Brain mets or scar tissue?

Hi,
I have had brain mets 3 times (2001,2002 and 2004). The first two times I had a cranionomy. They were both single lesions (3cm and 7mm). the last time was a year ago and it was a 5mm lesion which I had stereotactic surgery which went well except now I have scar tissue. The scar tissue is increasing and the doctors are unsure if it is brain mets or scar tissue. I have no s/e, no mass effect, no edema. Has this happened to anyone else? My doctors tell me it can happen and the only way to know for sure is a biopsy. Help!!

[StephN]

Hi Annemarie -
I had my usual quarterly visit with my med onc today and we covered this very topic!

Since my last brain MRI 3 months ago there is very little change in the spot where my 3cm tumor was. There is still a visible "enhancing lesion" in my left cerebellum. There is no inflammation or other noticeable characteristics consistent with active disease. Just seems to be scar tissue, as in your case, from Gamma Knife.
My med onc told me that if there were changes noticed we could do a PET scan of my brain as it actually can be a good indicator of mets getting active again.
But while the spot is stable there is no need.
Also, we had been running my CEA and this turned out to be the tumor marker produced by my brain mets that is a good indicator of an active or inactive spot. My CEA is now down to point7. I am VERY happy with this.

Hope this info helps a little.

Thanks Steph for your message. I will definately request a brain PET and ask about my CEA. I think my CEA has always been normal even with brain mets. The scar tissue has really increased over the year significantly. My oncologist said this is a common problem for cancer pts. in general (not just the brain). I think I am fine but I always want to be certain!

Hi AnneMarie
I had stereotactic rads to a brain met a year and a half ago. About 6 months ago, this spot started changing shape and enhancing more. This has continued for 6 months now. My case was presented at tumor board, I saw 3 outside neurosurgeons and 2 rad oncs. I had a PET scan that was negative but have been told PET in breast cancer brain mets are not reliable. I had a test called MR spectroscopy supposedly very sensitive and it came out probably not tumor but they always qualify it and say they can't be sure.

If it were tumor, I am told I could not have stereotactic rads again but would have to have surgery though one neurosurgeon disagrees with this and would reradiate the spot if he could clean it out well. However, all the neurosurgeons agreed that they would not operate and would continue to watch because I have no symptoms and it is still in the field of radiation and might be radiation damage.

I don't know if this helps. It was driving me nuts for months but I finally stopped worrying and figured if 6 neurosurgeons couldn't figure out what to do, then I better not do anything right now and just watch it closely.

I am also told that radiation damage usually starts about a year out and declares itself in about 6-10 months.

Best of luck,
Rosie