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# Brain metastases

Cancer that has spread to the brain from another organ, most often the lung, breast or [skin](https://durgical.com/en/anatomy/skin/). It is the most common brain tumour in adults.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [White matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/)
- [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/)
- [Frontal lobe](https://durgical.com/en/anatomy/superior-frontal-gyrus/)
- [Parietal lobe](https://durgical.com/en/anatomy/superior-parietal-lobule/)
- [Temporal lobe](https://durgical.com/en/anatomy/middle-temporal-gyrus/)
- [Occipital lobe](https://durgical.com/en/anatomy/superior-occipital-gyri/)
- [Lateral ventricles](https://durgical.com/en/anatomy/lateral-ventricle/)
- [Fourth ventricle](https://durgical.com/en/anatomy/fourth-ventricle/)
- [Middle cerebral artery](https://durgical.com/en/anatomy/middle-cerebral-artery/)
- [Dura mater](https://durgical.com/en/anatomy/cranial-dura/)

## Why it happens

- [Invasion and metastasis: the metastatic cascade, step by step](https://durgical.com/en/general-pathology/invasion-and-metastasis-the-metastatic-cascade-step-by-step/)
- [Pathways of spread and the usual metastatic sites](https://durgical.com/en/general-pathology/pathways-of-spread-and-the-usual-metastatic-sites/)
- [Local effects of tumours and cancer cachexia](https://durgical.com/en/general-pathology/local-effects-of-tumours-and-cancer-cachexia/)

## What it is

Secondary tumours in the brain from a cancer that started elsewhere, usually spread through the blood. They are the most common intracranial tumours in adults and are often multiple, located at the junction of grey and [white matter](https://durgical.com/en/anatomy/white-matter-of-telencephalon/).

## Who gets it

Up to a fifth to a third of adults with cancer develop brain metastases. The most frequent primary sites are lung, breast, melanoma, [kidney](https://durgical.com/en/anatomy/kidney/) and colorectal cancer. In Colombia, where lung and breast cancer are among the main causes of cancer death, brain metastases are a frequent reason for neuro-oncology and palliative care consultations.

## Causes

- Lung cancer (the most common source, especially small cell and adenocarcinoma)
- Breast cancer (especially HER2-positive and triple-negative)
- Melanoma (the highest tendency to spread to the brain; often hemorrhagic)
- Renal cell carcinoma (often hemorrhagic)
- Colorectal cancer (more often in the posterior fossa)

## Risk factors

- Advanced or poorly controlled systemic cancer
- Primary tumours with high brain tropism (lung, melanoma, HER2-positive breast)
- Longer survival with modern cancer treatments, which allows more time for brain spread

## Pathophysiology

Tumour cells reach the brain through the arterial blood and lodge where vessels narrow at the grey-white matter junction, mainly in the territory of the [middle cerebral artery](https://durgical.com/en/anatomy/middle-cerebral-artery/) and at watershed areas. About 80% are in the cerebral hemispheres, 15% in the [cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) and a few in the brainstem. The tumour and the vasogenic edema around it raise intracranial pressure, irritate the cortex (seizures) and compress neighbouring tissue; posterior fossa lesions can block the [fourth ventricle](https://durgical.com/en/anatomy/fourth-ventricle/) and cause hydrocephalus.

## Classification

- By number: single (one brain lesion), solitary (single and the only metastasis in the body) or multiple
- By location: supratentorial, infratentorial (cerebellum, brainstem), or leptomeningeal spread

## Symptoms and signs

- Headache, often worse in the morning or with coughing and straining
- Nausea and vomiting
- Focal weakness, numbness, language or visual problems depending on location
- Seizures
- Changes in cognition, personality or behaviour
- Imbalance and gait ataxia with cerebellar lesions

## Red flags

- Drowsiness, worsening headache with vomiting, or a dilated pupil (raised intracranial pressure, herniation)
- Sudden worsening from hemorrhage into a metastasis
- Prolonged or repeated seizures
- New neurological symptoms in any patient with known cancer

## Diagnosis

**Clinical**
Suspected in any patient with cancer and new neurological symptoms; in some patients the brain lesion is the first sign of the cancer. Performance status helps decide treatment.

**Tests**
Search for the primary tumour and staging; biopsy or resection gives the diagnosis when the primary is unknown or there is doubt. Molecular testing of the tumour (e.g. EGFR, ALK, HER2, BRAF) guides targeted therapy.

**Imaging**
Contrast-enhanced MRI is the test of choice: ring-enhancing or solid lesions at the grey-white junction with disproportionate surrounding edema. CT with contrast is used when MRI is not available; [chest](https://durgical.com/en/anatomy/region/chest/), [abdomen](https://durgical.com/en/anatomy/region/abdomen/) and [pelvis](https://durgical.com/en/anatomy/region/pelvis/) CT or PET-CT looks for the primary.

## Differential diagnosis

- Primary brain tumours (glioblastoma, lymphoma, meningioma)
- Brain abscess
- Toxoplasmosis in people with HIV
- Neurocysticercosis (frequent in Colombia and Latin America)
- Tuberculoma
- Ischemic or hemorrhagic stroke and demyelinating disease

## Goal of treatment

Control symptoms and edema, achieve local control of the brain lesions while protecting cognition, and treat the systemic cancer, in line with the patient's prognosis and wishes.

## Treatment

**Medical**
Corticosteroids (dexamethasone) to reduce vasogenic edema in symptomatic patients; antiseizure drugs only after a seizure, not for prevention.

**Surgical**
Surgical resection for a single accessible lesion, large lesions with mass effect, or when tissue diagnosis is needed, usually followed by radiotherapy to the cavity.

**Procedure**
Stereotactic radiosurgery for a limited number of small lesions; whole-brain radiotherapy (with hippocampal sparing when possible) for many lesions.

**Medical**
Systemic therapy that crosses into the brain, such as targeted therapy for EGFR, ALK or HER2 tumours and immunotherapy for melanoma and lung cancer.

**Follow-up**
Neurological checks, seizure precautions, glucose monitoring while on corticosteroids, and early palliative care for symptom control and decision-making.

## Complications

- Brain herniation from edema
- Hemorrhage into the tumour
- Obstructive hydrocephalus
- Seizures
- Cognitive decline after whole-brain radiotherapy, and radiation necrosis
- Side effects of corticosteroids (hyperglycemia, infections, myopathy)

## Prognosis

Prognosis depends on age, performance status, number of lesions, control of the systemic cancer and molecular markers. Median survival ranges from a few months to several years in patients with targetable tumours.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common intracranial tumour in adults?

Brain metastases.

## Which primary cancers most often spread to the brain?

Lung, breast, melanoma, kidney and colorectal cancer; lung cancer is the most common source.

## Where in the brain do metastases typically lodge?

At the grey-white matter junction, often in the territory of the middle cerebral artery.

## Which metastases are classically hemorrhagic?

Melanoma, renal cell carcinoma, choriocarcinoma and thyroid cancer.

## Which drug is used to reduce edema around brain metastases?

A corticosteroid, usually dexamethasone.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/brain-metastases/)

## Related conditions

- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Melanoma](https://durgical.com/en/conditions/melanoma/)
- [Renal cell carcinoma](https://durgical.com/en/conditions/renal-cell-carcinoma/)
- [Colorectal cancer](https://durgical.com/en/conditions/colorectal-cancer/)
- [Glioblastoma](https://durgical.com/en/conditions/glioblastoma/)
- [Meningioma](https://durgical.com/en/conditions/meningioma/)
- [Brain abscess](https://durgical.com/en/conditions/brain-abscess/)
- [Toxoplasmosis](https://durgical.com/en/conditions/toxoplasmosis/)
- [Neurocysticercosis](https://durgical.com/en/conditions/neurocysticercosis/)
- [Raised intracranial pressure and brain herniation](https://durgical.com/en/conditions/raised-intracranial-pressure-and-brain-herniation/)
- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)
- [Hydrocephalus](https://durgical.com/en/conditions/hydrocephalus/)
- [Malignant spinal cord compression](https://durgical.com/en/conditions/malignant-spinal-cord-compression/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Metastatic brain tumor: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000769.htm) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Source: https://durgical.com/en/conditions/brain-metastases/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/brain-metastases/