Leptomeningeal Metastases

This information describes leptomeningeal metastases and explains how they are treated.

About Leptomeningeal Metastases

Cells from some types of cancer, such as breast cancer, lung cancer, or melanoma, can sometimes spread to your meninges, cerebrospinal fluid (CSF), or both.

  • Your meninges are the layers of tissue, sometimes called a “jacket” or “envelope,” that cover and protect your brain and spinal cord.
  • CSF is a liquid found between the layers of your meninges. It’s made inside your brain and helps to cushion your brain and 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.

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Symptoms of Leptomeningeal Metastases

LM can trigger many different symptoms, such as:

  • Difficulty thinking
  • Double vision
  • Headaches
  • Difficulty speaking or swallowing
  • Pain
  • Weakness 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 doesn’t mean you will necessarily develop others.

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Diagnosing Leptomeningeal Metastases

Magnetic resonance imaging (MRI) scan

If your doctor thinks that you have LM, you may have a magnetic resonance imaging (MRI) scan of your brain or spine. An MRI scan can be used to diagnose LM.

Lumbar puncture

If the MRI doesn’t show LM, your doctor may want to do a lumbar puncture (sometimes called a spinal tap) to look for cancer cells in your CSF.

During a lumbar puncture, your doctor will numb the skin on your lower back. Then, they will insert a needle through your skin and into your spinal canal to take a sample of your CSF. The sample will be sent to the pathology department to see if there are any cancer cells. If there are cancer cells in your CSF, it means you have LM. You may need to have more than one lumbar puncture, because it can be hard to find cancer cells in CSF.

A lumbar puncture is also a way for your doctor to measure the pressure within your CSF. LM may cause high CSF pressure, which can make your symptoms worse.

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Treatment for Leptomeningeal Metastases

The goal of treatment for LM is to relieve your symptoms and to try to kill the cancer cells in your meninges and CSF. You may have 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 with you and your family.

Radiation therapy

You may get radiation therapy to places where clusters of cancer cells are seen, such as your head, areas on your spinal cord, or both. Sometimes, radiation therapy is given to one area first and to another area later.

Radiation therapy is usually given in an outpatient center, but it can also be given while you’re in the hospital. You and your doctor will make this decision together.

Chemotherapy

Chemotherapy for LM is often given straight into your CSF through an Ommaya reservoir, a dome-shaped device that’s placed under your scalp during a surgery. The Ommaya reservoir has a small tube that connects it to the areas of your brain where CSF is made. 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 chemotherapy through a lumbar puncture, even if you have an Ommaya reservoir.

Before the surgery to place your Ommaya reservoir, you will receive general anesthesia (medication to make you sleep). The surgery takes about 1 hour. When the anesthesia wears off, you will have some discomfort at your incision site (the place where the cut was made to place the reservoir). Ask your nurse for the resource Frequently Asked Questions about Ommaya Reservoirs and Ommaya Taps for more information.

Even if your have an Ommaya reservoir, you may also get chemotherapy through a needle in one of your veins (intravenous [IV] chemotherapy) or by swallowing a pill (oral chemotherapy). This is to control both your primary cancer and the LM.

Caring for Yourself During Your Treatment

There are many ways we can help you manage the symptoms of LM. It’s important to discuss any problems, changes, or improvements in your symptoms with your doctor or nurse. This helps us decide how your treatment is going and lets us know if we need to make any changes to your treatment plan.

Being diagnosed with LM may cause anxiety. Your doctor, nurse, and social worker are available if you would like to discuss your concerns about LM, your primary cancer, or both.

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