Spinal Tumor

Table of Contents

What are spinal tumors

A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, unchecked by the mechanisms that control normal cells. Spinal tumors can be benign (non-cancerous) or malignant (cancerous). Primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from cancer spreading from another site to the spine.

Spinal tumors are referred to in two ways.

1. By the region of the spine in which they occur. These basic areas are cervical, thoracic, lumbar and sacrum.
2. By their location within the spine.

A benign tumor…

Is not cancerous and will not spread to other parts of the body. Examples of spinal tumors that are usually benign include neurofibromas, schwannomas, meningiomas, ependymomas, astrocytoma, hemangioblastomas, osteosarcomas, and osteoid osteomas.

Meningiomas are often identified as a result of imaging scans performed for causes that turn out to be unrelated to the tumor, such as a head injury, stroke, or migraines, because they do not cause any visible signs or symptoms.

 

Benign tumors are relatively safe tumors when located on the arms or legs. But when benign tumors are located in the spinal cord or in its coverings, they are dangerous tumors as they may cause severe pain and pressure symptoms and a loss of sensation or motor function, depending on the site of the tumors. But in many cases, they are removable by surgery, and once excised the patient is cured.

A malignant tumor…

Is cancerous. It will destroy nearby tissue and spread to other parts of the body. Malignant spinal tumors include chordoma, Ewing sarcoma, and occasional tumors of the types mentioned above.Malignant tumors are more dangerous as they cause all the pressure symptoms listed for benign tumors and over and above that, malignant tumors are not localized tumors. They grow rapidly and their size increases. This worsens symptoms of the patients. Further, they can spread to distant parts of the body like the lungs and limbs, and thus the cancer spreads. While surgery is sufficient for most benign tumors, malignant tumors may need surgery, radiation therapy and/or chemotherapy [cancer treatment with medicines]. Sometimes benign tumors are converted to malignant tumors and the medical/surgical management policy for such patients suddenly changes.

Incidence and Prevalence of spinal tumors

Intracranial (brain) tumors account for 85-90% of all primary Central Nervous System (CNS) tumors. Primary tumors arising from the spinal cord, spinal nerve roots and dura are rare compared to CNS tumors that arise in the brain. Overall prevalence is estimated at one spinal tumor for every four intracranial lesions.

There are different incidences of tumor types related to the neural/dura mater elements versus the surrounding vertebral bony support. Intramedullary [inside the spinal cord] tumors are rare compared to metastatic tumors of the spine. Vertebral haemangiomas are the most common benign bony primary spinal tumor. Spinal epidural metastatic tumors are the most common type of spinal tumors. These are tumors which have migrated to the spine from cancer at other places in the body. They occur in up to 10% of cancer patients. Metastatic spinal tumors typically arise in the bony spine and then grow to cause compression of the spinal cord and nerve roots, which needs ‘decompression’ surgery.

Types of spinal tumors

Some of the common spine tumors are:

1. Astrocytoma
2. Chordoma
3. Ependymoma
4. Glioma
5. Meningioma
6. Neurofibroma
7. Schwannoma

Classification of spinal tumors

Spinal cord tumors may be classified as one of three different types depending on where they occur relative to the protective membranes of the spinal cord.

1. Intramedullary tumors begin in the cells within the spinal cord itself, such as gliomas, astrocytomas or ependymomas.
2. Extramedullary tumors grow in either the membrane surrounding the spinal cord or the nerve roots that reach out from the spinal cord. Although they don’t begin within the spinal cord itself, these types of tumors may affect spinal cord function by causing spinal cord compression and other problems. Examples of extramedullary tumors that can affect the spinal cord include meningiomas, neurofibromas, schwannomas and nerve sheath tumors.
3. Tumors from other parts of the body can spread (metastasize) to the vertebrae, the supporting network around the spinal cord or, in rare cases, the spinal cord itself.

Spinal tumors or growths of any kind can lead to pain, neurological problems and sometimes paralysis. A spinal tumor can be life-threatening and cause permanent disability.

Spinal tumor symptoms

Spinal cord tumors can cause different signs and symptoms, especially as tumors grow. The tumors may affect the spinal cord or the nerve roots, blood vessels or bones of the spine. Look up for tumor on spine symptoms:

1. Pain at the site of the tumor due to tumor growth
2. Back pain, often radiating to other parts of the body
3. Reduced sensitivity to to pain, heat and cold
4. Loss of bowel or bladder function
5. Difficulty walking, sometimes leading to falls
6. Back pain that’s worse at night
7. Loss of sensation or muscle weakness, especially in the arms or legs
8. Muscle weakness, which may be mild or severe, in different parts of the body
9. Back pain is a common early symptom of spinal tumors. Pain may also spread beyond the back to the hips, legs, feet or arms and may worsen over time, even with treatment.

 In around half of people with brain and spinal tumors, headaches that worsen over time are a common symptom. (Of fact, tumors do not cause the majority of headaches.)

Progress of spinal tumors

Spinal cord tumors progress at different rates depending on the type of tumor.

There are many causes of back pain, and most back pain isn’t caused by a tumor. But because early diagnosis and treatment are important for spinal cord tumors, it is advisable to consult the doctor as soon as possible about back pain if you have any of the following symptoms:

1. Back pain is persistent and progressive
2. Back pain is not activity related
3. Back pain is gets worse at night
4. Patient has a history of cancer and develops new back pain
5. Patient has other symptoms of cancer, such as nausea, vomiting or dizziness

Emergency Consultation

Seek medical advice immediately if you experience any of the following:

1. Progressive muscle weakness or numbness in the legs or arms
2. Changes in bowel or bladder function

Causes of spinal tumors

It’s not clear why most spinal tumours develop. Medical experts believe that genetic structure plays a role in the formation of spinal tumours.

But it is still not clear whether such genetic defects are inherited or simply develop over time. They might be caused by something in the environment, such as exposure to certain chemicals.

In some cases, however, spinal cord tumors are linked to known inherited syndromes, such as neurofibromatosis 2 and von Hippel-Lindau disease.

Risk factors for getting spinal tumors

Spinal cord tumors are more common in people who have:

1. Neurofibromatosis 2. In this hereditary disorder, benign tumors develop on or near the nerves related to hearing. This may lead to progressive hearing loss in one or both ears. Some people with neurofibromatosis 2 also develop spinal canal tumors.
2. Von Hippel-Lindau disease. This rare, multisystem disorder is associated with blood vessel tumors (hemangioblastomas) in the brain, retina and spinal cord and with other types of tumors in the kidneys or adrenal glands.

Complications of spinal tumors

Spinal tumors can compress spinal nerves, leading to a loss of movement or sensation below the location of the tumor. This can sometimes cause changes in bowel and bladder function. Nerve damage may be permanent.

However, if a spinal tumour is diagnosed early and treated properly, it may be possible to prevent further loss of function and regain nerve function.

Depending on its location, a tumor that presses against the spinal cord itself may be life-threatening.

Diagnosis

A thorough medical examination with emphasis on back pain and neurological deficits is the first step to diagnosing a spinal cord tumor. Radiological tests are required for an accurate and positive diagnosis. Radiological tests are X-Ray, CT Scan and MRI Scan. While a plain X-Ray is first done, it is the CT and MRI Scans which give accurate and specific information about the exact size and location of the tumors in three dimensions.

Sometimes a mylelogram is done to exactly mark the shape and location of the spinal tumour.

A myelogram is a diagnostic test that uses X-Rays to examine the spinal canal. A special dye is injected into the spinal canal through a hollow needle. X-Ray images are then captured. Myelograms can show conditions affecting the spinal cord and nerves within the spinal canal.

Bone Scan using Technectium-99: This is helpful for identification of bone tumors (such as primary bone tumors of the spine), infection, and diseases involving abnormal bone metabolism.

Biopsy

Spinal tumors radiology studies noted above help suggest the most likely tumor type. In some cases, however, a biopsy may be needed if diagnosis is unclear or if the doctors suspect malignant tumors. If the tumor is malignant, a biopsy also helps determine the cancer’s type, which subsequently helps decide the correct treatment options.

Staging spine tumors

Staging classifies malignant tumors according to the extent of the tumor. Staging helps assess bony, soft tissue and spinal canal involvement. Doctors may order a whole-body scan utilizing nuclear technology, as well as a CT scan of the lungs and abdomen for staging purposes. To confirm diagnosis, doctors compare laboratory test results and the above mentioned scans with the patient’s symptoms and decide the final diagnosis.

Spinal tumor treatment

Treatment for a spinal tumour may include surgery, radiation therapy, chemotherapy or other medications.

Nonsurgical spinal tumor treatment in india includes

1. Observation
2. chemotherapy
3. radiation therapy

Tumors that are asymptomatic or mildly symptomatic and do not appear to be changing or progressing may be observed and monitored with regular MRIs.

Some tumors respond well to chemotherapy and others to radiation therapy.

However, there are specific types of metastatic tumors that cannot be treated with radiotherapy. Example is gastrointestinal tract and kidney tumor metastasis in the spine. Hence in those cases, surgery may be the only viable treatment option.

Surgery for spinal tumors

Both children and adults can get spinal tumours. But unlike adults, children have not achieved complete skeletal growth, which surgeons must take into account when planning treatment says Dr. Ravindra Patil.

Other factors to consider before surgery for spinal tumors are spinal stability, surgical versus nonsurgical interventions and preservation of neurological function.

Basically, most of the spinal surgeries aim at ‘decompression’ because it reduces the ‘compression’ that is increased pressure around the spinal cord because of the tumor. The entire tumor or a part of it may be surgically removed. If a small part of the tumor is removed, it is called debulk (make smaller) surgery. Excision means the complete removal of the tumor. While resection means partial removal. These types of procedures decompress or relieve pressure to the spinal cord and nerve roots, thereby helping to reduce pain and other symptoms. Spinal tumor surgery cost in india is around 1 to 5 lakh.

Surgery from front or the back?

If surgery is considered, the approach to the tumor is determined by the tumor’s location within the spinal canal. For spinal cord tumors surgery, the posterior approach [meaning that the surgery is done with the patient lying supine or face down on the operation theatre] allows for the identification of the dura mater and exposure of the nerve roots. This approach is commonly used for tumors in the posterior aspect of the spinal column or to expose tumors inside the dura. Multiple levels can be decompressed, and multilevel segmental fixation can be performed if necessary.

The anterior approach [meaning that the surgery is done with the patient lying prone or face up on the operation theatre] is excellent for tumors in the front of the spine. This approach also allows for the reconstruction of defects caused by removal of the vertebral bodies. This approach also allows placement of short-segment fixation devices.

Some thoracic and lumbar spinal tumours that affect both the anterior and posterior vertebral columns can be a challenge to resect completely. So, both the above type of surgeries are done in tow stages. A posterior (back) approach followed by a separately staged anterior (front) approach helps the treatment of these complex lesions.

Pre-operative Embolization

This is done in benign tumors where surgical resection is possible. The aim to minimize bleeding during surgery as all nerve tissue has abundant blood supply and is likely to bleed profusely during surgery. Embolization means blocking. Preoperative embolization may be used to enable an easier resection. This procedure involves the insertion of a catheter or tube through an artery in the groin. The catheter is guided up through the blood vessels to the site of the tumor, where it delivers a glue-like liquid embolic agent that blocks the vessels that feed the tumor. When the blood vessels that feed the tumor are blocked off, bleeding can often be controlled better during surgery, helping to decrease surgical risks.

Risks in spinal tumor surgery

There is a slight risk of damage to the spine during to surgery. But if surgery is not performed, there’s definite risk of catastrophic nerve or spine injury.

If the patient refuses surgery and the tumor/s continue to grow, that patient may end up paralyzed because of the tumor’s growth. Such patients also face risks like blood clots and other serious health complications.

Radiation Therapy for spinal tumors

It is used mostly for Metastatic spinal tumours; it means the tumors began elsewhere in the body and has spread to the spinal cord.

Radiation therapy uses radioactive energy, much like x-ray, to kill cancer cells, reduce the size of tumors, and reduce symptoms caused by the cancer such as constant spine pain. Radiation may be used independently or in combination with surgery. Radiation destroys cancer cells by damaging their DNA.

Chemotherapy for spinal tumors

Chemotherapy drugs destroy cancer cells throughout the body. They are rarely used to treat spinal cord tumors unless the tumors are cancerous and fast-growing, increasing their risk of spreading outside of the spinal cord. When prescribed, these drugs are often given after surgery or radiation therapy.

Most chemotherapy is given through a vein with several intravenous (IV) infusions. Chemotherapy is usually delivered in cycles; one cycle involves a treatment followed by a period of rest.

Read more about chemotherapy for spinal tumor here.

Outlook of spinal tumors treatment

Outcome depends greatly on the age and overall health of the patient and on whether the spinal tumor is benign or malignant, primary or metastatic.

In the case of primary tumors, both benign and malignant, the goal is to remove the tumor completely. This leads to cure of the tumor, the malignancy if present, and the spinal cancer symptoms and loss of function.

In some primary tumors, particularly those that arise inside the spinal [cord-intramedullary tumors], complete resection is not possible without significant neural damage. Hence surgery may not be advised or the outcomes may not be as expected.

In the case of metastatic tumors [tumors which have spread to the spine from the other parts of the body], the goal is almost always palliative, with treatment aimed at providing the patient with an improved quality of life and possibly prolonged life expectancy. 

While spine surgery has the risks associated with any surgery like infections, blood clots in veins and so on, spine surgery in adults for a variety of spinal tumours has been associated with a risk for major complications. It may be noted that post-operative complications are more common in patients who have significant co-morbidities [presence of other diseases like diabetes, high blood pressure and use of steroids]. 

The best treatment in India is provided by Samarth Neuro and Superspeciality Hospital Dr. Ravindra Patil is a well-known neurosurgeon in Mumbai.

• Category: Spinal Tumors