a broad region where tumour cells may be present. WBRT may be used alone or in combination with other treatments depending on the number of brain metastases, symptoms, and overall treatment goals. Treatment plans may combine radiotherapy, surgery, and systemic therapies depending on the patient’s situation.
Stereotactic radiosurgery (SRS) offers a non-invasive option that delivers high-dose, focused radiation to specific tumour sites. Doctors commonly use SRS for patients with a limited number of brain metastases or when surgery is not appropriate.
Surgery may be appropriate for some patients, depending on tumour size, location, age, and whether the tumour causes complications such as hydrocephalus. When surgery is performed, neurosurgeons use specialised techniques to maximise tumour removal while protecting important brain functions.
Doctors may also use systemic therapies, including targeted drugs and immunotherapy. These treatments target specific molecular features of cancer cells or help the immune system recognise and attack cancer. They can control cancer both within the brain and elsewhere in the body.
A diagnosis of brain metastases often comes suddenly, alongside an existing cancer diagnosis. For carers and families, this can mean rapidly adjusting to complex care needs, treatment decisions, and uncertain timelines.
Support needs are often immediate and intensive, particularly as symptoms can progress quickly.
You don’t have to manage this alone. The National Advocacy Service can help you navigate healthcare systems, access services, and advocate for the care your loved one needs.
You can also visit our Support Hub for practical guidance and resources for carers.
References
- Brastianos PK, Carter SL, Santagata S, Cahill DP, Taylor-Weiner A, Jones RT, Van Allen EM, Lawrence MS, Horowitz PM, Cibulskis K, Ligon KL, Tabernero J, Seoane J, Martinez-Saez E, Curry WT, Dunn IF, Paek SH, Park SH, McKenna A, Chevalier A, Rosenberg M, Barker FG 2nd, Gill CM, Van Hummelen P, Thorner AR, Johnson BE, Hoang MP, Choueiri TK, Signoretti S, Sougnez C, Rabin MS, Lin NU, Winer EP, Stemmer-Rachamimov A, Meyerson M, Garraway L, Gabriel S, Lander ES, Beroukhim R, Batchelor TT, Baselga J, Louis DN, Getz G, Hahn WC. Genomic Characterization of Brain Metastases Reveals Branched Evolution and Potential Therapeutic Targets. Cancer Discov. 2015 Nov;5(11):1164-1177. doi: 10.1158/2159-8290.CD-15-0369. Epub 2015 Sep 26. PMID: 26410082; PMCID: PMC4916970.
- Bertolini, F., Spallanzani, A., Fontana, A., Depenni, R., & Luppi, G. (2015). Brain metastases: an overview. CNS Oncol, 4(1), 37-46. https://doi.org/10.2217/cns.14.51
- Fink, KR & Fink, JR 2013, ‘Imaging of brain metastases’, Surgical Neurology International, vol. 4, Suppl. 4, pp. S209-S219.
- Franchino, F., Rudà, R., & Soffietti, R. (2018, 2018-May-24). Mechanisms and Therapy for Cancer Metastasis to the Brain [Review]. Frontiers in Oncology, Volume 8 – 2018. https://doi.org/10.3389/fonc.2018.00161
- Lillekroken, D., Bye, A., Halvorsrud, L., & Lundeby, T. (2025, Dec). Living with brain metastasis – a qualitative study of patients’ and family members’ coping strategies. Int J Qual Stud Health Well-being, 20(1), 2555228. https://doi.org/10.1080/17482631.2025.2555228
- Owonikoko, T. K., Arbiser, J., Zelnak, A., Shu, H.-K. G., Shim, H., Robin, A. M., Kalkanis, S. N., Whitsett, T. G., Salhia, B., Tran, N. L., Ryken, T., Moore, M. K., Egan, K. M., & Olson, J. J. (2014, 2014/04/01). Current approaches to the treatment of metastatic brain tumours. Nature Reviews Clinical Oncology, 11(4), 203-222. https://doi.org/10.1038/nrclinonc.2014.25
- Soffietti, R, Ahluwalia, M, Lin, NU, Ruda, R, Preusser, M, et al. 2024, ‘EANO-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up of patients with brain metastases from solid tumours’, Annals of Oncology.
- Vogelbaum, MA, Brown, PD, Messersmith, H, Brastianos, PK, Burri, S, Cahill, D, Dunn, IF, Gaspar, LE, Gatson, NTN, Jordan, JT, Lassman, AB, Mohile, N, Schiff, D, Suh, JH & Taylor, JW 2022, ‘Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline’, Journal of Clinical Oncology, vol. 40, no. 5, pp. 492-516.