Carcinomatous Meningitis

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Carcinomatous meningitis

Definition

Carcinomatous meningitis, also called meningeal carcinomatosis, neoplastic meningitis, or leptomeningeal carcinoma, is a form of metastatic cancer that has spread to the lining of the brain and spinal cord, the parts of the body that make up the central nervous system.

Description

The meninges are membranes that cover the brain and spinal cord. There are two types of meninges, thin membranes called the pia-arachnoid or leptomeninges, and firmer, tougher membranes called the dura or pachymeninges. Carcinomatous meningitis is cancer of the leptomeninges. These membranes are bathed in and help contain cerebrospinal fluid (CSF).

Carcinomatous meningitis is a metastatic cancer. The cancer cells that form tumors on the leptomeninges have come from other places in the body. Cancer cells break off from the primary tumor and circulate through the blood stream. When they enter the CSF, they act like seeds, attaching to many sites on the leptomeninges and developing into many tumors. The most common cancers that metastasize to carcinomatous meningitis are leukemia, lymphoma , melanoma , breast, lung, and gastrointestinal cancers .

Demographics

Once thought to be a rare complication of cancer, carcinomatous meningitis is increasing in frequency. This may be because people with cancer are living longer, giving the cancer a chance to spread to the central nervous system. The number of people who develop carcinomatous meningitis is difficult to determine. One study suggested that up to 8% of cancers become carcinomatous meningitis. Another small study published in 2000 found that 2% to 3% of women with breast cancer develop carcinomatous meningitis. Frequently, people who develop tumors in the leptomeninges also develop them in other parts of the brain.

Causes and symptoms

Carcinomatous meningitis is caused by the spread of other types of cancer to the central nervous system. There are many symptoms, including:

headache
decrease in mental abilities
confusion
disturbances in the ability use the legs and arms
back pain
weakness
burning or prickling sensations
loss of feeling in the face
problems with vision, hearing, or swallowing
increased pressure in the brain due to the accumulation of fluid

Diagnosis

Magnetic resonance imaging (MRI) scans of the brain and spinal cord may be done as part of the diagnosis for carcinomatous meningitis. However, the definitive diagnosis comes from removing a sample of cerebrospinal fluid, looking at it under the microscope, and finding cancer cells. This procedure is called a lumbar puncture . It is common for doctors to have to do several lumbar punctures before a firm diagnosis can be made.

Treatment team

The treatment team for a patient with carcinomatous meningitis usually involves an oncologist (cancer specialist), possibly a surgeon, radiation oncologist (specialist in radiation therapy ), radiation technicians, nurses with special training in cancer care, and a social worker.

Clinical staging, treatments, and prognosis

Carcinomatous meningitis is treated with either radiation or intrathecal chemotherapy . In radiation therapy, high-energy, penetrating waves or particles such as x rays, gamma rays, or proton rays are aimed at the spot where the tumor is located. The goal is to destroy the cancer cells or keep them from reproducing.

Intrathecal chemotherapy involves injecting chemotherapy drugs directly into the CSF. Drugs are injected either through a lumbar puncture or through an Ommaya reservoir located on the skull. The goal is for the drugs to kill the cancer cells, although some normal cells are also killed.

Carcinomatous meningitis is an advanced form of cancer that usually leads to degeneration of the nervous system and then to death. A person who has developed carcinomatous meningitis is likely to have tumors in other places in the body as well. The chance of recovery is very slight.

Alternative and complementary therapies

Alternative and complementary therapies range from herbal remedies, vitamin supplements, and special diets to spiritual practices, acupuncture, massage, and similar treatments. When these therapies are used in addition to conventional medicine, they are called complementary therapies. When they are used instead of conventional medicine, they are called alternative therapies.

No specific alternative therapies have been directed toward carcinomatous meningitis. However, good nutrition and activities, such as yoga, meditation, and massage, that reduce stress and promote a positive view of life have no unwanted side effects and may help improve the quality of life. Alternative and experimental treatments are usually not covered by insurance.

Coping with cancer treatment

Carcinomatous meningitis is usually fatal. In addition, radiation and chemotherapy cause fatigue , nausea and vomiting , and other uncomfortable side effects. Emotions are intense and often conflicting. In this extremely stressful time, it is often helpful for both the patient and loved ones to have the support of a therapist, religious leader, or other counselor. Hospice staff members or hospital social workers or chaplains can direct patients and family members to resources that address their individual needs.

Clinical trials

In 2001, there were several clinical trials related to intrathecal chemotherapy treatment for carcinomatous meningitis. Current information on what clinical trials are available and where they are being held can be found by entering the search term "carcinomatous meningitis" at the following websites:

National Cancer Institute <http://cancertrials.nci.nih.gov> or (800) 4-CANCER.
National Institutes of Health Clinical Trials <http://clinicaltrials.gov>.
Center Watch: A Clinical Trials Listing <http://www.centerwatch.com>.

Prevention

Carcinomatous meningitis arises from the spread of other cancers. The best form of prevention is immediate and thorough treatment of the primary cancer.

Resources

PERIODICALS

Martinelli, Giovanni, et al. "Intrathecal Chemotherapy in Carcinomatous Meningitis from Breast Cancer." Annals of Oncology 11:suppl 4 (October 2000): 153.

ORGANIZATIONS

American Brain Tumor Association. 2720 River Road, DesPlaines, IL 60018. (847) 827-9910. Patient line (800) 886-2282. <http://www.abta.org>.

OTHER

Groerwald, Susan. "Brain & Central Nervous System Cancer:Brain Metastases." cancersourceMD. 14 February 2000. 4 July 2001 <http://www.cancersourceMD.com>.

Tish Davidson, A.M.