MRI\'s on the brain

[Ruth S]

It seems that people are having this test done - I never have. I am finished with Herceptin in Aug. Should I request this test? I have had this year a cat scan on my thorax, MUGA, ECHO, and mammogram on my remaining breast but that is it as far as tests go. At diagnoses I had bone scan, MUGA, x-ray, and cat scans done but that was over a year ago now. I feel fine but should I request this test? Is it something that your dr.'s do routinely with HER2 folks? My Onc. usually only does diagnostic tests if there is a reason to by way of symptoms or something that shows up in blood tests. I got my cat scan done earlier this year because I bugged him - not because I felt anything. I was diagnosed with 3cm, 10/16 lymphnodes, HER2 +++, ER/PR - , grade 3.
Any suggestions? Thanks! Ruth

[janelle]

Ruth,
It doesn't seem to be protocol to do an MRI on the Brain, unless there are symptoms or maybe the insurance co. doesn't want to pay for it But after reading the stories here, I decided to fudge a few symptoms to get one... and they found a small 5 mm spot. I will find out Tues if it is anything to worry about. Since Herceptin does not cross the blood brain barrier, it is a test I was going to get one way or the other.

Hugs

[Steph N]

Hi Ruth -
Your tumor pathology sounds about like mine. My mets (not brain) came fast and furious only 3 months after completing chemeo and rads (no Herceptin avail at the time of adjuvent treatment). So, I hope your getting Herceptin now will stave off progression.

With that many positive nodes, your med onc may be willing to order a brain MRI for you a short way down the road. Just tell him you have some strange feeling down your arm or something and that should be enough for the insurance to pay. (That is what I said - but it was true.)
Just getting off Herceptin may not be a good time to push for brain MRI if you indeed have no symptoms. Supposedly the Herceptin is targeting all the loose cancer cells before they can get into your brain. This is the logic, but I don't buy it 100% myself.
I think the most important thing is to have regular checks for ALL possible mets sites - i.e. scans and frequent markers drawn. Mets normally do not have pain associated with them in the early stages and this is why we need all the regular tests.
Live your life, but stay On Guard.

[Al]

Is the chemo for brain mets different than that for other mets? In other words, if you are getting chemo for mets already, should you go looking for brain mets or is it already being treated with the current chemo anyway?

[Steph N]

There is so much to say on each topic, easy to forget to add important info.
When mets are discovered in the body from the neck down, routinely a brain MRI is done to rule out mets there. Any med onc worth his salt will have this done so that the entire extent of mets is understood before embarking on a new treatment plan.
All clinical trials require that mets to the brain be ruled out before a patient is accepted. (This was so in my case.)
So, the answer is that when mets are being treated, it should already be determined that there is no spread in the brain area. And the reason for this is something called the "blood/brain barrier." This means that many molecules are too large to pass into the brain - as a natural protectant. Chemo does not breach this barrier normally.
Hope this clears up your question.

[Al]

Hi Steph,
Not really, (my question cleared-up). Is Chemo for brain mets the same as other mets? Our Onc isn't worth his salt, that's why I ask. My wife has a second consulting Onc and I should check if she tested for brain mets.
Thanks,
Al