A spinal tumor is abnormal tissue that grows within or surrounding the spinal cord and spinal column. These tumors can be benign (noncancerous) or malignant (cancerous). Primary tumors originate in the spine or spinal cord and metastatic (secondary) tumors result from cancer spreading from another site to the spine.
Spinal tumors are divided according to location into three major groups: intradural-extramedullary, intramedullary, and extradural.
Metastatic spinal tumors
The spinal column is the most common site for bone metastasis. Common primary cancers that spread to the spine are lung, breast and prostate. Lung cancer is the most common cancer to metastasize to the bone in men, and breast cancer is the most common in women. Other cancers that spread to the spine include gastrointestinal tract, lymphoma, melanoma, kidney, sarcoma and thyroid.
Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors can affect outcome, including the nature of the primary cancer, the number of lesions, the presence of distant metastases and the presence and/or severity of spinal cord compression.
The cause of most primary spinal tumors is unknown. Spinal cord lymphomas, which are cancers that affect lymphocytes (a type of immune cell), are more common in people with compromised immune systems. There appears to be a higher incidence of spinal tumors in particular families, so there is most likely a genetic component. In a small number of cases, primary tumors may result from presence of these two genetic diseases:
Nonmechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumors. This back pain is not specifically attributed to injury, stress or physical activity. However, the pain may increase with activity and is often worse at night. Pain may spread beyond the back to the hips, legs, feet or arms and may worsen over time, even when treated by conservative, nonsurgical methods that can often help alleviate back pain attributed to mechanical causes.
Depending on the location and type of tumor, other signs and symptoms can develop, especially as a malignant tumor grows and compresses on the spinal cord, the nerve roots, blood vessels or bones of the spine. Impingement of the tumor on the spinal cord can be life-threatening in itself. Additional symptoms can include:
A thorough medical examination with emphasis on back pain and neurological deficits is the first step. Radiological tests are required for an accurate and positive diagnosis.
After radiological confirmation of the tumor, the only way to determine whether the tumor is benign or malignant is to examine a small tissue sample (biopsy) under a microscope. If the tumor is malignant, biopsy also helps determine the cancer's type, which provides information that helps determine treatment options.
Staging classifies neoplasms (abnormal tissue) according to the extent of the tumor, assessing bony, soft tissue, and spinal canal involvement. A whole body scan utilizing nuclear technology may be ordered as well as a CT scan of the lungs and abdomen for staging purposes. The above findings and results from laboratory tests are compared with the patient's symptoms to confirm diagnosis.
Nonsurgical treatment options include observation, chemotherapy and radiation therapy. Tumors that are asymptomatic or mildly symptomatic and do not appear to be changing/progressing, may be observed and monitored with regular MRIs. Some tumors res pond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumors that are i nherently radioresistant (i.e. gastrointestinal tract and kidney), and in those cases, surgery may be the only viable treatment option.
Indications for surgery vary and depend on the type of tumor. Primary spinal tumors may be removed through complete en bloc resection for a possible cure. In patients with metastatic tumors, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine, and alleviating pain. Generally, surgery is considered only as an option for patients with metastases who are expected to live 12 weeks or longer and the tumor is resistant to radiation or chemotherapy. Indications for surgery include intractable pain, spinal cord compression and the need for stabilization of impending pathological fractures. Tumors that occur within the spinal cord itself can be biopsied and microsurgically removed. DNS surgeons have significant experience in these delicate neurosurgical procedures.