Spinal Cancer

What Is Spinal Cancer?

Primary spinal cancer develops from cells within the spinal cord or from its surrounding structures (the bones, tissues, fluid or nerves of the spine).

Part of the central nervous system (CNS), the spinal cord is a column of nerve tissue which extends from the base of the brain down the back. It is surrounded by three protective membranes and is enclosed within the vertebrae. The spinal cord carries important messages between the brain and the rest of the body.

Depending on the location and type of spinal tumor, different signs and symptoms can develop, especially as a tumor grows and affects your spinal cord, surrounding nerves or blood vessels. Signs and symptoms of tumors affecting the spinal cord may include:

  • Back pain, sometimes radiating to other parts of your body
  • Loss of sensation, especially in your arms or legs
  • Difficulty walking, sometimes leading to falls
  • Decreased sensitivity to pain, heat and cold
  • Loss of bowel or bladder function
  • Muscle weakness that may occur in varying degrees and in different parts of your body, depending on which nerves or part of the spinal cord is compressed.

Back pain is a common early symptom of both noncancerous and cancerous spinal tumors. Pain may also spread beyond your back to your hips, legs, feet or arms and may become more severe over time in spite of treatment.

Spinal tumors progress at different rates. In general, cancerous spinal tumors grow more quickly, and noncancerous spinal tumors tend to develop very slowly.

Spinal Cancer: Types & Stages

1. Vertebral Column Tumors

Primary tumors: These tumors occur in the vertebral column, and grow either from the bone or disc elements of the spine. They typically occur in younger adults. Osteogenic sarcoma (osteosarcoma) is the most common malignant bone tumor. Most primary spinal tumors are quite rare and usually grow slowly.

Metastatic tumors: Most often, spinal tumors metastasize (spread) from cancer in another area of the body. These tumors usually produce pain that does not get better with rest, may be worse at night, and is often accompanied by other signs of serious illness (such as weight loss, fever/chills/shakes, nausea or vomiting).

  • In women, spinal tumors most frequently spread from cancer that originates in the breast or lung.
  • In men, spinal tumors most frequently spread from cancer that originates in the prostate or lung.

2. Intradural­Extramedullary Tumors

Intradural­Extramedullary (inside the dura) tumors grow within the spinal canal (under the membrane that covers the spinal cord) but outside of the nerves. Usually these tumors are benign and slow growing. However, they can cause symptoms of pain and weakness.

Most of these spinal tumors are:

  • Meningiomasthat occur in the membranes surrounding the spinal cord and are usually benign but may be malignant. These tumors are more common in middle age and elderly women.
  • Nerve sheath tumors (schwannomas and neurofibromas)that arise from the nerve roots that come off the spinal cord. Again, this type of tumor is usually benign and slow growing, and it may be years before any neurological problems occur.

3. Intramedullary Tumors

Intramedullary tumors grow from inside the spinal cord or inside the individual nerves and often arise from the cells that provide physical support and insulation for the nervous system (glial cells). These tumors occur most often in the cervical spine (neck). They tend to be benign, but surgery to remove the tumor may be difficult.

The two most common types of intramedullary tumors are astrocytomas and ependymomas.

Stages

The stage of a cancer is a measure of how far it has spread. A staging system is a standard way for the cancer care team to describe the extent of this spread. For most types of cancer, the stage is one of the most important factors in selecting treatment options and in determining the outlook (prognosis).

But tumors of the brain and spinal cord differ in some important ways from cancers in other parts of the body. One of the main reasons other cancers are dangerous is that they can spread throughout the body. Tumors starting in the brain or spinal cord can spread to other parts of the central nervous system, but they almost never spread to other organs. These tumors are dangerous because they can interfere with essential functions of the brain.

Because tumors in the brain or spinal cord almost never spread to other parts of the body, there is no formal staging system for them. Some of the important factors that help determine a person’s outlook include:

  • The person’s age
  • The person’s functional level (whether the tumor is affecting normal brain functions and everyday activity)
  • The type of tumor (such as astrocytoma, ependymoma, etc.)
  • The grade of the tumor (how quickly the tumor is likely to grow, based on how the cells look under a microscope)
  • The size and location of the tumor
  • How much of the tumor can be removed by surgery (if it can be done)
  • Whether or not the tumor has spread through the cerebrospinal fluid (CSF) to other parts of the brain or spinal cord
  • Whether or not tumor cells have spread beyond the central nervous system

Spinal Cancer: Detection & Treatment Options

An effective spinal cancer treatment plan begins with an accurate diagnosis. Our team of cancer experts uses advanced imaging technologies and tools to precisely evaluate tumors in the spinal cord and column.

Once we have made an accurate spinal cancer diagnosis and determined the location, type and grade of the tumor, we’ll work with you to formulate a treatment plan that best suits your needs. Because of the complexities of spinal tumors, treatment should be based on a tailored, individualized approach.

Physical exam, neurological exam and health history

Within the first two days of your arrival at our hospital, we will perform a complete array of diagnostic tests, and thoroughly review your medical history and symptoms. Your doctor will also likely conduct a physical exam to check the spine for abnormal curvature, determine muscle strength, and evaluate reflexes and range of motion. Your doctor may also conduct a neurological examination, which includes a series of questions and tests for vision, hearing, motor skills, memory, cognition, and other neurologic functions.

Reduced wait times for appointments and test results

We understand that waiting for test results can create a great deal of stress. To ease anxiety and help you begin your spinal cancer treatment sooner, we provide reduced wait times for appointments and test results. Our turnaround time goal—from the time of the scan to providing results so treatment planning can occur—is four hours.

Comfort equipment

We also want you to be as comfortable as possible during your imaging tests. Our team uses padding and comfort equipment, as well as a variety of positioning devices, to help you feel more relaxed during scans and procedures.

If any tumor is found in the spine (and there is no other known cancer), a complete examination of all common organs where cancer develops is usually warranted. Evaluation may include:

  • Complete medical history
  • Complete physical examination
  • Complete neurological examination
  • Radiographic studies of the spine, chest and GI system to screen for tumors
  • MRI and CAT scans to examine the spine.

Treatments for each common type of spinal tumor is explained in more detail below.

Treatment of Vertebral Column Tumors

Because most of these tumors arise from advanced cancer from another organ, the goal of spinal treatment is usually to:

  • Control the severe pain that often occurs with these tumors (e.g. by removing pressure on the nerve roots)
  • Preserve neurological function (e.g. by removing the pressure on the spinal cord)
  • Fix structural instability in the spine (e.g. by reconstructing the unstable spine with aspinal fusion)

Treating Intradural­Extramedullary and Intramedullary Tumors

These types of tumors are usually surgically removed. The goal of treatment is usually to:

  • Totally remove the tumor
  • Preserve neurological function

The spinal cord and nerves are highly sensitive and avoiding damage to these structures is a critical part of surgery. Monitoring techniques may be used throughout the surgery to determine the function of the spinal cord as the tumors are being removed (e.g. SSEP).

If the tumor cannot be completely removed (e.g. if it adheres to many spinal nerves), post­operative radiation therapy may improve outcome in some cases. If the tumor is metastatic, chemotherapy may also be helpful.

Following the surgery, it may take some time for the nerves to fully heal. Usually rehabilitation and time significantly helps improve a patient’s neurological function.

Spinal Cancer: FAQs

Answer :

Most SCT are benign or slow growing tumors. Malignant tumors account for less than 10% of all these tumors. Once the diagnosis is made, you should see a neurosurgeon who specializes in these tumors. Most tumors are amenable to surgery and adjuvant radiation and chemotherapy are withheld.

Answer :

The only treatment for these tumors is a laminectomy (removal of the bone) and an attempt for a radical or gross total resection. Biopsy of these tumors is not justified unless the differential diagnosis is not conclusive.

Answer :

Since the majority of these tumors are slow growing or benign, treatment is not urgent for the majority of cases. One should research a center or surgeon who specializes or performs frequent operations. A cause for urgency is when the symptoms such as motor weakness or pain are rapidly worsening.

Answer :

Yes, this is operation can be risky but at most centers who perform surgery in these region the risks are minimal.

Answer :

At this time research is in spinal cord regeneration following injury. For SCT there is no medical therapy that will treat these tumors.

Answer :

Spinal cord tumors are similar to brain tumors. Both arise from the central nervous system. Both areas have similar tumors

Answer :

The role of radiotherapy should only be reserved for tumors which are malignant or those tumors which are not surgically operable. This accounts for very few tumors. Radiography should not be administered for intramedullary ependymomas.

Answer :

Depending upon your functional status prior to surgery, most patients remain the same or get slightly worse for a temporary period of time. However, the majority of patients 2/3 to 3/4 will stay the same or improve in function following surgery.

Answer :

It is quite unusual for spinal cord tumors to recur. Ependymomas usually do not recur. Astrocytomas or gangliogliomas can recur. This accounts for a small percentage of all tumors. The chance for recurrence can be 30% in 10 years.

Answer :

Unless malignant most spinal cord tumors do not spread or seed within the central nervous system or in the body.

Answer :

Spinal cord tumors are relatively uncommon and account for around 1/1,000,000 individuals per year

Answer :

Most of the pain before surgery should improve with the operation. However following surgery some patients develop new numbness or tingling pain which sometimes is worse than the pain before surgery. These type of burning sensation is more common following epemdymomas than astrocytomas. It will subside over several months, but some patients may require medicine to help control this type of pain.

Answer :

The central pain is described as being hypersensitive or burning type pain. It more commonly occurs in patients with ependymomas. There are several medications which help this type of pain and research in spinal stimulation for severe pain.

Answer :

No one is certain the cause of spinal cord tumors. There is an association of spinal cord tumors with neurofibromatosis.

Answer :

You need to speak to several surgeons and see how many procedures they have performed in this region.

Answer :

There is no special preparation necessary except to have an optimistic outlook and intense physical therapy.

Answer :

There are resources for patients with no insurance. You should talk to social workers in your area.

Answer :

Most HMOs will allow to go you to go out of network to see an expert. It will take several letters from your primary physician and out of network surgeon.

Answer :

MRI should be done at 3 months,6 months and then annual for several years and then biannual or every three years but it depends upon histology and extent of resection.

Answer :

Intramedullary are tumors which arise from the spinal cord tissue itself. Extramedullary tumors are those tumors which arise outside of the spinal cord from nerves or coverings and push or compress the spinal cord.

Intramedullary: Astrocytomas, Gangliogliomas, Cavernomas, Hemangioblastomas, Ependymomas.

Extramedullary: Meningiomas, Schwannomas, Neurofibromas and other bone tumors

Answer :

Cysts are present in 50­70% of all spinal cord tumors. Once the tumor is removed the cyst should decompress. Some patients may have some problems from the cyst re­accumulation however this is quite small.

Answer :

The long term outcome is good to excellent.

Answer :

The research for Spine Cord Tumors is about new surgical techniques only.

Answer :

Sometimes it will but others it will not.

Answer :

Although most SCT are benign the only way for certainity is the microscopic examination by a pathologist after the tumor is removed.

Answer :

Since most tumors are benign the only treatments necessary is physical and occupation therapy.

Answer :

These treatments are started in the hospital and then may continue as an outpatient or inpatient program.

Answer :

In most cases the patients are out of bed in 1­2 days and then ambulating with assistance by day 3 or 4. Aside from the pain, the limitations vary from one person to another.

Answer :

Surgery should not affect your respirations unless the tumor is located high in the cervical spine. In these cases there is a small chance of some respiratory compromise.

Answer :

There are no limitations or precautions following removal of the vertebrae. However, in very young patients and particularly children there is a concern for progression of a spinal deformity which needs to be monitored.