Meningeal carcinomatosis
Meningeal carcinomatosis, also known as carcinomatous meningitis or leptomeningeal metastasis, is a serious condition characterized by the spread of cancer cells to the meninges, the protective membranes covering the brain and spinal cord. This spread can originate from a primary central nervous system (CNS) tumor or metastasize from cancers such as breast, lung, melanoma, or lymphoma. As life expectancy improves for cancer patients, the incidence of meningeal carcinomatosis is becoming more common, affecting approximately 5 to 30 percent of patients with certain types of cancer. Symptoms often include headaches, confusion, seizures, and weakness, which can complicate diagnosis. Diagnostic methods typically involve imaging techniques like MRI or CT scans and may include a lumbar puncture to analyze cerebrospinal fluid. Treatment options focus on alleviating symptoms rather than curing the condition, often involving chemotherapy delivered directly into the spinal fluid and potential radiotherapy. Unfortunately, the prognosis remains poor, with untreated cases often leading to death within weeks, although some patients may survive longer with treatment. Understanding this condition is crucial for those affected by cancer, as it highlights a potential complication that can arise during the course of their illness.
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Subject Terms
Meningeal carcinomatosis
ALSO KNOWN AS: LM, Carcinomatous meningitis, leptomeningeal carcinomatosis, leptomeningeal disease, leptomeningeal metastasis, meningeal metastasis, neoplastic meningitis
RELATED CONDITIONS: Almost any type of cancer can be associated with this condition, but it is generally seen with breast, melanoma, and lung cancers.
DEFINITION: Carcinomatous meningitis is the spread of tumor cells from a primary central nervous system (CNS) source, such as a brain tumor, or from a distant source, such as a lung or breast tumor, via the blood to the subarachnoid space, where it spreads via the fluid covering the brain, called the cerebrospinal fluid (CSF), to involve the coverings of the brain, known as the leptomeninges.
Risk factors: In adults, primary brain tumors such as oligodendroglioma or secondary tumors, also called metastases, from lung, breast, melanoma, lymphoma, ovarian, or gastric cancer, can spread to the brain surfaces.
Etiology and the disease process: Unlike other forms of meningitis, where the invading organism is a bacterium, fungus, or virus, the invaders in carcinomatous meningitis are cancer cells. In adults, meningeal carcinomatosis is usually the result of the metastasis of a primary brain tumor or a secondary cancer in a person who has lymphoma, melanoma, or lung, breast, or gastric tumors.
Incidence: As the lifespan of patients with cancer increases with improved and earlier medical interventions, meningeal carcinomatosis becomes more common. Between 5 and 15 percent of meningeal carcinomatosis result from hematological malignancies (most commonly B-cell lymphoma) and 5 to 8 percent from solid tumors. Because of underdiagnoses of meningeal carcinomatosis, incidence may be as high as 20 percent or more. Incidence varies between types of cancer—in breast cancer, between 5 and 8 percent, lung cancer, 9 to 25 percent, and up to 30 percent of melanoma cases.
Symptoms: Patients usually complain of nonspecific symptoms of headache, confusion, seizures, hearing loss, facial weakness, back pain, or weakness in an extremity.
Screening and diagnosis: Meningeal carcinomatosis can be diagnosed by magnetic resonance imaging (MRI) or myelography together with computed tomography (CT). The usual diagnosis method is a spinal tap (also called a lumbar puncture), whereby a needle is inserted into the cerebral spinal fluid within the subarachnoid space, and the fluid is sampled. However, cerebral spinal fluid cytology is negative in 10 percent of cases.
Treatment and therapy: Meningeal carcinomatosis is difficult to cure, and the aim of treatment is usually to ameliorate symptoms by injecting chemotherapy into the spinal fluid via lumbar puncture (intrathecal methotrexate) or by radiotherapy to the brain.
Prognosis, prevention, and outcomes: Some patients respond to treatment. However, the prognosis is generally poor, with death occurring in four to six weeks if the disease is untreated. With treatment, survival averages two to four months. Breast cancer patients typically live longer, up to seven months.
Bibliography
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