What is Spinal Cancer?
Spinal cancer, or more commonly known as spinal tumor, is a neoplasm (an abnormal growth) in the spinal cord. Spinal tumors may be primary which start in the spinal cord or secondary which result from metastasis (transmission of cancerous cells) from other cancers in the body. Primary spinal tumors are sometimes benign, but more commonly they are malignant. Spinal malignancies are most often secondary tumors resulting from metastasis.
Spinal cancer can occur in the form of lymphoma and accounts for 1% of the central nervous system lymphomas. The incidence of spinal cancer increases with age and can occur in both males and females.
Spinal cancer often spreads through the subarachnoid CSF (cerebrospinal fluid), or through the blood. Metastases via the lymphatics are rare. Spinal tumor growth may affect the spinal vertebrae, blood vessels, nerve roots, meninges and cells of the spinal cord itself. The compression of the spinal cord produces vast symptoms and may be permanently damaged.
Vertebra is collapsed in spinal tumor
Spinal Cancer Types
Spinal cancer may be categorized according to the type of cellular changes or the location of the tumor.
According to location:
- Extradural Spinal Tumors – These tumors grow outside the dura mater in between the meninges and the vertebral column. This type comprises most of the spinal tumors and is responsible for most of the metastasis outside the central nervous system.
- Intradural – The tumors grow in the dura mater and come in the form of nerve sheath tumors such as meningiomas or neurofibromas. This type of tumor is accompanied by nerve root involvement and spinal cord compression.
- Intramedullary – This tumor develops inside the spinal cord and usually present as gliomas or astrocytomas. This causes swelling on the spinal cord leading to loss of spinal cord function below the level of the spinal tumor.
According to cell characteristics:
- Chondrosarcoma – This is the second most common spinal tumor accounting for up to 12% of all spinal tumor cases. The most common site of development is the thoracic spine.
- Ewing Sarcoma – This is the most common spinal tumor in children.
- Osteosarcoma – This is the rarest form of spinal tumor and usually occurs on the lumbosacral area.
- Chordoma – This is the most common primary malignant spinal tumor in adults and accounts for almost all of the metastases in other areas because of being lymphoproliferative.
- Multiple Myeloma – This is the primary malignancy of the spine and other bones.
- Solitary Plasmacytoma – This is similar to multiple myeloma, which primarily affects the vertebral body. This type affects the young population and generally has better prognosis than multiple myeloma.
Spinal Cancer Symptoms
The signs and symptoms of spinal cancer are related to the nerve compression and the symptoms usually arise at the level or below the tumor. The symptoms of spinal tumor can also progress slowly over a matter of weeks or years.
Signs and symptoms include:
- Difficulty in ambulation
- Muscle spasms or fasciculations
- Pain usually in the back that gets worse, not responsive to pain medications and worsens when lying down. The pain may also radiate to the lower extremities.
- Reduced sensory function
- Cold sensation in the lower limbs
- Cold, clammy skin
- Incontinence, both urinary and fecal
- Paresthesia (burning, prickling, itching, or tingling of the skin) especially on the lower limbs
Spinal Cancer Causes
The cause of primary spinal tumors is unknown, but certain genetic predisposition is a factor. Presence of myeloma, leukemia and lymphoma may also contribute to the development of spinal tumors. Secondary spinal tumors are caused by distant metastases of other malignancies in the body specifically bone cancers and breast cancers. Spinal tumors may also arise in the cases of Acquired Immunodeficiency Syndrome (AIDS).
Staging of spinal tumors refers to the extent of the spread of the malignancy. Tumors in the central nervous system differ from other forms of malignancies and have lower incidences of metastasis and slow progression compared to other cancers. There is no formal staging of these types of tumors. Spinal tumors are staged using the AJCC (American Joint Committee on Cancer) staging for soft and bone tissue cancers.
The following table presents the staging of spinal tumors based on AJCC staging system.
Diagnosis of spinal cancer involves the following procedures:
- Neurologic Tests. Physical examination is done to determine affectation of the neurologic system. Reflexes, muscle strength and tone, level of consciousness, sensory functions (pain and temperature) and tenderness along the spine are checked to determine the extent of the tumor.
- Imaging tests. Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Position Emission Tomography, or Bone scanning is done. These imaging tests determine the location of the malignant tumor in the spine and presence of nerve compression.
- Electroencephalogram (EEG). This test measures the electrical conductivity in the brain which may be affected by spinal tumors.
- Lumbar Tap. A lumbar tap is done to collect tissues and CSF (cerebrospinal fluid) on the spine. These specimens are subjected to microscopic analysis and biopsy to determine any malignancy.
- Surgery – This is the treatment of choice for most spinal tumors although there is increased risk for nerve damage. Surgery involves the use of microscopes to help surgeons determine the cancerous tumors from healthy spinal cells. Microsurgery also renders it safe because electrodes are used to test the nerves during the procedure to determine damaged from functioning nerves. Sound waves may also be used to break spinal tumors for easier removal. The only drawback of surgery is, it cannot remove all tumors from the spine. In this regard, chemotherapy or radiation may be used as adjunct treatments.
- Chemotherapy – This may be instituted although most spinal tumors do not respond very well to this type of treatment. Chemotherapy results in side-effects such as nausea, anorexia, temporary hair loss and weight loss.
- Radiation – This type of therapy is the first line treatment for metastatic tumors to prevent further spread and growth. Radiation may be instituted as an adjunct therapy to surgery also. The most advanced technique is the use of stereotactic radio surgery or SRS, which precisely delivers radiation to the specific cells from different angles with pinpoint accuracy.
- Corticosteroids – Steroid therapy is also used to reduce inflammation in cases of cord compression. This treatment does not remove the tumor, but decreases the tension on the spinal cord through its anti-inflammatory properties. The most common steroid administered is dexamethasone.
These treatments should be instituted immediately because the prognosis of spinal cancer is better when treatments are given promptly.
Complications of Spinal cancers or tumors include:
- Paralysis and loss of sensations
- Permanent nerve damage
- Spinal cord compression
- Bowel and bladder incontinence
The prognosis of spinal cancer depends on the type of tumor. Early detection and prompt management usually have a better prognosis. Spinal tumors spread through the CSF and may metastasize to the bones, soft tissues and viscera. Spinal tumors tend to reoccur, and when this happens the prognosis is not as good. The presence of poor neurologic signs and advanced age in patients also causes poorer outcomes. There is also a high probability of permanent disability if the patient survives.
Patients with spinal cancer have a median survival term of up to several months from the diagnosis. Implementation of treatment can prolong the life of patients for up to five years.
The mean survival rate of spinal cancer is up to 40% when treatments are instituted. Some forms may have as low as 8% survival rate and others as high as 84% depending on the location, type and prognostic factors of the patient.
Updated and proofreaded by Justine on 26/8/2012
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