Lung cancer and brain metastases

Brain metastases are very common with small cell lung cancer (SCLC). Within sub-types of non-small cell lung cancer (NSCLC), brain metastases are more common with adenocarcinoma than with squamous cell carcinoma.

Once your doctor suspects that cancer has spread to your brain, whether or not you have symptoms, they may carry out different checks and tests to assess the extent and possible impact of the tumours.

These procedures can help your medical team get a clearer picture of what is going on, and gather more information to help you think about what you want to do next:

• Neurological examination
• CT scan (computerised tomography)
• MRI scan (magnetic resonance imaging)
• Biopsy (tissue sample).

Symptoms of brain metastases

Brain metastases can affect people in various ways, including:

• Headaches
• Weakness in parts of the body
• Feeling sick
• Mood swings and changes in behaviour
• Fits or seizures
• Problems with co-ordination
• Confusion
• Lethargy
• Problems with reading or talking.

Not everyone with brain metastases has symptoms or will notice any effects.

Treatment for brain metastases

Treatment for brain metastases is primarily about managing symptoms and improving your quality of life. Your doctor may recommend more than one type of treatment.

The main thing to remember is that there are treatment options. Talk to your lung cancer nurse if you are worried about any changes in your health as early treatment is always best, and they can help take the worry out of a situation for you.

Sharon, lung cancer nurse specialist

They will consider the outcomes of any scans and X-rays and other tests you may have had that show the size and location of the cancer, and your general health and medical history before offering any treatment. This can include:

• Medicines to reduce symptoms
• Radiotherapy
• Stereotactic radiosurgery
• Systemic treatments: chemotherapy and targeted therapies
• Clinical trials
• Surgery.

Just because you have treatment options doesn’t mean that you have to take them. Only you can weigh up the pros and cons and ultimately decide what you want.

Deciding on treatment for brain metastases can be a stressful process, and some of the side-effects of any treatment can be hard to deal with. If you feel low or depressed, speak to your doctor or lung cancer nurse. They may refer you to other healthcare professionals who might be able to support you, such as a counsellor.

Living with brain metastases

Some of the problems and symptoms associated with brain metastases don’t get resolved when the tumour is removed or treated. For example, you may continue to have muscle weakness, fits or seizures, problems walking, or difficulties with speaking or swallowing.

There are services available that can give you extra support to help you overcome or adapt to some of these problems:

• Physiotherapy: This can help you maintain or improve your strength, mobility, balance and co-ordination through exercise and other advice. Physiotherapy can also help you with breath control, as well as coughing and chest clearing techniques.
• Occupational therapy: If you are struggling with some every day activities, like getting upstairs, bathing or cooking, an occupational therapist will look at equipment or alterations that can be made to help. They can also help you deal with fatigue or poor sleep, as well as some aspects of going back to work, if this an option for you.
• Speech and language therapy (SALT): This is a specialist team that helps people who find speaking clearly or loudly enough difficult, or who are not able to eat and swallow properly.

Driving with brain metastases

The effects of brain metastases on a person’s capability are unpredictable. Because of this, any driver diagnosed with brain metastases must STOP driving to minimise any risks to themselves or others. If they continue to do so, they run the risk of a hefty fine (£1000) and face prosecution if they are involved in an accident.

Many people who hear this news tell us that it has been a very difficult thing to come to terms with as it can significantly change their independence and what they can do.

You may be able to reapply for your driving licence after a year or two if you’re are clear of brain metastases and your cancer is controlled.

There is a legal responsibility for driving licence holders to tell the Driver and Vehicle Licensing Agency (DVLA), or the Driver and Vehicle Agency (DVA) in Northern Ireland, about certain medical conditions that could affect their driving. You can do this by using Form B1, available here.

They may ask for permission to make further medical enquiries, ask you to surrender your licence, if you haven’t already done so, or revoke your licence, and give a medical reason why. They will also tell you if and when you may reapply for your licence.

If you have a lorry, bus or coach licence, use Form B1V. Fill in the form and send it to: Drivers Medical Group, DVLA, Swansea, SA99 1TU.

Hospice care

There may come a time when you need additional care. Hospices provide care and support to 360,000 people with life-limiting or terminal conditions every year.

As well as taking care of people’s physical needs, they also look after their emotional, spiritual and social needs. They also support carers, family members and close friends, both during a person’s illness and during bereavement.

Hospice care is free for everyone, and is provided for however long it is needed, which could be days, weeks or even months.

Hospices provide a range of services, including:

• Pain and symptom control
• Psychological and social support
• Rehabilitation
• Complementary therapies, such as massage and aromatherapy
• Counselling
• Spiritual care
• Practical and financial advice
• Support in bereavement.

You can find out more about hospices, including finding one near you by visiting Hospice UK.