What Is Carcinomatous Meningitis?

Carcinomatous meningitis, also called leptomeningeal disease, can occur as a result of any type of late-stage cancer. It is caused by the spread of cancerous cells to the meninges, the membranes that cover your brain and spinal cord. The cells come from tumors that exist elsewhere in the body.

Symptoms of this problem vary, but often include headaches, numbness, pain, and lower limb weakness. Detecting carcinomatous meningitis early is difficult. It is often found through the use of imaging studies and a draw of cerebrospinal fluid, which flows in and around your brain and spinal cord.

Treatment of carcinomatous meningitis is complex. It often involves more than one approach aimed to improve the quality and length of life. Since carcinomatous meningitis occurs in the end stages of cancer, the prognosis is often poor.

This article describes carcinomatous meningitis symptoms, diagnosis, and treatment, and how to cope with the prognosis.

Types of Meningitis

Meningitis is when the membranes that protect your brain and spinal cord become inflamed (swollen). Meningitis is most often caused by a bacterial or viral infection, but it can also result from other sources or conditions, such as cancer or certain medications.

The most common type is viral meningitis, which is caused by a virus that is spread from one person to another.

Less common types of infectious meningitis originate from other sources in the environment. These types are:

• Bacterial meningitis
• Fungal meningitis
• Parasitic meningitis
• Amoebic meningitis

Meningitis can also occur as a result of non-infectious causes like diseases, drugs, brain injuries, or brain surgeries. Since carcinomatous meningitis originates from cancerous tumors elsewhere in the body, it is considered a noninfectious form of meningitis.

All types of meningitis involve swelling of the meninges. These membranes include the three layers of tissue that surround and protect the central nervous system, which includes the brain, its cranial nerves, and the spinal cord. When swelling occurs, it causes pressure to build on the spinal cord or brain and interferes with the normal flow of cerebrospinal fluid.

Symptoms

Symptoms of carcinomatous meningitis occur when cancer cells cause a fluid buildup and increase pressure in the brain. While symptoms typically develop, they are often vague or common to other conditions.

Since people who get this condition may also be living with the effects of the primary cancer or its treatment, it can be hard to determine the source of symptoms to get an early diagnosis.

Symptoms of carcinomatous meningitis can include:

• Headaches that are worse in the morning
• Nausea
• Vision changes
• Difficulty walking
• Numbness/weakness
• Seizures
• Neuropathic pain
• Stroke
• Radiculopathy (pinched nerve)
• Encephalopathy (changes in brain structure or function)
• Psychological problems like confusion

Causes

Carcinomatous meningitis occurs when cells from cancerous tumors break away and spread to the meninges, where they affect the brain and spinal cord. There, the meninges and cerebrospinal fluid provide conditions that allow tumor cells to rapidly multiply in this area.

This process, in which cancer cells break away from their original site and spread to other parts of the body, is called metastasis.

Carcinomatous meningitis can develop as a complication of many types of cancer but usually results from the following types:

• Breast cancer
• Lung cancer
• Melanoma
• Lymphoma

You have the highest risk of developing carcinomatous meningitis if you have one of the following risk factors:

• Incomplete surgical resection of brain metastasis
• Surgery without postoperative radiation therapy
• Onset of brain metastasis at younger than 40 years old
• Advanced systemic disease (disease throughout the body)

Diagnosis

The diagnosis of carcinomatous meningitis starts with a comprehensive history and physical exam. A neurological assessment can determine whether your symptoms align with those common to the condition.

When carcinomatous meningitis is suspected, a definitive diagnosis can be obtained with a lumbar puncture, also known as a spinal tap. The procedure involves the insertion of a needle into your back between the bones of the spine and below the spinal cord. A sample of cerebrospinal fluid is extracted and examined under a microscope for the presence of cancer cells.

For many patients, the condition can often be identified in imaging studies of the nervous system, particularly magnetic resonance imaging (MRI).

Treatment

Carcinomatous meningitis isn't curable. The goals of treatment are often to improve symptoms to extend the affected person's life span and improve their quality of life during that time.

Treatment involves a combination of approaches to reduce pressure on the brain caused by the buildup of cerebrospinal fluid and lower the number of cancerous cells causing the pressure. Even though the cancerous cells affect the brain, they are still considered part of the primary type of cancer.

Treatment involves a combination of the following approaches based on the type of primary cancer present, your symptoms, and your test results:

• Administration of chemotherapy systemically or via intrathecal (spinal cord) injection
• Reduction of pressure from cerebrospinal fluid via a spinal tap, medication, or shunt
• Use of radiation therapy to kill cancer cells on the meninges and relieve symptoms of pain, weakness or numbness

Prognosis

The prognosis for someone diagnosed with carcinomatous meningitis varies significantly based on the primary tumor type. The median time of survival with this condition is 2–4 months, even with appropriate treatment.

However, the extent of your disease and the timing of your diagnosis can impact your outcomes. Early diagnosis before the onset of neurological problems may improve survival rates.

Coping

A diagnosis of carcinomatous meningitis can be difficult to handle. Since it occurs in late-stage cancers, it can complicate existing treatment plans and deal an emotional blow to someone who is already managing an illness.

This disease is typically treated with a multidisciplinary approach. Treatment teams likely include neurologists, neurosurgeons, medical oncologists, radiation oncologists, psychiatrists, and nurses who specialize in this condition.

These healthcare professionals can provide the care and support you need to manage the biological, psychological, and social challenges of this condition.

Summary

Carcinomatous meningitis can develop as a secondary problem in late-stage cancers. It occurs when cancer cells spread to your brain and spinal cord. These cells come from tumors that exist elsewhere in your body.

Common symptoms of this problem include headaches, numbness, pain, and weakness in your lower limbs. Finding it early can give you the best outcome, but it can be hard to do. Many common symptoms are vague and may also occur as a result of cancer treatment. This can make it hard to notice the first signs of the disease.

Finding the problem requires the use of a spinal tap to review a sample of cerebrospinal fluid. It can also be found through imaging with an MRI.

There is no cure for this condition. Treatment depends on the extent of the disease and the type of primary cancer present. It often involves a combination of drugs, chemotherapy and radiation therapy.

The goals of treatment are often focused on improving quality of life and extending survival.

A Word From Verywell

Even if you're accustomed to not feeling well as a result of living with long-term cancer, don't delay in reporting changes in your symptoms as soon as they occur. Early diagnosis is one of the key factors that can improve your outcome with this difficult diagnosis.

Don't make assumptions about your treatment outcome. Many unique factors about your condition can affect your physical health and prognosis.

Your healthcare provider and cancer team are the best resources for getting answers to difficult questions about this disease. Be open and honest with those close to you about your diagnosis. That way they can support you in dealing with both the physical and emotional challenges that arise.