What Are the Other Names For This Condition? (Also known as/Synonyms)

• CM (Carcinomatous Meningitis)
• Leptomeningeal Carcinomatosis
• Meningeal Carcinomatosis

What Is Carcinomatous Meningitis? (Definition/Background Information)

• Carcinomatous Meningitis (CM) is the spreading of malignant cancer cells from the primary tumor to the meninges; the thin layers of tissue protecting the brain and spinal cord
• The spine is primarily affected (in about 75-80% of the cases), while the brain is affected in up to 50% of the cases. Carcinomatous Meningitis is generally observed to occur in individuals during the advanced stages of any cancer type
• The signs and symptoms of Carcinomatous Meningitis may include altered mental state, cranial nerve palsies, feelings of weakness, gait disturbance, headache, seizure, and spinal nerve disorders. The condition may lead to complications such as segmental numbness, ataxia, seizures, memory loss, and irreversible brain damage
• The management of Carcinomatous Meningitis involves a multi-modal approach involving radiotherapy and chemotherapy. However, the condition involves the functional tissues of organs and often results in a dismal prognosis; typically, the inhibition and rapid deterioration of neurological function occurs, limiting survival rates to a median time of 2-4 months even with intensive treatment
• There are no specific methods available to prevent Carcinomatous Meningitis, although one’s risk for specific cancer types may be lowered through certain cancer preventive vaccinations, such as hepatitis B and human papillomavirus vaccines, completely avoiding the use of tobacco, eating healthy, avoiding alcohol, practicing safe sex, and receiving regular medical care

Who gets Carcinomatous Meningitis? (Age and Sex Distribution)

• Individuals of all ages, races, ethnic groups, and both genders are susceptible to Carcinomatous Meningitis if they have extracranial cancers or brain tumors
• Overall, those who have late-stage cancers, or a secondary brain tumor are most likely to be affected

What Are the Risk Factors for Carcinomatous Meningitis? (Predisposing Factors)

The risk factors for Carcinomatous Meningitis may include the following:

• Individuals with incomplete removal of brain metastasis
• Individuals who did not receive radiation therapy post their surgery to remove the primary tumor
• Individuals under the age of 40 with parenchymal or secondary brain metastasis
• Individuals with advanced systemic diseases such as late stages of cancer

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What Are the Causes of Carcinomatous Meningitis? (Etiology)

The most common cause of Carcinomatous Meningitis in children is leukemia. In adults, it is breast cancer, followed by lung cancer and melanoma. 

• Most solid tumors have the potential to result in Carcinomatous Meningitis. The most common  solid tumors include breast, lung, melanoma, gastrointestinal, and primary central nervous system tumors
• Metastatic breast cancer, lung cancer, and melanoma are the most common causes of Carcinomatous Meningitis that lie outside the brain
• Within the brain, cerebellar medulloblastoma, malignant ependymomas, neuromas, and gliomas may cause Carcinomatous Meningitis

What Are the Signs and Symptoms of Carcinomatous Meningitis?

The signs and symptoms of Carcinomatous Meningitis may vary from one individual to another (depending on the type of malignancy), and may include:

• Headaches
• Confusion:
  • Altered states of consciousness
  • Cognitive impairment
  • Temporal lobe seizures that can be indicated by deja vu, stereotypical movements, euphoria, hallucinations, and amnesia
• It is possible that the involvement of the posterior fossa (of the brain) can cause cerebellar signs and cranial neuropathies. These can be presented as the following:
  • Nausea and vomiting
  • Dizziness
  • Ataxia (loss of full bodily movements)
  • Diplopia (seeing two images of an object)
• If Carcinomatous Meningitis involves the spinal cord and nerve roots, the symptoms may occur in specific anatomic regions, and result in:
  • Segmental numbness
  • Dysesthesia (a condition in which touch is distorted)
  • Pain
  • Lower motor neuron pattern limb weakness
• 2% of the patients may be asymptomatic (show no significant signs and symptoms)

How Is Carcinomatous Meningitis Diagnosed?

A diagnosis of Carcinomatous Meningitis may involve:

• Complete physical examination and evaluation of medical history, including a history of cancer
• Blood tests, as needed
• Enhanced CT scans of the brain
• Magnetic resonance imaging (MRI) scans of the affected regions: An MRI with contrast dye will be used to view images of the brain and spinal cord in order to see if there is a solid malignant tumor
• Cerebrospinal fluid (CSF) examination: CSF examination is taken via a lumbar puncture and used to determine if cancer cells are present. Several samples may be collected to ensure effective analysis and exam

Differential diagnosis: Conditions that can present similar symptoms to Carcinomatous Meningitis that should be taken into consideration include the following:

• Primary brain lesions can present with similar symptoms. Carcinomatous Meningitis can present separately or co-exist with the involvement of CNS regions
• Chronic meningitis caused by bacterial, fungal, viral, or protozoal organisms can resemble signs and symptoms of Carcinomatous Meningitis. Drug-induced causes of meningitis should be considered as well
• Paraneoplastic syndrome, myasthenic crisis, cerebellar degeneration, neuropathies, and limbic encephalitis can mimic Carcinomatous Meningitis as they are associated with advanced stages of meningitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What Are the Possible Complications of Carcinomatous Meningitis?

The complications of Carcinomatous Meningitis may include the following:

• Segmental numbness
• Ataxia
• Migraine headaches
• Lower motor neuron pattern limb weakness
• Seizures
• Memory problems
• Hearing and vision loss
• Hydrocephalus (buildup of fluid between the brain and the skull)
• Brain damage 

Carcinomatous Meningitis, in itself, is a complication to some of the malignancies. Treatment of the condition can result in:

• Surgical complications
• Methotrexate, a chemotherapy medication that interferes with cell growth in attempts to treat the cancer can cause neurological complications such as aseptic meningitis (inflammation of brain meninges)

How Is Carcinomatous Meningitis Treated?

The treatment for Carcinomatous Meningitis may include the following:

• Methotrexate and cytosine arabinoside, both medications that slow down cancer cell growth in the body, may be used to treat Carcinomatous Meningitis
• Radiotherapy and chemotherapy that includes:
  • Intrathecal chemotherapy (main treatment form): It is a form of chemotherapy administered into the fluid surrounding the spinal cord during a lumbar puncture
  • Palliative radiation therapy, a form of chemotherapy using high-energy X-rays
• Neurosurgical procedures including ventriculoperitoneal shunt placement to alleviate cerebral spinal fluid pressure on the brain

Considering the fact that Carcinomatous Meningitis has a low rate of survival, the treatment goal is to increase the quality of life and prolong survival time.

How Can Carcinomatous Meningitis Be Prevented?

Even though there are no specific methods available to prevent Carcinomatous Meningitis, one’s risk for cancer may be lowered through the following measures:

• Getting vaccinated
  • Hepatitis B vaccine that can lower the risk for developing liver cancer
  • Human papillomavirus (HPV) vaccine: HPV is a sexually transmitted virus that can lead to cervical cancer, cell cancers related to the head and neck, and other genital cancers
• Completely avoid using tobacco
• Healthy diet
  • Limiting processed meats
  • Avoiding alcohol, else drinking in moderation
  • Consuming plenty of fruits and vegetables
• Remaining physically active
• Protecting from the sun
• Avoiding risky behaviors such as:
  • Practicing safe sex
  • Completely avoiding the sharing of needles (use of illicit drugs related)
• Availing regular medical care

What Is the Prognosis of Carcinomatous Meningitis? (Outcomes/Resolutions)

Carcinomatous Meningitis represents an advanced-stage disease and often portrays a dismal prognosis.

• Early diagnosis, normal cerebrospinal fluid (CSF) protein levels, and lower disease burden are often associated with improved prognoses and increased survival times
• Even with treatment, the median time of survival is between 2-4 months

Additional and Relevant Useful Information for Carcinomatous Meningitis:

The following article link will help understand how Carcinomatous Meningitis can result in headaches:

https://www.dovemed.com/diseases-conditions/headache-attributed-carcinomatous-meningitis/