In an extraordinary public bout with metastatic breast cancer, actress Shannen Doherty, 52, underwent brain surgery to improve her prognosis. The “Beverly Hills 90210” star is bravely battling an incurable cancer that admittedly leaves her “petrified” but her latest treatment on her brain should give her reason to have hope. Several neurosurgeons tell SurvivorNet that the procedure once considered terminal now allows patients with cancer in their brain to live longer vibrant lives.
As cancer treatments improve year over year so does the number of people battling this form of cancer that spreads to the brain says Dr. Michael Lim who is the Chair of the Department of Neurosurgery and a board-certified neurosurgeon specializing in brain tumors at Stanford Medicine.
"A third of the patients with systemic cancers develop brain metastasis and we estimate that number is starting to go higher not because the cancers are becoming more aggressive but because people are living longer," Dr. Lim explained. When cancer spreads from one part of the body into the brain, it's called brain metastasis. Doherty's stage 4 breast cancer has undergone this process.
"A couple of decades ago, to have a brain metastasis was a very bad prognosis for patients. They didn't live for more than a couple of months, so it was a very terminal thing. Thanks to a lot of advancements in microsurgery we do and radiation…patients are living longer," says board-certified neurosurgeon at Emory University School of Medicine Dr. Kimberly Hoang.
Some cancers are more prone to spread to the brain than others, Dr. Krishanthan Vigneswaran, a neurosurgeon with UT Health Houston and Memorial Hermann tells SurvivorNet.
WATCH: When cancer spreads to the brain.
"Breast cancer is among the types of cancers that more commonly spread to the bone and to the brain along with melanoma, prostate cancer, renal cell cancer, and lung cancer," Dr. Vigneswaran explained.
Research is ongoing to learn why certain cancers are more likely to metastasize toward the brain.
Understanding the Surgery Doherty Received
The surgery Doherty underwent in January is called a craniotomy. "It's a procedure to cut out a tumor and it can be metastasized or a tumor that started someplace else like the breasts and went to the brain especially if the tumor is causing symptoms or if it's large," Dr. Hoang explained.
Neurosurgeons SurvivorNet spoke to say usually your symptoms will indicate if your metastatic cancer has spread to the brain. An MRI scan can help confirm if this is the case.
"Often patients have symptoms such as weakness, headache, or seizures. Or some patients don't have symptoms and brain metastases are discovered on a routine MRI," explained Dr. Peter Forsyth who is the Chairman of the Neuro-Oncology Program at Moffitt Cancer Center and Professor of Oncology at the University of South Florida.
"With breast cancer going to the brain so commonly, sometimes MRIs are done without symptoms," Dr. Forsyth added.
The MRI helps doctors pinpoint the exact location of the tumor within the skull. Dr. Hoang explains the surgical procedure to remove the tumor involves making an incision near where the tumor is.
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"We take off the bone overlaying the area we need to get to. We open the little envelope around the brain called the dura and then we move through the brain tissue to get to where the tumor is to try to cut out as much as we can safely without hurting the patient's function or other important things like big blood vessels that can cause things like a stroke," Dr. Hoang said.
After the procedure, the patient is closely monitored and usually receives radiation to keep the tumor from growing back.
"Because many patients can have more than one brain tumor or metastasis from their cancer, that was not reasonable to think about surgery for, they also get radiation for those spots as well to try to keep those tumors from growing or shrink them down," Dr. Hoang further explained.
In addition to surgery, other forms of treatment have also seen improvements to help treat brain metastasis. Proven cancer-fighting drugs such as chemotherapies, immunotherapies, and targeted drugs while effective in many parts of the body were less effective at treating tumors in the brain due to the blood-brain barrier. This barrier is a "network of blood vessels and tissue that is made up of closely spaced cells and helps keep harmful substances from reaching the brain," the National Cancer Institutedescribes.
However, advancements in chemotherapy, immunotherapy, and targeted drugs designed to target cancer cells are beginning to make headway even in the brain Dr. Hoang tells SurvivorNet.
What Side Effects Can Patients Treated for a Brain Tumor Expect?
Treatment side effects from metastatic brain tumors depend on the size, location, and number of brain tumors within the skull.
"Radiation treatment can cause swelling in the tumor as the tumor 'dies' and the surrounding tissue can also become swollen as the treatment takes effect," Dr. Vigneswaran explained.
"This swelling can cause symptoms of headache, nausea, vomiting, and neurological loss of function based on the location of the treated lesion. Similarly, surgical resection (to remove the tumor from the brain) can also induce swelling in the area that was operated upon, however, this is more transient than the effect of radiation," Dr. Vigneswaran added.
Among all of the variables that influence what kind of side effects a patient may experience from brain metastasis, perhaps its location is the most poignant.
"If it's near your movement area (of the brain), movement on one side of the body can be affected. If it's near your speech area (of the brain), your speech and the way you form words and the way you can express them can be affected," Dr. Hoang explained.
Dr. Hoang also says brain metastasis surgery is less painful than you might expect. This is because there are "far fewer nerves" when compared to back or abdominal surgery.
Your care team will likely have resources available to you to help minimize some of the side effects along your journey.
What Does Recovery Look Like after Having a Brain Tumor Removed?
For patients like Doherty who undergo brain metastasis surgery, in the weeks that follow they will undergo regular monitoring by their doctor for recurrence of the disease. Additional radiation treatments are also likely to treat surrounding brain tissue that may have been impacted by the tumor that was removed during surgery.
"Because of this unique quality of metastatic brain disease, an oncology team will have to monitor a patient indefinitely during remission," Dr. Vigneswaran said.
Many neurosurgeons SurvivorNet spoke to say finding a support group that includes people who underwent the same procedure is a powerful resource. Their first-hand experience can help you prepare for challenges during recovery by giving your tips to cope.
"Support groups can be incredibly helpful to patients and are commonly offered at major cancer centers and hospitals," says Dr. Jennifer Moliterno, Chief of Neurosurgical Oncology and Clinical Director of the Chenevert Family Brain Tumor Center at Smilow Cancer Hospital and Yale Cancer Center.
Your neurosurgeons will usually work with your cancer doctors as part of your overall care team throughout your recovery. Many major cancer centers may include mental health professionals to help you during this stage of your journey to offset feelings of anxiety, depression, or other emotions that may appear.
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Kavontae Smalls is a writer and reporter for SurvivorNet. Read More
