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Understanding brain metastases
Brain metastases are cancers that began somewhere else in the body and spread to the brain. They are the most common type of brain tumor in adults, far more common than tumors that start in the brain. Lung cancer, breast cancer, melanoma, kidney cancer, and colorectal cancer are the most frequent sources. Some patients are diagnosed with a brain metastasis before the original cancer is found.
A diagnosis of brain metastasis is frightening, but the outlook has changed dramatically in the past decade. Focused radiation can control most metastases without open surgery, modern systemic therapies increasingly reach the brain, and many patients live for years with well-controlled disease. The goal of treatment is to protect neurologic function and quality of life while the rest of the cancer is treated.
A comprehensive cancer care team
Brain metastases are never treated by one doctor alone. At Santa Barbara Cottage Hospital, I work as part of a comprehensive team that includes specialists in medical oncology, neuro-oncology, radiation oncology, and neurocritical care. We coordinate directly with one another and with each patient's own oncologist. That means your surgical decision, your radiation plan, and your systemic therapy are made as one plan rather than three.
Having this team on the Central Coast matters. Patients no longer need to travel to Los Angeles for specialized brain tumor expertise, and the neurologic complications of cancer and its treatment are managed by specialists who do this every day.
Treatment options
Stereotactic radiosurgery
Stereotactic radiosurgery delivers a highly focused dose of radiation to each metastasis in one or a few sessions, sparing the surrounding brain. It is the primary treatment for most brain metastases, can treat multiple tumors in a single session, and requires no incision. I completed fellowship training in stereotactic radiosurgery at Massachusetts General Hospital and Harvard Medical School, and I plan radiosurgery for my own patients.
Microsurgical resection
Surgery is recommended when a metastasis is large, causing significant swelling or pressure, located where radiation alone would be risky, or when a tissue diagnosis is needed. Using image-guided navigation and, when appropriate, awake mapping, the tumor is removed while protecting critical brain function. Surgery is usually followed by focused radiation to the surgical cavity.
Whole brain radiation
Whole brain radiation is used less often than it once was, but it remains an option for patients with many metastases or certain cancer types. Our radiation oncology colleagues use techniques that spare the memory centers of the brain when it is needed.
Systemic and targeted therapy
Many modern cancer drugs, including targeted therapies and immunotherapy, can reach and control tumors in the brain. Your medical oncologist and the neuro-oncology team determine how these fit alongside surgery and radiation.
Symptoms of brain metastases
- New or worsening headaches, often worse in the morning
- Seizures
- Weakness, numbness, or clumsiness on one side
- Difficulty with speech, vision, or balance
- Confusion, personality change, or memory problems
- Nausea and vomiting from pressure inside the head
If you have a known cancer and develop new neurologic symptoms, contact your oncologist promptly. For sudden severe symptoms, call 911.
Why choose Dr. Walcott for brain metastases?
- Comprehensive Cancer Team: Care coordinated with medical oncology, neuro-oncology, radiation oncology, and neurocritical care
- Radiosurgery and Microsurgery: Fellowship training in both, so the recommendation is based on what is best for you, not on which tool is available
- Harvard and MGH Training: Neurosurgical residency at Massachusetts General Hospital and Harvard Medical School
- Care Close to Home: Surgery, radiosurgery, and neuro-oncology follow-up in Santa Barbara
- Academic Excellence: Author of over 160 peer-reviewed publications
Frequently asked questions
Is a brain metastasis the same as brain cancer?
Not exactly. A brain metastasis is cancer that started elsewhere, such as the lung or breast, and spread to the brain. It is treated differently from tumors that originate in the brain, and the treatment plan depends heavily on the type of cancer it came from.
Do brain metastases always require surgery?
No. Most brain metastases are treated with stereotactic radiosurgery, a focused form of radiation that requires no incision. Surgery is recommended for large tumors, tumors causing significant swelling or pressure, or when a tissue diagnosis is needed.
Who is on the brain metastasis care team?
Care is coordinated by a comprehensive team at Santa Barbara Cottage Hospital. Dr. Walcott provides neurosurgery and radiosurgery, working alongside specialists in medical oncology, neuro-oncology, radiation oncology, and neurocritical care, so that surgery, radiation, and systemic therapy are planned together as one treatment plan.
Can multiple brain metastases be treated?
Yes. Stereotactic radiosurgery can treat multiple metastases in a single session, and modern systemic therapies increasingly control tumors in the brain. The number of tumors is only one of several factors that shape the plan.
What is the outlook after treatment for a brain metastasis?
This depends on the type of cancer, how well it is controlled elsewhere in the body, and the patient's overall condition. Many patients now live for years with well-controlled brain disease. Dr. Walcott and the care team discuss the individual outlook honestly with every patient and family.
