Do headaches in stage 3 BC indicate brain metastases?

Question

Hello doctor,

My cousin, 40, was diagnosed with stage 3 breast cancer and started chemotherapy last month. She now gets these major headaches almost daily and has blurry vision sometimes. We are scared it might be related to brain mets, but the oncologist has not ordered an MRI (magnetic resonance imaging) yet.

Should we push for one or wait?
She is also having sharp pains around her chest that she says feel like little electric shocks. Is that related to her treatment?
What is the earliest point during her cancer journey at which immunotherapy might be considered an option, or does it depend entirely on genetic factors?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concerns about your cousin's symptoms and treatment. I will provide guidance on her symptoms, the potential for brain metastases, and the role of immunotherapy in her treatment.

Headaches and blurry vision:

Chemotherapy side effects: Headaches and blurry vision can be side effects of chemotherapy, particularly certain medications like 5-Fluorouracil (5-FU) or Cyclophosphamide.
Brain metastases: Although it is possible that these symptoms could be related to brain metastases, it is essential to investigate other potential causes before jumping to conclusions.
Requesting an MRI (magnetic resonance imaging): Not required unless her oncologist insists, as before starting chemotherapy, a PET (positron emission tomography) scan has been done, which is enough to rule out her brain or any other site mets.

Chest pain:

Chemotherapy-related pains: Sharp pains around the chest, described as electric shocks, can be related to chemotherapy. Certain medications can cause neuropathic pain or muscle spasms.
Other potential causes: Other possible causes of chest pains include musculoskeletal issues, anxiety, or cardiac complications. Her oncologist can help determine the underlying cause.

Immunotherapy:

Genetic factors: Immunotherapy is often considered for patients with specific genetic mutations, such as BRCA1 (breast cancer gene) or BRCA2, or those with high tumor mutational burden (TMB).
Programmed death-ligand 1 (PD-L1) expression: Immunotherapy may be considered for patients with PD-L1-positive tumors (programmed death-ligand 1 (PD-L1) protein).
Early consideration: Immunotherapy can be considered as early as the neoadjuvant setting (before surgery) or in the adjuvant setting (after surgery) for high-risk patients.
Ongoing clinical trials: Encourage her to discuss potential clinical trials with her oncologist, as new immunotherapy options are being explored.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.