Kidney Cancer Metastasis to the Brain

Kidney cancer can spread (metastasize) to other parts of the body through the bloodstream or lymphatic system. If cancerous cells break away from a primary kidney tumor and reach the brain, the rogue cells can bind together and form secondary tumors (brain metastases), typically in the cerebral cortex or cerebellum.

Metastatic brain cancer is much more common than primary brain cancer, which originates in the brain itself. The presence of a metastatic brain tumor often signals an advanced stage of primary cancer and may require a multidisciplinary treatment approach that involves oncologists, neurologists and other specialists.

Brain metastasis occurs in approximately 4 to 11% of patients with kidney cancer, most often in those with advanced tumors. Renal cell carcinoma (RCC), the most common type of kidney cancer, has a known tendency to spread to the brain, particularly in late stages. Although it occurs less frequently than kidney cancer metastasis to the lungs and bones, brain involvement is a recognized complication that can significantly impact treatment planning.

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What are the symptoms of kidney cancer metastasis to the brain?

The symptoms of kidney cancer metastasis to the brain can vary depending on the location, size and number of tumors. Common warning signs include:

• Loss of balance and coordination – Metastatic brain cancer can impair the brain’s ability to send clear signals to the muscles to control bodily movement. This can lead to muscle weakness, numbness, postural instability and difficulty walking.
• Headaches – A brain tumor can create pressure inside the skull or press on sensitive neural tissues. The resulting headaches are often worse in the morning and may not respond to over-the-counter pain relievers.
• Neurological issues – A mass or tumor that develops in the cerebral cortex, which controls many high-level functions, can interfere with language, memory, consciousness or sensory perception.
• Seizures – A brain tumor may irritate or compress sensitive neural tissues, triggering abnormal electrical signals that lead to sudden bursts of uncontrolled activity. New-onset or worsening seizures, which can range from brief lapses in awareness to full-body convulsions, are often one of the first signs of a brain tumor.

These symptoms can develop gradually or appear suddenly. Any new or unexplained neurological issues in an individual with a history of kidney cancer should be evaluated promptly by a physician.

How is kidney cancer metastasis to the brain diagnosed?

Kidney cancer metastasis to the brain is typically diagnosed through a neurological evaluation and imaging tests. If a patient with kidney cancer develops neuro-related symptoms, such as headaches, seizures or changes in coordination or mental status, the physician may order imaging studies to investigate the cause.

Magnetic resonance imaging (MRI) is the preferred imaging technique for detecting brain metastasis. An MRI scan of the brain can provide the physician with detailed visuals of soft tissues, helping them identify even small tumors. For enhanced visualization, a contrast dye may be injected before the images are captured.

In some cases, computed tomography (CT) may also be used to check for brain metastasis, particularly if MRI is unavailable or inappropriate for the patient. In general, CT is less sensitive than MRI in detecting small or hidden brain tumors.

If brain metastasis is suspected but the results of diagnostic imaging are inconclusive, the physician may order further testing, such as a lumbar puncture (spinal tap) or biopsy, to confirm the diagnosis, assess the extent of cancer spread and guide treatment planning.

What are the risk factors for kidney cancer metastasis to the brain?

Several factors can increase the likelihood of kidney cancer metastasis to the brain. These include:

• Advanced-stage kidney cancer – Patients with stage 4 renal cell carcinoma are at high risk for distant metastasis, including to the brain.
• Aggressive tumor type – Certain histologic cancer subtypes, such as clear cell renal cell carcinoma, are more likely to spread beyond the kidneys.
• Large primary tumor size – A large kidney tumor is more likely to invade the surrounding tissues, enter the bloodstream or lymphatic system and travel to the brain.
• Spread to other organs – A patient with lung, liver or bone metastasis from kidney cancer is at heightened risk of also developing brain metastasis.
• High tumor grade – Kidney tumors with a high Fuhrman grade or a high International Society of Urological Pathology (ISUP) grade tend to grow and spread more rapidly.
• Weakened immune response – A suppressed immune system may be less able to control cancer progression.

After identifying one or more of these risk factors, the physician can monitor a high-risk kidney cancer patient more closely for signs of brain involvement.

What is the prognosis for kidney cancer metastasis to the brain?

The prognosis for kidney cancer metastasis to the brain is generally guarded, mainly because brain involvement often indicates an advanced-stage primary tumor. However, the patient’s outcome and quality of life can vary significantly depending on several factors, including:

• The location, size and number of metastatic brain tumors
• The molecular characteristics of the primary kidney tumor
• The patient’s overall health and functional status
• The presence of kidney cancer metastasis to other organs
• The patient’s response to treatment, such as surgery, radiation therapy or systemic therapy

Ongoing advances in targeted therapy, immunotherapy and neurosurgical techniques continue to improve the prognosis for many patients with kidney cancer metastasis to the brain. If the brain metastases are limited and well-controlled, long-term survival may be possible.

How is kidney cancer metastasis to the brain treated?

When kidney cancer spreads to the brain, treatment focuses on shrinking or removing the tumors, managing the symptoms and improving the patient’s quality of life. The specific approach can vary based on the location, size and number of brain tumors and the patient's overall health. In many cases, a customized combination of therapies is used.

Surgery for kidney cancer metastasis to the brain

If there is only one metastatic brain tumor and it can be safely accessed and removed by a surgeon, neurosurgery may be considered. The goal is to quickly relieve intracranial pressure and reduce the related symptoms, such as headaches and muscle weakness. Surgical treatment is usually followed by radiation therapy to help prevent cancer recurrence.

Surgical removal of a brain tumor caused by kidney cancer can potentially offer several important benefits. These include:

• Prompt relief from pressure-related symptoms, such as headaches, vision changes and movement difficulties
• Complete removal of the brain tumor, particularly if it is small and well-defined
• An enhanced outcome and quality of life, especially if the surgery is combined with radiation therapy

Brain surgery also carries some risks, including:

• Bleeding, infection and swelling in the brain
• Temporary or permanent changes in speech, movement and thought processes

Typically, a hospital stay and rest period are required to support healing. Some patients may need rehabilitation to recover their strength, coordination or cognitive function.

Radiation therapy for kidney cancer metastasis to the brain

Often used to destroy cancerous cells and shrink brain tumors, radiation therapy is a noninvasive treatment that may be a particularly good option for a patient who is not a candidate for neurosurgery. In addition to serving as a standalone treatment, radiation therapy can be combined with other therapies for heightened effectiveness. When used appropriately, it can potentially improve both the patient’s brain function and quality of life.

The two main types of radiation therapy for kidney cancer metastasis to the brain are:

• Stereotactic radiosurgery (SRS) – A highly focused form of radiation therapy, SRS can target one or a few small brain tumors with minimal impact on the surrounding healthy tissues.
• Whole-brain radiation therapy (WBRT) – If several tumors have developed in the brain, WBRT may be used to treat the entire brain and help prevent the development of new tumors.

Although radiation therapy is generally well tolerated, it can sometimes affect healthy brain tissues in addition to cancer cells. This may lead to a range of short- and long-term side effects, such as:

• Fatigue and weakness
• Hair thinning and hair loss
• Inflammation and swelling in the brain
• Memory or cognitive changes, especially after WBRT

Medication for kidney cancer metastasis to the brain

Kidney cancer that has spread to the brain can also be treated with medications that work throughout the body. Options may include:

• Targeted therapy – Specialized drugs can block the cellular proteins that promote tumor growth and spread. For example, HER2-positive kidney cancer can be treated with a medication designed to penetrate the blood-brain barrier, such as tucatinib, trastuzumab or lapatinib.
• Immunotherapy – A biological therapy that capitalizes on the power of the body’s immune system to fight cancer, immunotherapy may be an option for a patient with triple-negative kidney cancer, especially if the tumors express certain immune markers, such as PD-L1.

The side effects of medication-based (systemic) treatment for kidney cancer metastasis to the brain can vary depending on the specific medication used. Some patients experience:

• Fatigue
• Nausea and vomiting
• Diarrhea
• Skin rash
• Changes in blood pressure or liver function (with targeted therapy)
• Inflammation in healthy organs (with immunotherapy)

Chemotherapy for kidney cancer metastasis to the brain

Chemotherapy is not usually a primary treatment for kidney cancer that has spread to the brain, mainly because the most common type of kidney tumor—renal cell carcinoma—is resistant to most standard chemo drugs. This resistance can limit the effectiveness of chemotherapy in controlling the cancer.

Additionally, the brain is protected by the blood-brain barrier, a filtering mechanism that prevents many substances circulating in the bloodstream, such as chemo drugs, from reaching the brain tissues in therapeutic concentrations. As a result, even if chemotherapy was effective against kidney cancer elsewhere in the body, it may not adequately reach or treat brain metastases.

For these reasons, treatment for kidney cancer metastasis to the brain more often involves surgery, radiation therapy, targeted therapy and/or immunotherapy, which are better suited to the tumor biology as well as the unique challenges of treating cancer in the brain.

Symptom management for kidney cancer metastasis to the brain

Corticosteroids can help reduce brain swelling, which can ease headaches and other neurological symptoms. Additionally, anti-seizure medications may be prescribed for a patient who is experiencing—or at risk for—seizures.

Benefit from world-class care at Moffitt Cancer Center

The renowned Neuro-Oncology Program at Moffitt offers the latest treatment options for kidney cancer metastasis to the brain, including a robust portfolio of clinical trials. As a high-volume cancer center and established leader in cancer care, Moffitt takes a multispecialty approach to brain tumor treatment, leveraging the collective expertise of our neurosurgeons, medical oncologists, radiation oncologists, neuroradiologists and other specialists. Due in part to our extensive research efforts and unwavering commitment to improving brain cancer outcomes, Moffitt is recognized as a Comprehensive Cancer Center by the National Cancer Institute, and we are the only cancer center based in Florida to have earned this prestigious distinction.

If you would like to learn more about kidney cancer metastasis to the brain, you can request an appointment with a specialist in Moffitt’s Neuro-Oncology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.