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Leptomeningeal Metastases

This information explains leptomeningeal metastases and how it is treated.

Cancer cells from some types of cancer can spread to the membranes that cover the brain and spinal cord. These membranes are called the meninges. They can also spread to the cerebrospinal fluid (CSF). CSF bathes these membranes and the spinal cord.

When cancer cells are found in either the meninges or CSF, it is called leptomeningeal metastases (lep-toe-men-IN-geel me-TASS-ta-seez), or LM. It can trigger a wide variety of symptoms.

Symptoms

Symptoms of LM include:

  • Difficulty thinking
  • Double vision
  • Headaches
  • Difficulty speaking or swallowing
  • Pain
  • Weakness and/or lack of coordination in your arms and legs
  • Loss of bladder or bowel control
  • Seizures

You may have 1 or more of these symptoms. Having 1 symptom does not mean you will necessarily develop others.

Diagnosis

Your doctor may perform several diagnostic tests to see if you have LM. If your doctor suspects that you have LM, you may have magnetic resonance imaging (MRI) of your brain or spine. An MRI scan takes detailed pictures of a specific part of your body without using x-rays. It can be used to diagnose LM.

If the MRI does not show LM, your doctor may want to do a lumbar puncture, sometimes called an LP or a spinal tap. For an LP, the skin on your lower back will be numbed. Then, a needle will be inserted into your spinal canal so that a sample of your CSF can be removed. Your doctor or nurse does this test so that your CSF can be examined for cancer cells. If cancer cells are found, a diagnosis of LM is confirmed.

You may need to have more than one LP because it can be hard to find cancer cells in the CSF. An LP also may be done to measure the pressure of your spinal fluid. If it is high, it can also cause symptoms, even if the MRI shows LM.

Treatment

The goal of treatment for LM is to relieve your symptoms and to try to kill the cancer cells that are in your CSF. Treatments include radiation therapy, chemotherapy, or both. The type of treatment your doctor thinks is best will depend on the type of cancer you have, your symptoms, and your test results. Your doctor and nurse will discuss your treatment plan in depth with you and your family.

Radiation therapy

You may receive radiation therapy to your head or to areas on your spinal cord where clusters of cancer cells are seen. You may need radiation to both your head and spinal cord. Sometimes, it is given to 1 area first and to another area at a later time.

Radiation therapy can be given to you while you are in the hospital, but they are usually given when you are an outpatient. Your doctor will make this decision with you.

Chemotherapy

Chemotherapy for LM is usually given straight into the CSF. It may be given to you during an LP. More commonly, it is given through an Ommaya reservoir. This is a dome-shaped device that is placed under your scalp during a surgery. It is done under general anesthesia and takes about 1 hour. You will have some discomfort at the incision when the anesthesia wears off. Be sure to ask for pain medication, if you need it.

The Ommaya reservoir has a small tube that connects it to the areas of the brain where CSF is formed. Chemotherapy given through the Ommaya reservoir can get into your CSF directly. This means you do not need to have an LP. Chemotherapy given this way has very few side effects because only a small dose is needed to treat the cancer cells in the CSF. There may be times when you will need to have an LP, even though you have an Ommaya reservoir. Your chemotherapy will be  given to you as an outpatient.

You may also receive chemotherapy by vein or by mouth. This is to control both your primary cancer and the LM.

Caring for Yourself During Your Treatment

There are many ways to help you manage the symptoms of LM. It is important to describe new problems or any change or improvement in your symptoms to your doctor or nurse. This helps them decide whether your treatment is working. It also lets them know if some adjustments are needed in your treatment plan.

A diagnosis of LM may cause anxiety. Your doctor, nurse, or social worker will discuss any concerns you may have about LM and your primary cancer. Please share your questions with them.