Topic 13: Brain metastases and associated complications

Brain metastases can lead to serious complications including increased intracranial pressure, seizures and haemorrhage. These complications can result in permanent neurological deficits and death and are considered an oncological emergency.

In this rapid learning you will learn how to:

• recognise the signs and symptoms of brain metastases and associated complications
• assess the severity
• initiate the right interventions and escalate care appropriately

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Module

Additional resources

You can use the following resources in the workplace to assist you in caring for patients.

Save a copy of these resources so you can refer back to them in the workplace.

• Brain metastases summary sheet
• Brain metastases signs and symptoms
• ESMO Handbook of Oncological Emergencies
• Tabouret E, Chinot O, Metellus P, et al. Recent trends in epidemiology of brain metastases: an overview. Anticancer Res 2012; 32:4655–4662
• Oncological emergencies - Oncology for Medical Students
• eviQ ID 3243 Brain metastases (1-4) palliative EBRT stereotactic radiosurgery
• Recommendations regarding driving should be discussed with the patient depending on their presentation. Further information for fitness to drive can be found at https://austroads.com.au/drivers-and-vehicles/assessing-fitness-to-drive/for-health-professionals.

Patient information

• ASCO- Caring for a Person with a Brain Tumor or Metastatic Brain Cancer

References: 

1. L. de Mattos-Arruda and M. Preusser.2016. ESMO Handbook of oncological emergencies. 2nd edn, ESMO press
2. Esquenazi, Y., Lo, V.P. and Lee, K., 2017. Critical care management of cerebral edema in brain tumors. Journal of intensive care medicine, 32(1), pp.15-24.
3. Pease, N.J., Edwards, A. and Moss, L.J., 2005. Effectiveness of whole brain radiotherapy in the treatment of brain metastases: a systematic review. Palliative medicine, 19(4), pp.288-299.
4. Giglio, P. and Gilbert, M.R., 2010. Neurologic complications of cancer and its treatment. Current oncology reports, 12(1), pp.50-59.
5. Throvardur R. et al. 2017. Emergencies in hematology and oncology. Mayo clin proc. 92(4)):609-641
6. Hatiboglu, M.A., Wildrick, D.M. and Sawaya, R., 2013. The role of surgical resection in patients with brain metastases. Ecancermedicalscience, 7. Bhangoo, S.S., Linskey, M.E. and 
7. Joshi, A, Ryan, C, Olver, I, Cancer Council Australia Oncology Education Committee. Oncological emergencies. In: Sabesan S, Olver I, editors. Sydney: Cancer Council Australia. Available from: https://wiki.cancer.org.au/oncologyformedicalstudents/Clinical_Oncology_for_Medical_Students.
8. Arvold, N.D., Lee, E.Q., Mehta, M.P., Margolin, K., Alexander, B.M., Lin, N.U., Anders, C.K., Soffietti, R., Camidge, D.R., Vogelbaum, M.A. and Dunn, I.F., 2016. Updates in the management of brain metastases. Neuro-oncology, 18(8), pp.1043-1065.
9. Kalkanis, S.N., 2011. Evidence-based guidelines for the management of brain metastases. Neurosurgery Clinics, 22(1), pp.97-104
10. Anticonvulsant Prophylaxis and Steroid Use in Adults With Metastatic Brain Tumors: ASCO and SNO Endorsement of the Congress of Neurological Surgeons Guidelines​
11. Lewis, M.A., Hendrickson, A.W. and Moynihan, T.J., 2011. Oncologic emergencies: pathophysiology, presentation, diagnosis, and treatment. CA: a cancer journal for clinicians, 61(5), pp.287-314.