Health condition · Clinically reviewed
Metastatic brain tumour, when cancer spreads to the brain - and what treatment looks like.
Secondary brain tumours are more common than primary ones. Modern neuro-oncology now offers focused, brain-sparing treatment tailored to the original cancer.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, ESMO and EANO sources you can see at the end.
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Current for 2026
Reflects modern UK neuro-oncology practice including stereotactic radiosurgery, molecular profiling and brain-penetrant targeted therapy.
Key facts
Metastatic brain tumours at a glance.
The essentials, in plain English - what it is, where it comes from, and how it’s treated in the UK today.
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What it is
Cancer that has spread to the brain from a primary tumour elsewhere in the body - actually more common overall than primary brain tumours.
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Most common sources
Lung cancer is the single most common source, followed by breast cancer, melanoma, renal cell carcinoma and colorectal cancer.
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Number and site
Can be solitary or multiple, and often sit at the grey-white matter junction, where blood flow changes favour tumour cells settling.
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Key investigation
Contrast-enhanced MRI brain is the investigation of choice - classic ring-enhancing lesions with surrounding oedema.
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Molecular testing
Increasingly central to treatment choice - EGFR/ALK status for lung primaries, BRAF for melanoma, guiding targeted therapy.
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Treatment approach
Steroids for symptom control, then a combination of radiosurgery, surgery and systemic therapy tailored to number, size and primary cancer type.
Why this guide matters
Two cancer teams, one coordinated plan.
A secondary brain tumour is treated by neuro-oncology and by the team looking after the original cancer, working together. The three points below shape everything else on this page.
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The primary tumour matters as much as the brain
What is driving treatment choice is often not the brain deposit itself, but which cancer it came from and its molecular profile.
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Number and size guide the approach
A single accessible deposit is managed very differently from multiple widespread metastases - this decides surgery, radiosurgery or whole brain radiotherapy.
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Newer drugs reach the brain better than ever
Brain-penetrant targeted therapies and immunotherapy have changed outcomes for cancers such as EGFR-mutant lung cancer and BRAF-mutant melanoma.
How the diagnosis is made
From first symptoms to a coordinated plan.
The steps a UK neuro-oncology team will normally follow, in order - so you know what to expect and why.
Phase 1 · Assessing
Neurological review and cancer history
Phase 2 · Confirming
MRI, finding the primary, and biopsy if needed
Phase 3 · Planning
Molecular testing and MDT decision
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Assessing
Neurological assessment
A structured history and examination looking for focal deficits, cognitive change, seizures and signs of raised pressure.
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Assessing
Cancer history review
Checking for a known primary cancer, or symptoms that might point towards lung, breast, skin, kidney or bowel disease.
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Confirming
Contrast-enhanced MRI brain
The investigation of choice - typically shows ring-enhancing lesions with vasogenic oedema, solitary or multiple, at the grey-white junction.
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Confirming
Search for the primary tumour
If not already known, CT chest, abdomen and pelvis plus tumour markers to establish where the cancer started.
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Confirming
Stereotactic biopsy if needed
Reserved for an unknown primary needing tissue diagnosis, or a solitary lesion where the diagnosis is genuinely uncertain.
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Planning
Molecular and genetic profiling
Tumour tissue is tested for markers such as EGFR, ALK and BRAF, which increasingly steer which targeted therapy is used.
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Planning
Neuro-oncology multidisciplinary team
Neuro-oncology, neurosurgery and the oncology team for the primary cancer type agree a coordinated plan together.
Typical timeline: MRI to an agreed multidisciplinary plan within one to two weeks.
Symptoms
What a secondary brain tumour can look like.
Presentation varies enormously by location and number of deposits. And the features that mean it’s time to seek urgent care.
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Morning headache
Often worse on waking and easing through the day, sometimes with nausea or vomiting from raised intracranial pressure.
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Focal neurological deficits
Weakness, sensory change or visual disturbance that depends on where in the brain the deposit sits.
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New-onset seizures
A new seizure in someone with a known cancer history should always raise suspicion of brain involvement.
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Cognitive or personality change
Slowed thinking, memory difficulty or a shift in personality can be the first thing family members notice.
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Ataxia
Unsteadiness and loss of coordination when the cerebellum is involved.
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Papilloedema
Swelling of the optic disc found on examination - a sign of raised intracranial pressure.
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Solitary or multiple deposits
Number matters for treatment choice - a single accessible deposit is managed very differently from widespread disease.
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Red flag - rapid deterioration
Sudden worsening of headache, consciousness or neurological function needs emergency assessment.
Treatment
How brain metastases are treated in the UK.
Steroids for symptom control first, then a tailored combination of radiosurgery, surgery, radiotherapy and systemic therapy.
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Corticosteroids
Dexamethasone reduces peri-tumoural swelling and often brings rapid symptomatic relief while further management is planned.
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Anti-seizure medication
Started if seizures have occurred, under specialist neurology guidance.
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Stereotactic radiosurgery
Gamma Knife or CyberKnife - preferred for a limited number of metastases, delivering focused high-dose radiation while sparing surrounding brain.
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Whole brain radiotherapy
Used for multiple metastases, though increasingly reserved more selectively given its effect on memory and thinking, sometimes combined with a stereotactic boost.
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Surgical resection
Considered for a large, solitary and surgically accessible deposit, particularly if it is causing significant mass effect or a tissue diagnosis is needed.
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Targeted and systemic therapy
Brain-penetrant agents such as osimertinib for EGFR-mutant lung cancer, or targeted therapy for BRAF-mutant melanoma, alongside immunotherapy where appropriate.
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Palliative care
Introduced early alongside active treatment, particularly where disease is widespread or the outlook is guarded.
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Multidisciplinary follow-up
Ongoing surveillance imaging and review by neuro-oncology and the primary cancer team together.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your neuro-oncology team knows your scans, your primary cancer and your history, and can tell you which parts apply to you. If in doubt, get seen.
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NICE. Brain tumours (primary) and brain metastases in adults (NG99).
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European Society for Medical Oncology (ESMO). Guidelines on brain metastases from solid tumours.
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European Association of Neuro-Oncology (EANO). Guideline on the diagnosis and treatment of brain metastases.
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The Brain Tumour Charity. Information and support for secondary brain tumours.
Red flags
When a secondary brain tumour needs urgent attention.
Most changes can wait for a scheduled review. These are the situations that can’t - and where emergency care is needed.
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Rapid neurological decline
Sudden worsening of weakness, speech or consciousness needs emergency same-day assessment.
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Signs of herniation
A fixed dilated pupil, deepening drowsiness or irregular breathing are neurosurgical emergencies.
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Status epilepticus
A seizure lasting more than five minutes, or repeated seizures without recovery between them, needs immediate emergency care.
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New-onset seizure with cancer history
A first seizure in someone with a known cancer, or an undiagnosed primary, warrants urgent imaging.
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Severe or sudden headache
A thunderclap or rapidly worsening headache, especially with vomiting, should not wait for a routine appointment.
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Visual loss or double vision
New visual disturbance can reflect raised pressure or a deposit affecting the visual pathways and needs prompt review.
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Steroid complications
High-dose or long-term dexamethasone can cause hyperglycaemia, infection risk and mood change that need monitoring.
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Spinal cord or leptomeningeal spread
Back pain with leg weakness or bladder change can signal spread beyond the brain and needs urgent specialist input.
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Confusion or falls in known disease
New confusion or unexplained falls in someone with known brain metastases should prompt reassessment, not be assumed to be progression.
Living with it
A demanding diagnosis, with a coordinated plan behind it.
Four things that make the biggest difference day to day - careful steroid use, understanding the driving rules, having support at appointments, and joined-up care.
A quiet reminder
Ask which team is leading, and how they’re talking to each other.
You shouldn’t have to relay information between your neuro-oncology and primary cancer teams yourself - it’s reasonable to ask how they coordinate.
- 01 Steroids
Take dexamethasone exactly as prescribed
Never stop suddenly - doses are usually tapered gradually once symptoms settle, under specialist guidance.
- 02 Safety
Know the seizure and driving rules
A new seizure means an automatic driving ban - your team will explain the DVLA rules that apply to you.
- 03 Support
Bring someone to appointments
Cognitive change can make it hard to retain information - a second pair of ears helps enormously.
- 04 Team
Keep both teams talking
Neuro-oncology and your primary cancer team should be working from the same plan - ask how they coordinate.
Frequently asked
Everything we get asked about secondary brain tumours.
Quick answers on causes, diagnosis, molecular testing and treatment choice.
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What is a metastatic brain tumour?
It is cancer that has spread to the brain from a primary tumour somewhere else in the body, rather than a cancer that started in the brain itself. Overall, these secondary tumours are actually more common than primary brain tumours.
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Which cancers most commonly spread to the brain?
Lung cancer is the most common source, followed by breast cancer, melanoma, renal cell carcinoma and colorectal cancer. Melanoma in particular has a high propensity to spread to the brain even when the original skin lesion was small.
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What scan is used to diagnose it?
Contrast-enhanced MRI of the brain is the investigation of choice. It typically shows one or more ring-enhancing lesions surrounded by oedema, often at the grey-white matter junction.
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Will I need a brain biopsy?
Not always. A biopsy is usually only needed if the primary cancer is unknown and tissue is required to guide treatment, or if there is a solitary lesion and the diagnosis is genuinely uncertain.
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How are brain metastases treated?
Treatment is tailored to the number and size of deposits and the primary cancer type. Options include corticosteroids for symptom control, stereotactic radiosurgery, whole brain radiotherapy, surgery for a suitable solitary deposit, and targeted or systemic therapy guided by molecular testing.
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Why does molecular testing of the tumour matter?
Testing for markers such as EGFR, ALK and BRAF increasingly determines which targeted therapies are used. Newer agents penetrate the brain more effectively than older systemic treatments, which has changed outcomes for some cancer types.
Related content
Keep reading.
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Meningioma
A common primary brain tumour, usually benign.
Learn more -
Medulloblastoma
A primary brain tumour most common in children.
Learn more -
Hydrocephalus
Raised pressure from fluid build-up in the brain.
Learn more -
Lung cancer
The most common source of brain metastases.
Learn more -
Invasive ductal carcinoma
A breast cancer type that can spread to the brain.
Learn more -
Gamma Knife radiosurgery
Focused radiation treatment for brain metastases.
Learn more -
Brain tumour surgery
Surgical resection for suitable solitary deposits.
Learn more -
Tumour molecular profiling
Genetic testing that guides targeted therapy.
Learn more
Speak to a specialist