A spinal tumor is a growth of cells (mass) within or surrounding the spinal cord.
Causes, incidence, and risk factors
Spinal tumors can occur inside the cord (intramedullary), within the meninges (membranes) covering the spinal cord (extramedullary - intradural), between the meninges and the bones of the spine (extradural), or they may extend from other locations. Most spinal tumors are extradural. They may be primary tumors originating in the spine, or secondary tumors that are the result of the spread of cancer ( metastasis ) from other locations, primarily the lung, breast, prostate, kidney, or thyroid gland.
Any type of tumor may occur in the spine, including lymphoma , leukemic tumors, myeloma, and others. A small percentage of spinal tumors occur within the nerves of the spinal cord itself, most often consisting of ependymomas and other gliomas. The cause of primary spinal tumors is unknown. Some primary spinal tumors are associated with genetic defects. A spinal tumor is much less common than a primary brain tumor .
As it grows, the tumor affects the spinal-cord cells, nerve roots, meninges, blood vessels, and/ or the bones of the spine. It causes symptoms because of compression of the spinal cord or nerve roots (similar to spinal cord trauma ), invasion of normal cells by the tumor, or ischemia (lack of oxygen) that results from blockage of blood vessels.
Signs and tests
A neurologic examination may indicate the location of the tumor. Spastic weakness may be present, with increased muscle tone and abnormal reflexes. Pain and temperature sensation may be lost simultaneously with or independently of other sensation losses. There is often localized spine tenderness on examination of the back, which is more pronounced with epidural tumors.
These tests may confirm spinal tumor:
a spine X-ray
a spinal CT
a spine MRI or lumbosacral spine MRI
a myelogram (an X-ray or CT scan after dye has been inserted into the spinal fluid) may be needed to isolate the location of the tumor
A CSF (cerebrospinal fluid) examination may be normal, or abnormal but nonspecific. Cytology (cell studies) of CSF sometimes shows tumor cells.
This disease may also alter the results of an ADH test.
Treatment
The goal of treatment is to reduce or prevent nerve damage from compression of the spinal cord. The most important aspect of treatment is that it be given quickly, so any new or unexplained back pain in a patient with cancer should be taken seriously.
Corticosteroids, such as dexamethasone, reduce inflammation and swelling and may temporarily reduce symptoms.
Surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, a portion of the tumor may be removed to relieve the pressure on the spinal cord. Radiation therapy may be used in addition to (or in some cases, instead of) surgery. Chemotherapy has not been developed that has proven effective against most spinal tumors, but it may be recommended in some cases.
Physical therapy and other interventions may be needed to improve muscle strength and to improve the ability to function independently when permanent neurologic losses occur.
Support groups
The stress of illness can often be helped by joining a support group where members share common experiences and problems.
Expectations (prognosis)
The outcome varies. Early diagnosis and treatment usually leads to a better outcome. Nerve damage may persist even after surgery. Although permanent disability is likely, treatment may delay the development of major disability and may delay death.
Calling your health care provider
Call your health care provider if you have a history of cancer and suddenly develop severe back pain. Go to the emergency room or call the local emergency number (such as 911) if new symptoms develop or symptoms worsen during treatment of spinal tumor.