Spinal Cancer

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3d illustration. Close-up of bone structure and intervertebral discs. Herniated disk concept.

What is Spinal Cancer?

Overview

Spinal cancer involves tumors or masses of abnormal cells originating in spinal tissue or brain (also known as spinal tumors).  Primary tumors may start due to certain inherited gene mutations.

Those that metastasize or spread to the spine from other body areas are secondary spinal tumors. Typically they come from the breast, lung, prostate and other areas of the body.

Cause of Spinal Cancer

The location of spinal cancers can occur:

  • In Extramedullary-intradural tissue (in the membranes or meninges that cover the spinal cord
  • At Extradural sites (between the meninges and spinal bones)
  • Intramedullary (inside the spinal cord)

Most spinal cancers are extradural.

In addition to all types of tumors occurring in the spine, three are:

  • Leukemia- a type of blood cancer originating in the white cells of bone marrow
  • Lymphoma- cancer located in the lymph tissue
  • Myeloma- a type of blood cancer originating in the plasma cells of the bone marrow

Areas of the body that the tumor can distress:

  • Blood vessels
  • Meninges
  • Nerve roots
  • Spinal bones
  • Spinal cord cells

When the cancerous growth impinges on the nerve roots or spinal cord, it can cause damage, which if left untreated, becomes permanent.

Symptoms of Spinal Cancer

Symptoms depend on the size and location of the spinal cancer but includes:

  • Back pain
  • Cold feeling of legs, hands and fingers
  • Decreased or lost sensation of legs
  • Loss of bladder or bowel control
  • Loss of muscle function
  • Muscle contractions (twitches) or weakness

Short-Term Treatment of Spinal Cancer

Short-term therapy involves the use of corticosteroids (dexamethasone) to decrease inflammation and swelling around the spinal cord.

Surgery may be warranted to alleviate compression on the spinal cord.  Some or the entire tumor can be removed for this purpose.

Long Term Treatment of Spinal Cancer

Radiation therapy (alone or in conjunction to surgery) is used to reduce the size of the tumors.

Chemotherapy may be attempted although it has not been shown to be effective against most primary spinal cancers.

Alternate Treatment Therapies for Spinal Cancer

A physiatrist is important to the treatment team of a patient suffering from spinal cancer.  The role of this professional is to relieve symptoms, increase functional independence and prevent further complications.  The physiatrist gives input to the oncologist (cancer specialist) on the spinal stability and the non-cancer related factors like decreased bone density leading to increased fracture risk, and arthropathy or damage to the joints.

Physical therapy can be used to improve the strength of affected muscles and improve muscle function. The primary aim is to improve the quality of life and functional independence.

Depending on the type and cause of pain, therapy includes postural bracing, physical and occupational therapy with strengthening exercises, improved balance, and training with assistive devices.  Also activities of daily living are reviewed and gait training or wheelchair mobility training is done.

Acupuncture may help diminishing the pain from the tumors pressing on the nerve roots or spinal cord itself.

References

Deangelis LM. Tumors of the central nervous system. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 189.

Ruppert LM: Malignant Spinal Cord Compression: Adapting Conventional Rehabilitation Approaches. Phys Med Rehabil Clin N Am 28:101-114, 2017

https://medlineplus.gov/ency/article/001403.htm

Moron FE, Delumpa A, Szklaruk J. Spinal tumors. In: Haaga JR, Boll DT, eds. CT and MRI of the Whole Body. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 30.

Sciubba DM, Baaj AA, Gokaslan ZL. Spinal cord compression. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 49.