What should you know about triple-negative brain metastases?

Metastases are cancer cells that have travelled from another part of the body to the brain. Triple-negative usually describes breast cancer cells that lack oestrogen receptors, progesterone receptors and excess HER2; it is not a description of every brain tumour. Brain metastases can also arise from lung cancer, melanoma or other cancers, so the original diagnosis matters.

Symptoms vary with the location and number of deposits. Headache, nausea, seizures, weakness, balance problems, vision changes, speech difficulty or changes in thinking can occur. An MRI is commonly used to examine the brain, while the oncology team also reviews scans elsewhere in the body.

Treatment may combine corticosteroids for swelling, anti-seizure medicine when indicated, radiotherapy, surgery or medicines aimed at the primary cancer. Stereotactic radiosurgery focuses radiation on selected lesions. Whole-brain radiotherapy may be discussed when there are many areas or when the distribution makes focused treatment unsuitable. Brain tumour surgery can provide tissue or relieve pressure in selected situations.

The decision depends on neurological symptoms, lesion size and position, number of lesions, overall health, previous treatment and the cancer outside the brain. Ask who will coordinate oncology, radiation and neurosurgical care.

Call emergency services for a first seizure, a seizure lasting longer than usual, sudden one-sided weakness, new speech trouble, fainting, severe confusion or a rapidly worsening headache with vomiting. Contact the treating team promptly about new balance problems, vision changes, persistent nausea or a change in alertness.

How many brain lesions are present, and where are they located? Is there swelling or pressure? Would surgery, stereotactic radiosurgery or whole-brain radiotherapy be suitable? What symptoms should trigger emergency help? Which treatment is aimed at cancer elsewhere in my body?