Breast Cancer Case Study

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List A – A critical analysis of diagnostic tests performed and the way in which their results influence management
Brain metastases have caused substantial mortality and morbidity in cancer patients. Approximately 15% of women with breast cancer will be diagnosed with brain metastases (Zakaria et al., 2014). With early diagnosis and appropriate treatment, the quality of the patient’s life could be enhanced. Therefore, it is vital for patients with a known primary tumour to undergo imaging studies once they develop neurological signs and symptoms.
Imaging studies aid to accurately identify the type, number, size, and location of the brain metastases. These details are essential to help discern the interventions appropriate for the patient
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Figure 1: (A) A non-contrast CT scan showing single metastasis while (B) multiple metastases are visible on an MRI of the same patient (Gerrard & Franks, 2004).

Patients with single brain metastases have a wider range of treatment options, including whole brain radiotherapy (WBRT), radiosurgery, and neurosurgical resection. Patients are fit for surgery if the risk-benefit has been weighed out, the metastatic lesion has been accurately located, and other sites of systemic disease are well regulated (Kirsch & Loeffler, 2005). While surgical resection remains the gold standard for the treatment of single brain metastases (Figure 2), it is paramount to adequately stage the extent of the metastases pre-operatively via MRI. Occult metastases undetected on CT scan may render surgery inappropriate if multiple metastases are present (Chang & Lo, 2003).

Figure 2: Therapy for brain metastasis based on the number and size of lesions (Chang & Lo, 2003).

WRBT is the primary therapy for patients with multiple brain metastases, like Mrs R (Figure 2). The benefits of chemotherapy for brain metastases is still debatable, as it had been thought that the blood-brain barrier prevented chemotherapy agents crossing into the cerebrospinal fluid. However, chemotherapy

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