Leptomeningeal metastases, also known as leptomeningeal disease, carcinomatous meningitis or meningeal carcinomatosis, is a rare complication of advancedat a late stage, far along cancers where malignantcancerous, may grow and spread to other areas of the body or cancerous cellsthe basic structural and functional unit of all living things spread to the two inner most layers of tissue that cover the brain and the spinal cord (known as leptomeninges) and cerebrospinal fluid (CSF). It most commonly occurs as a result of breast cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs, lung cancer or cutaneous melanomaa type of cancer that develops from melanocytes, which are the cells that produce pigment generally in the skin (but can develop in other areas of the body), however, can also develop as a result of other malignancies such as gastrointestinal or haematological cancers.
There are three primary membranes that make up the meninges: the dura mater, the arachnoid and the pia mater. The dura mater is the thick, membranous, outermost layer of the meninges located directly under the skull. Its main functions are to provide structural support, anchor the central nervous system (CNS) and assist in regulating CSF circulation. The arachnoid is the middle layer of the meninges. Its main function is to cushion the brain and spinal cord from trauma, and facilitate the circulation of CSF. The pia mater is the innermost layer of the meninges, and its main functions are to act as a barrier to protect the CNS from contaminants, and allowing the passage of small bloodthe red bodily fluid that transports oxygen and other nutrients around the body vessels that nourish the brain.
It is currently unknown whether leptomeningeal metastases is likely to affect one sex more than another, and it is difficult to determine an average age of diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results as it is a rare, late-stage complication of different types of cancer. However, it is thought that anyone can develop this disease.
Treatment
When cancers are detected, they are staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you. However, as leptomeningeal metastases is often a complication of late-stage or metastatic cancer, it is automatically classified as stage IV disease.
Treatment options for leptomeningeal metastases are often palliative, and may include:
- Shunt insertiona procedure to relieve build-up of cerebrospinal fluid (CSF) in the brain
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells
- Intrathecal chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells
- Immunotherapya treatment that uses a person's immune system to fight cancer (limited)
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease
Risk factors
Because of how rare leptomeningeal metastases is, there has been limited research done into the riskthe possibility that something bad will happen factors of this disease.
Symptoms
Symptoms of leptomeningeal metastases may include:
- Headaches.
- Nauseato feel sick or likely to vomit and/or vomiting.
- Light-headedness or dizziness.
- Encephalopathy, which may include:
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- Confusion.
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- Forgetfulness.
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- Disorientation.
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- Behavioural changes.
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- Lethargylack of energy, fatigue.
- Diplopiaseeing two images of a single object, also known as double vision
- Facial pain, weakness, tingling and/or numbness
- Hearing changes and/or loss
- Seizures
- Facial drooping
- pain in your lower back, legs or neck
- Difficulties speaking
- Dysphagia (difficulties swallowing)
- Poor balance
- Difficulties walking
- Incontinenceloss of control over release of urine or faeces
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have leptomeningeal metastases, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Neurological examinationan assessment of sensory and motor functions, such as vision, balance and coordination
- Imagingtests that create detailed images of areas inside the body studies, most commonly an magnetic resonance imaging (MRI) scan of the brain and/or spine
- Lumbar puncturea procedure that involves inserting a needle between two vertebrae in the lower spine and extracting a sample of cerebrospinal fluid (CSF) for analysis