Carcinomatous meningitis: symptoms, causes and outlook

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Carcinomatous meningitis (CD) is a rare complication that can occur with advanced cancer. It develops when cancer cells break away from the original tumor and invade the meninges, which are the protective membranes that surround the brain and spinal cord.

CM is rare, representing approximately 4 to 15% of all solid tumor cancer cases. Although many types of cancer can cause this complication, cancers such as breast cancer, lung cancer, and melanoma are more likely to cause CM.

In this article, we discuss CM in detail, including its symptoms, causes, and outlook.

CM is a complication of cancer. It occurs when cancer cells break away from the main tumor and invade the thin membranes that cover the brain and spinal cord, or meninges.

The name of the complication comes from two different medical conditions: carcinoma and meningitis.

Carcinoma is a type of cancer that starts in the epithelial cells. These cells line a person’s skin, organs, and internal passageways. According to the National Cancer Institute, carcinomas account for 80 to 90% of all cancer cases.

Meningitis is inflammation of the meninges. There are various causes of the disease, including viral, bacterial, or fungal infection, parasites, and different types of cancer.

CM can occur with most types of advanced cancer. The most common solid tumor cancer that experts associate with CM is metastatic breast cancer. The second most common form is lung cancer, followed by melanoma.

Although many types of cancer can cause this complication, it is more likely to develop in certain cancers. These include:

CM by healthcare professionals may refer to other names, such as:

  • neoplastic meningitis
  • meningeal metastasis
  • leptomeningeal carcinoma
  • leptomeningeal carcinoma
  • leptomeningeal metastasis
  • meningeal carcinoma

Symptoms of CM can vary and can affect the brain, cranial nerves, and spinal cord.

A 2021 article reports that 2% people with CD may not have any symptoms.

The authors note that the most common symptom of CM is a headache, occurring in 39% of people with the disease.

The headache results from increased pressure in the skull or irritation of the meninges. If the cause is increased pressure in the skull, a person may also experience nausea which worsens in the morning.

The second most common symptom is confusion. It occurs due to the presence of active cancer cells in the cortex, which is the outermost layer of the brain. It can also lead to temporal lobe seizures, which can lead to:

If CM affects the posterior fossa, which is the space in the skull near the brainstem, a person may experience:

If CM affects the spinal cord, initial symptoms include weakness in the legs and back pain or paralysis. Other symptoms may include:

  • segmental numbness
  • dysesthesia, which is unusual sensations, such as burning or tingling, in the legs or feet
  • pain
  • weakness of limbs

A person can suffer from bowel and bladder dysfunction if CM has affected the sacral nerve roots. The sacred roots are involved with the lower limbs and the area between the vaginal opening and the anus.

CM develops as a complication of advanced stage cancer. It occurs when cancer cells reach the cerebrospinal fluid, which surrounds the brain and spinal cord.

CM is a complication of several different solid tumor cancers and lymphomas or leukemias.

According to a 2018 study, of all CM cases:

  • 70% occur when a person is living with systemic cancer or cancer that has spread
  • 20% develop in people living with stable cancer
  • 10% occur in people with their first manifestation of cancer

Some risk factors for developing CM understand:

  • advanced stages of cancer
  • parenchymal brain metastasis in people under 40
  • not receiving radiation after surgery
  • incomplete surgical removal, or resection, of brain metastases

There is no known way to prevent CD from occurring in people with cancer. However, there are steps a person can take to reduce their risk of cancer.

Some general tips to help reduce the likelihood of developing cancer, depending on the Centers for Disease Control and Prevention (CDC), understand:

  • Vaccination: Vaccines against hepatitis B and the human papillomavirus can help prevent cancers of the liver, cervix, and others.
  • Lifestyle changes: This includes:
  • Projections: Regular cancer screening tests can help catch it early and improve a person’s outlook.

Treating CM can be difficult. People with CM usually have advanced cancer that has spread to different parts of the body. This means that the outlook is often bad.

Treatment for CM tends to focus on:

  • improve neurological problems
  • CM symptom management
  • improved quality of life
  • prolong survival

Healthcare professionals try to treat CM while minimizing toxicity.

A doctor will assess a person to decide which treatment options will be most appropriate. They will assess the grade of the person’s tumor, the burden the disease places on their health and neurological status.

The doctor can also use the person’s Karnofsky Performance Status (KPS). It is a standard way to measure how well a person with cancer can perform ordinary tasks.

The doctor can use a KPS to help determine a person’s prognosis, track changes in their ability to function, and determine their chances of survival.

Once they have completed an assessment, they will work with the person to decide which treatment will be most appropriate.

Treatment options for CM include:

Radiotherapy

Radiation therapy uses beams of x-rays to kill cancer cells. A healthcare professional will target cells in the meninges.

The authors of a article 2021 note that although radiation therapy may relieve pain, it may not improve a person’s survival.

Intrathecal chemotherapy

Intrathecal chemotherapy involves injecting chemotherapeutic drugs into the intrathecal space. This is the space that contains the cerebrospinal fluid.

A healthcare professional will inject the chemotherapy drugs into the cerebrospinal fluid using a lumbar puncture or an Ommaya catheter, a device that doctors place under a person’s scalp.

Intrathecal chemotherapy is the main form of treatment because it bypasses the blood brain barrier. This means that it can go directly into the area around the brain and the cerebrospinal fluid, rather than being delivered through the bloodstream.

A article 2021 note that this form of treatment can prolong a person’s survival.

Systemic chemotherapy

A doctor can use systemic chemotherapy to treat CM in people who are unable to have surgery because it does not require the placement of the Ommaya catheter. Doctors can also combine it with other treatment regimens.

Systemic chemotherapy can improve a person’s survival and may be beneficial for various types of cancer, including breast cancer and small cell lung cancer.

Targeted therapy

This treatment targets proteins that control the division and growth of cancer cells. Examples include:

  • epidermal growth factor receptor tyrosine kinase (TKI) inhibitors to treat lung cancer with EGFR mutations
  • HER2 TKI to treat certain breast cancers
  • BRAF for treating people with melanoma
  • Anaplastic lymphoma KIs used to treat certain lung cancers

Other treatment options

Other treatments may include:

Diagnosis often begins with a physical exam and a discussion of a person’s symptoms. Often, a person diagnosed with CM is already living with advanced cancer and may have other complications as well.

To diagnose the condition, a doctor may order a cerebrospinal fluid examination. They may also order an MRI of the brain, spinal cord, and other relevant areas.

However, he can be difficult to arrive at a diagnosis. This is due to the low sensitivity of diagnostic methods, which means that it is possible for a doctor to misdiagnose the disease.

People with CM often have advanced cancer, which means their outlook is poor.

The researchers behind a article 2021 note that without treatment, the average life expectancy for CD is 4-6 weeks. With treatment, this increases to 2 to 4 months.

People whose breast cancer has caused CD tend to have better prospects and respond better to treatment. The average survival time for people with breast cancer and CD is 5-7 months.

It should be noted, however, that while the outlook may be poor, some people survive for long periods of time.

For example, a 2016 study mentions a 65-year-old woman who developed CM as a complication of breast cancer. After responding well to treatment, this study participant lived another 9 years, dying of an ischemic bowel, which was unrelated to cancer.

Anyone living with cancer who has new or worsening symptoms should see a doctor.

The doctor can help adjust the treatment plan and plan for palliative care.

CM is a serious and often fatal complication of cancer. It occurs when cancer cells break away from the original tumor and enter the meninges.

People with advanced cancer, lung cancer, breast cancer, or other solid tumor cancer are most at risk of developing the complication.

Diagnosing CM can be difficult, and treatment can extend a person’s life expectancy by several weeks.

A person should seek medical advice if they are living with or have survived cancer and have any new or worsening symptoms that could result from CD.


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