by Kimberly Allen, RN
Leptomeningeal carcinomatoisis (LC) is also called neoplastic meningitis and is a serious complication of cancer that is considered uncommon but not rare. Most people don’t hear about these types of cancer until someone they know, whether it’s personally or someone that is well known like Valerie Harper, is diagnosed with the condition. Experts believe that approximately 8% of cancer patients in the US develop LC. However, LC is present in 19% of cancer patients autopsied that had neurologic symptoms with their cancer. Though adenocarcinomas are the most common to spread to the leptomeninges it can occur with any systemic cancer. Current statistics indicate that up to 25% of small cell lung cancers spread to the leptomeninges along with 23% of melanomas. Though the statistics indicate that only 5% pf breast cancers spread to the leptomeninges because breast cancer occurs more frequently than the others most people that develop LC have breast cancer. Also, the longer a person has their primary cancer the greater the chance they will develop LC.
LC is not a primary brain cancer, it is a secondary cancer that is the result of cancer cells from another site that metastasize or spread to the brain. Cancer cells produce an enzyme that is able to breakdown the Blood Brain Barrier (BBB) and enter into the cerebral spinal fluid. Once the cancer cells are in the cerebral spinal fluid they establish themselves and scatter throughout the leptomeninges which make up the arachnoid and pia layers of the meninges. Then after entering the cerebral spinal fluid they spread throughout the neural pathways of the brain. These cells once in the cerebral spinal fluid can also spread to the spinal cord.
Most people that develop LC will experience meningeal symptoms first. Meningeal symptoms can vary from person to person and are usually the result of increased intercranial pressure. This means the most common symptom is headaches. These headaches tend to be severe and are usually accompanied by nausea and vomiting as well as lightheadedness. Many will also complain of weakness and unsteadiness as well as some degree of numbness in their face and/or extremities. As the LC continues to spread throughout the brain the patient becomes confused, has memory loss and behavior changes as well as pain and seizures.
Unfortunately there is currently no definitive treatment established for LC. The goals of treatment for LC are to improve and/or stabilize the patients neurologic status and prolong life as well as palliative care. Most doctors will treat LC with chemotherapy. It may be systemic using intravenous or oral chemotherapeutic agents or intrathecal chemotherapy. In intrathecal chemotherapy the chemotherapeutic agent is injected directly into the sub-arachnoid space to the spinal cord to avoid the Blood Brain Barrier and get directly into the cerebral spinal fluid. The intrathecal method is the preferred method of treatment as systemic chemotherapy does not penetrate the Blood Brain Barrier.
Though patients rarely survive past 7 months after diagnosis there is research ongoing with new medications and technology being developed giving hope to the people currently suffering with LC as well as those currently undergoing treatment for other types cancer.