Understanding Metastatic Breast Cancer that Spreads to the Brain
- Actress Shannen Doherty, 52, recalled her first thoughts after finishing brain surgery for metastatic breast cancer on her podcast with her neurosurgeon. She revealed she asked, “What’s wrong with me,” to which her doctor replied, “Nothing.” She noted the sense of calm before and after the procedure, which helped ease her nerves.
- Doherty continues to shed light on the ups and downs of her cancer journey that began in 2015 on her podcast by focusing on her unsettled nerves last year when her stage 4 breast cancer spread to her brain.
- Doherty underwent last year is called a craniotomy. During the procedure, surgeons cut out the tumor. This procedure is an option if the tumor causes symptoms like weakness, headache, or seizures.
- After the procedure, the patient is closely monitored and usually receives radiation to keep the tumor from growing back. Since the procedure, Doherty learned the cancer also spread to her bones, but she is managing well and remains positive.
- Cancer care team members strive to stay on the same page and communicate a clear and uniform message to their patients. The team may include a surgeon, oncologist, radiation therapist, patient navigator, and more.
Just over a year has passed since actress Shannen Doherty, 52, underwent brain surgery to combat stage 4 breast cancer that had metastasized (spread) to her brain. In the latest episode of her podcast “Let’s Be Clear,” she vividly recounts her initial exchange with the neurosurgeon who treated her immediately following the procedure.
“What’s wrong with me,” Doherty recalled asking her neurosurgeon, who replied, “Nothing.”
Read More“I was scared enough, but knowing to that extent,” Doherty lamented to Dr. Chu.
Dr. Chu said it’s common for patients to want to know details—sometimes intimate details—about the brain surgery process.
Doherty says she dislikes pity or sad looks and likes to get test results over the phone.
As the conversation winded down, Doherty noted the possibility of additional surgery in the event the cancer evolves and she needs more treatment.
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The Power of Doherty’s Care Team
Doherty’s gratitude toward her care team is unmistakable, as their work helped make many facets of her cancer journey more manageable. When you’re diagnosed with cancer, you have more than just one doctor helping you throughout your cancer journey. Doctors work collaboratively with specialists. For instance, during your surgery, other surgical specialists can be present if you have cancer in different organs or places that might require their expertise.
Cancer care team members strive to stay on the same page and communicate a clear and uniform message to their patients.
Different members of your care team may include:
- The surgeon
- The oncologist
- The radiologist
- A genetic counselor
- A nutritionist
- An emotional support/mental health professional
- A reproductive medicine specialist
- A physical therapist
- A patient navigator
“Cancer care is multidisciplinary, and a team approach is simply the best way to organize it,” Dr. Elizabeth Berger tells SurvivorNet. Berger is a breast surgical oncologist in The Breast Center at Yale University’s Smilow Cancer Center in New Haven, CT.
“Teams communicate on an almost daily basis. When I receive a [lab] report on a patient, I immediately reach out to the radiologist and the medical oncologist. We have calls where all that patient’s team members are on the call discussing appropriate care for each patient,” Berger says.
Patients shouldn’t worry themselves trying to maintain a close relationship with each care team member. Instead, focus on one of your doctors to serve as your point person.
“I recommend that patients designate one of their doctors, whether the medical oncologist, the surgeon, or whomever, as their point person, the one they go to for questions and discussions. The point guard of that team,” Berger says.
Understanding the Surgery Doherty Received
Doherty was first diagnosed with breast cancer in 2015. It went into remission in 2017 but returned as stage 4 (or metastatic) in 2019. Metastatic cancer, for which there is no cure, means it has spread to distant areas of the body, like the bones, liver, lungs, or brain.
The surgery Doherty underwent last year 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. Kimberly Hoang, a board-certified neurosurgeon at Emory University School of Medicine, explained.
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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, 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.
“We take off the bone overlaying the area we need to get to. We open the little envelope around the brain called the dura. 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 in brain metastasis treatment. 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. The National Cancer Institute describes this barrier as a “network of blood vessels and tissue made up of closely spaced cells and helps keep harmful substances from reaching the brain.”
However, Dr. Hoang tells SurvivorNet that advancements in chemotherapy, immunotherapy, and targeted drugs designed to target cancer cells are beginning to make headway even in the brain.
Overall, according to research published in the journal Cancers, “the prognosis after brain metastasis remains poor” for patients because of how difficult it is for medicine to reach the brain.
It’s important for other stage 4 breast cancer patients to remember that what Shannen Doherty is experiencing is not necessarily what every person with stage 4 breast cancer experiences, and only 10-15% of women with stage 4 breast cancer” may experience brain metastasis, says Dr. Eleonora Teplinsky.
Dr. Teplinsky is the head of breast and gynecologic medical oncology at Valley Health System. She’s also a clinical assistant professor of medicine at Icahn School of Medicine at Mount Sinai.
Doherty had initially undergone hormone therapy, a single mastectomy (the removal of all breast tissue from one breast), chemotherapy, and radiation after her 2015 diagnosis. The full scope of her treatment leading up to recent years is unclear.
Are there side effects that patients who undergo brain surgery can 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. Krishanthan Vigneswaran, a neurosurgeon with UT Health Houston and Memorial Hermann, tells SurvivorNet.
“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 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 help minimize some of the side effects you experience during your journey.
Recovery After Brain Surgery
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 you 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.
Questions for Your Doctor
If your breast cancer journey involves metastasis, you may be wondering what to expect and if radiation therapy is an option for you. Here are some questions you can ask your doctor to get the conversation started:
- What type of breast cancer do I have? Does it have a risk of spreading?
- Does my breast cancer have a risk of spreading to my brain?
- Will radiation help treat the cancer in my brain? What type of radiotherapy do you recommend?
- How long does radiation treatment typically last? Will I have to take time away from work and daily activities?
- Would I be on any other forms of treatment while receiving radiation?
- How do you expect my cancer to respond to the treatment?
- What financial resources are available to me to help cover costs associated with radiation treatment?
- What’s the efficacy of radiation treatment?
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