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Carcinomatous meningitis

Carcinomatous meningitis is when cancer cells spread to one of the membranes that surround the brain. You can read about

 

What carcinoma meningitis is

Carcinomatous meningitis means there is inflammation of the covering of the brain, caused by cancer. 

It is an uncommon condition caused by cancer cells getting into the thin layers of body tissue that surround and protect the brain and spine. These layers are called the meninges. Meningitis means inflammation of the meninges.

It is also sometimes called leptomeningeal metastases, which just means that there is cancer spread to these layers of body tissue covering the brain.

 

What causes it

Cancer cells can reach the meninges by travelling in the bloodstream from a cancer somewhere else in the body.  Or they may spread from a secondary cancer that has already developed in the brain. A secondary cancer happens when cancer cells break away from a cancer (the primary cancer) and spread to another organ or part of the body. Doctors call secondary cancers metastases.

 

How common it is

Overall, about 5 out of every 100 people who have cancer (5%) develop carcinomatous meningitis. It happens most often with some types of blood cancer (leukaemia or lymphoma), and with melanoma skin cancer, lung cancer and breast cancer

The number of people with this condition has gone up in recent years. This is because people are living longer due to better treatments for their primary cancer. If you have had cancer and are worried about your risk of carcinomatous meningitis you can talk to your cancer specialist or specialist nurse.

 

Symptoms

The cancer cells in the covering of the brain can cause a range of symptoms, including confusion, headaches and weakness.

 

Diagnosis

It can be difficult to diagnose carcinomatous meningitis. It may show up on an MRI scan or cancer cells may be found in fluid taken from the spine by a lumbar puncture.

 

Treatment

There are no set guidelines for treating carcinomatous meningitis because we don't really know which treatments work best. Scientists are researching new treatments and better ways of treating it. Some treatments can control the cancer cells in the meninges for some months or possibly more than a year but they can't cure it. The main aim is to help to control symptoms. 

Treatments currently used can include

Chemotherapy

Chemotherapy may be injected into a vein (intravenous). Or it may be injected into the spinal fluid (by lumbar puncture). The most common drugs used include methotrexate, cytarabine, and thiotepa.  The best drug to use will depend on the type of primary cancer. Pemetrexed is being used in trials. 

A team of European doctors looked at using different combinations of chemotherapy drugs to treat carcinomatous meningitis due to breast cancer. They found that giving chemotherapy directly into the spinal fluid as well as into the bloodstream improved the outlook for some people. Hopefully this work will develop into better treatments for carcinomatous meningitis in the future.

Some hospitals are researching giving chemotherapy into a plastic, dome shaped device implanted under the skin of the scalp. It is called an Ommaya reservoir. The device has thin tubing attached to the underside that gives chemotherapy into the fluid filled spaces (ventricles) of the brain.

Biological therapy

The biological therapy drug bevacizumab (Avastin) can sometimes help people with carcinomatous meningitis after bowel cancer, breast cancer, melanoma skin cancer or non small cell lung cancer. You have it as an injection into a vein.

Gefitinib is a type of biological therapy that has been used for people with carcinomatous meningitis from non small cell lung cancer. It is not clear how much it may help. You have it as tablets.

Radiotherapy to the brain

Radiotherapy to the brain can help to reduce symptoms. This is usually radiotherapy to the whole brain. But some people may have targeted radiotherapy to one area of the brain. We have detailed information about brain tumour radiotherapy.

 

Help and support

It can be difficult to cope when cancer cells have spread to the meninges. But there is a lot of help available. You may find it useful to look at our pages about treating secondary brain tumours and living with a brain tumour. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday.

Our brain tumour organisations page gives details of people who can give information and support. Some organisations can also put you in touch with a cancer support group. You can find details of counselling organisations in our counselling section

Our brain tumour reading list has information about books and leaflets on brain tumours and treatments.

If you want to find people to share experiences with online, you could use CancerChat, our online forum.

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Updated: 20 November 2013