Epidemiology, clinical manifestations, and diagnosis of brain metastases
- Jay S Loeffler, MD
Jay S Loeffler, MD
- Section Editor — Neurooncology
- Professor of Radiation Oncology
- Harvard Medical School
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
Brain metastases are the most common intracranial tumors in adults, accounting for significantly more than one-half of brain tumors. In patients with systemic malignancies, brain metastases occur in 10 to 30 percent of adults and 6 to 10 percent of children [1-5].
The incidence of brain metastases may be increasing, due to both improved detection of small metastases by magnetic resonance imaging (MRI) and better control of extracerebral disease resulting from improved systemic therapy [4-10].
The etiology, clinical manifestations, and diagnosis of brain metastases will be reviewed here, along with an overview of the approach to treatment. Specific treatment approaches to good and poor risk patients, as well as the use of systemic therapy, are discussed separately. (See "Overview of the treatment of brain metastases" and "Systemic therapy for brain metastases".)
In adults, the most common primary tumors responsible for brain metastases are carcinomas, and include lung, breast, kidney, and colorectal cancers, and melanoma. In contrast, carcinomas of the prostate, esophagus, and oropharynx and non-melanoma skin cancers rarely metastasize to the brain. In children, the most common sources of brain metastases are sarcomas, neuroblastoma, and germ cell tumors [3,9,10].
For all types of cancer, brain metastases diagnosed during life are relatively uncommon. This was illustrated in two large series, one from the Metropolitan Detroit Cancer Surveillance System and the other from a Dutch series [11,12]. In both studies, the cumulative incidence of brain metastases detected was similar:
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