Spinal Cord Tumor

Definition

A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and spinal column. Spinal tumors can be benign, meaning non-cancerous, or malignant, meaning cancerous. Tumors originating in the spine or spinal cord are referred to as primary. Tumors resulting from cancer that spreads from another site to the spine are referred to as metastatic or secondary. 

Spinal tumors are also referred to by the part of the spine in which they occur:

  • Cervical
  • Thoracic
  • Lumbar
  • Sacrum

Clinically, spinal cord tumors are divided into three major groups according to location:

  • Intradural-extramedullary turmors:  When these develop in the spinal cord arachnoid membrane they are referred to as meningiomas. In the nerve roots that extend out from the spinal cord they may be schwannomas or neurofibromas. At the spinal cord base they are called filum terminale ependymomas. Meningiomas are often benign, but can be difficult to remove, and may also recur. Nerve root tumors also are usually benign, although neurofibromas may over time become malignant.
  • Intramedullary tumors:  These grow within the spinal cord, or inside individual nerves. They most frequently occur in the cervical, or neck, region. Intramedullary tumors usually derive from glial or ependymal cells which are found throughout the interstitium of the cord. Astrocytomas and ependymomas are the most common types. Although often benign, these kinds of tumors can be difficult to remove
  • Extradural tumors:  These lesions are most often attributed to metastatic cancer or schwannomas that are derived from cells covering the nerve roots.
  • Metastatic spinal tumors:
    • The most common site for bone metastasis is the spinal column. Some estimates suggest that as many as 70 percent of cancer patients will experience metastasis to the spine, most commonly lung, breast, and prostate cancers.
    • The success of overall treatment is highly reliant upon early diagnosis and identification of the primary malignancy. Many factors can affect the outcome, including the nature of the primary cancer, the number of lesions, distant non-skeletal metastases, and presence and/or severity of compression of the spinal cord.
     

http://www.aans.org 

 

Symptoms

The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.

Tumors in the spinal cord usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord may grow for a long time before causing nerve damage.

Symptoms may include:

  • Abnormal sensations or loss of sensation:
    • Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)
    • Cold sensation of the legs, cool fingers or hands, or coolness of other areas
     
  • Back pain:
    • Gets worse over time
    • In any area -- middle or low back are most common
    • Is usually severe and not relieved by pain medication
    • Is worse when lying down
    • Is worse with strain, cough, sneeze
    • May extend to the hip, leg, or feet (or arms), or all extremities
     
  • Fecal incontinence
  • Inability to keep from leaking urine (urinary incontinence)
  • Muscle contractions, twitches, or spasms (fasciculations)
  • Muscle function loss
  • Muscle weakness (decreased muscle strength not due to exercise):
    • Causes falls
    • Especially in the legs
    • Makes walking difficult
    • May get worse (progressive)
     

Diagnosis

A doctor will usually perform a neurologic exam to diagnose a spinal cord tumor. The exam will look for these signs:

 

  • Soreness in the area of the spine
  • Inability to feel pain, heat, or cold
  • An abnormal reflex response

 

These tests help your doctor see a spinal cord tumor and find out more information about it:

 

  • Imaging tests of the spine, such as a CT scan, MRI, or myelogram, which uses an X-ray in combination with an injection of contrast dye into the spine to better see the tumor
  • Hormone tests
  • Examination of the cerebrospinal fluid and the cells in the fluid

 

Treatment

Non-surgical:

  • Observation – Tumors that cause mild or no symptoms and do not appear to be progressing may be observed and monitored with regular MRIs.
  • Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling around the spinal cord.
  • Radiation therapy may be used with, or instead of, surgery. If you are a candidate to receive radiation therapy to the spine, you will be evaluated by a radiation oncologist who specializes in radiation treatments. If indicated, radiation therapy may be delayed in order to allow time for healing following surgery.  Your doctor will make this determination.
  • Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases. If you require chemotherapy for systemic cancer, you will be referred back to your original oncologist to make determinations regarding chemotherapy.
  • Physical therapy may be needed to improve muscle strength and the ability to function independently.

Surgical

Surgery may be required in order to relieve spinal cord compression. Complete removal of a tumor is possible in some cases, while in others, part of the tumor may be removed.

Recovery

The duration of your hospital stay will vary according to the extent and type of surgery. Each patient will respond differently and recover differently. Typical hospital stays following spinal tumor surgery range from 5 to 10 days. 

Following surgery, you may require help with daily living activities, often referred to as rehabilitation. Rehabilitation may take place in an inpatient setting, meaning that you are admitted to a rehab unit or hospital. Rehabilitation may also take place on an outpatient basis, in which you would receive therapy in your home, or you would be transported to a rehab facility during the week.