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Brain metastases are the most common type of brain tumors, with the total number diagnosed annually outnumbering all other intracranial tumors combined. Autopsy data show that the frequency of brain metastases in patients dying from cancer varies from 20 to 50%, and may be higher if dural, leptomeningeal, or spinal metastases are taken into account.
Metastatic disease can be viewed as two simultaneously occurring diseases: Brain cancer and systemic cancer (elsewhere in the body). Each disease has quite different mortality rates. Untreated brain metastases are rapidly fatal.
The most common source of brain metastases in males is lung cancer and in females is breast cancer, but with the increasing frequency of lung cancer in females, it is expected that for females this too will be the primary cause of metastatic brain tumors.
Different types of primary tumors have different relative frequencies of single versus multiple metastases. Melanoma has the highest tendency to produce multiple lesions, followed by lung and breast cancers.
Metastatic brain tumors present with the usual signs and symptoms of any expanding intracranial mass lesion. These include increased intracranial pressure and focal neurological deficits with focal irritations. Such symptoms include headaches, focal weakness, mental status changes, seizures, ataxia [inability to coordinate voluntary muscular movements] and sensory and visual changes. Though most of these symptoms are of gradual onset, acute episodes may occur due to hemorrhages into a metastasis. When such an event occurs, either choroid carcinoma or melanoma must be considered, because these have the greatest tendency to hemorrhage.
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