Leptomeningeal cancer

Leptomeningeal cancer, also known as leptomeningeal disease (LMD) or neoplastic meningitis, refers to a rare complication of cancer in which the disease spreads to the membranes (meninges) surrounding the brain and spinal cord.

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Clinical Presentation

Patients with leptomeningeal cancer may present with a range of neurologic symptoms, which can include headaches, nausea, vomiting, changes in behavior, seizures, weakness or numbness in the limbs, problems with balance or coordination, and difficulty with speech or swallowing.

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Pathogenesis

The cancer spreads to the leptomeninges through the blood or lymphatic system, or by direct extension from pre-existing lesions. The most common cancers that lead to leptomeningeal disease are breast cancer, lung cancer, and melanoma, as well as certain types of brain tumors.

Diagnosis

Diagnosis is based on clinical symptoms, imaging studies, and cerebrospinal fluid (CSF) analysis. Magnetic resonance imaging (MRI) is typically used to identify any abnormalities in the brain or spinal cord. A lumbar puncture is performed to collect a sample of CSF, which is then examined for cancer cells.

Treatment

The treatment of leptomeningeal cancer is challenging and primarily aimed at controlling symptoms and improving quality of life. Therapeutic options may include systemic chemotherapy, targeted therapy, radiation therapy, or intrathecal chemotherapy, in which drugs are injected directly into the CSF. The specific treatment plan will depend on the type of primary cancer, the extent of disease, and the patient's overall health.

Prognosis

The prognosis for leptomeningeal cancer is generally poor, with a median survival of a few months. However, with optimal treatment and management, some patients may live longer.

Epidemiology

The incidence of leptomeningeal disease is increasing, which is thought to be due to improved cancer treatments leading to longer survival times, as well as improved diagnostic methods.

Future Directions

Research is ongoing to develop new treatments for leptomeningeal disease, including more effective chemotherapeutic agents, targeted therapies, and immunotherapies. Further study is also needed to better understand the biology of this disease and to identify potential biomarkers for early detection and monitoring of treatment response.

See also

• Meninges
• Neoplasia
• Metastasis

References

Leptomeningeal cancer Resources
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