What is Spinal Cancer?
Spinal cancer, or more commonly known as spinal tumor, is a neoplasm (an abnormal growth) in the spinal cord. Spinal tumors may be primary which start in the spinal cord or secondary which result from metastasis (transmission of cancerous cells) from other cancers in the body. Primary spinal tumors are sometimes benign, but more commonly they are malignant. Spinal malignancies are most often secondary tumors resulting from metastasis.
Spinal cancer can occur in the form of lymphoma and accounts for 1% of the central nervous system lymphomas. The incidence of spinal cancer increases with age and can occur in both males and females.
Spinal cancer often spreads through the subarachnoid CSF (cerebrospinal fluid), or through the blood. Metastases via the lymphatics are rare. Spinal tumor growth may affect the spinal vertebrae, blood vessels, nerve roots, meninges and cells of the spinal cord itself. The compression of the spinal cord produces vast symptoms and may be permanently damaged.
Vertebra is collapsed in spinal tumor
Spinal Cancer Types
Spinal cancer may be categorized according to the type of cellular changes or the location of the tumor.
According to location:
- Extradural Spinal Tumors – These tumors grow outside the dura mater in between the meninges and the vertebral column. This type comprises most of the spinal tumors and is responsible for most of the metastasis outside the central nervous system.
- Intradural – The tumors grow in the dura mater and come in the form of nerve sheath tumors such as meningiomas or neurofibromas. This type of tumor is accompanied by nerve root involvement and spinal cord compression.
- Intramedullary – This tumor develops inside the spinal cord and usually present as gliomas or astrocytomas. This causes swelling on the spinal cord leading to loss of spinal cord function below the level of the spinal tumor.
According to cell characteristics:
- Chondrosarcoma – This is the second most common spinal tumor accounting for up to 12% of all spinal tumor cases. The most common site of development is the thoracic spine.
- Ewing Sarcoma – This is the most common spinal tumor in children.
- Osteosarcoma – This is the rarest form of spinal tumor and usually occurs on the lumbosacral area.
- Chordoma – This is the most common primary malignant spinal tumor in adults and accounts for almost all of the metastases in other areas because of being lymphoproliferative.
- Multiple Myeloma – This is the primary malignancy of the spine and other bones.
- Solitary Plasmacytoma – This is similar to multiple myeloma, which primarily affects the vertebral body. This type affects the young population and generally has better prognosis than multiple myeloma.
Spinal Cancer Symptoms
The signs and symptoms of spinal cancer are related to the nerve compression and the symptoms usually arise at the level or below the tumor. The symptoms of spinal tumor can also progress slowly over a matter of weeks or years.
Signs and symptoms include:
- Weakness
- Difficulty in ambulation
- Muscle spasms or fasciculations
- Pain usually in the back that gets worse, not responsive to pain medications and worsens when lying down. The pain may also radiate to the lower extremities.
- Reduced sensory function
- Cold sensation in the lower limbs
- Cold, clammy skin
- Incontinence, both urinary and fecal
- Paresthesia (burning, prickling, itching, or tingling of the skin) especially on the lower limbs
- Paralysis
Spinal Cancer Causes
The cause of primary spinal tumors is unknown, but certain genetic predisposition is a factor. Presence of myeloma, leukemia and lymphoma may also contribute to the development of spinal tumors. Secondary spinal tumors are caused by distant metastases of other malignancies in the body specifically bone cancers and breast cancers. Spinal tumors may also arise in the cases of Acquired Immunodeficiency Syndrome (AIDS).
Staging
Staging of spinal tumors refers to the extent of the spread of the malignancy. Tumors in the central nervous system differ from other forms of malignancies and have lower incidences of metastasis and slow progression compared to other cancers. There is no formal staging of these types of tumors. Spinal tumors are staged using the AJCC (American Joint Committee on Cancer) staging for soft and bone tissue cancers.
The following table presents the staging of spinal tumors based on AJCC staging system.
Diagnosis
Diagnosis of spinal cancer involves the following procedures:
- Neurologic Tests. Physical examination is done to determine affectation of the neurologic system. Reflexes, muscle strength and tone, level of consciousness, sensory functions (pain and temperature) and tenderness along the spine are checked to determine the extent of the tumor.
- Imaging tests. Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Position Emission Tomography, or Bone scanning is done. These imaging tests determine the location of the malignant tumor in the spine and presence of nerve compression.
- Electroencephalogram (EEG). This test measures the electrical conductivity in the brain which may be affected by spinal tumors.
- Lumbar Tap. A lumbar tap is done to collect tissues and CSF (cerebrospinal fluid) on the spine. These specimens are subjected to microscopic analysis and biopsy to determine any malignancy.
Treatment
- Surgery – This is the treatment of choice for most spinal tumors although there is increased risk for nerve damage. Surgery involves the use of microscopes to help surgeons determine the cancerous tumors from healthy spinal cells. Microsurgery also renders it safe because electrodes are used to test the nerves during the procedure to determine damaged from functioning nerves. Sound waves may also be used to break spinal tumors for easier removal. The only drawback of surgery is, it cannot remove all tumors from the spine. In this regard, chemotherapy or radiation may be used as adjunct treatments.
- Chemotherapy – This may be instituted although most spinal tumors do not respond very well to this type of treatment. Chemotherapy results in side-effects such as nausea, anorexia, temporary hair loss and weight loss.
- Radiation – This type of therapy is the first line treatment for metastatic tumors to prevent further spread and growth. Radiation may be instituted as an adjunct therapy to surgery also. The most advanced technique is the use of stereotactic radio surgery or SRS, which precisely delivers radiation to the specific cells from different angles with pinpoint accuracy.
- Corticosteroids – Steroid therapy is also used to reduce inflammation in cases of cord compression. This treatment does not remove the tumor, but decreases the tension on the spinal cord through its anti-inflammatory properties. The most common steroid administered is dexamethasone.
These treatments should be instituted immediately because the prognosis of spinal cancer is better when treatments are given promptly.
Complications
Complications of Spinal cancers or tumors include:
- Paralysis and loss of sensations
- Permanent nerve damage
- Spinal cord compression
- Bowel and bladder incontinence
Prognosis
The prognosis of spinal cancer depends on the type of tumor. Early detection and prompt management usually have a better prognosis. Spinal tumors spread through the CSF and may metastasize to the bones, soft tissues and viscera. Spinal tumors tend to reoccur, and when this happens the prognosis is not as good. The presence of poor neurologic signs and advanced age in patients also causes poorer outcomes. There is also a high probability of permanent disability if the patient survives.
Life Expectancy
Patients with spinal cancer have a median survival term of up to several months from the diagnosis. Implementation of treatment can prolong the life of patients for up to five years.
Survival Rate
The mean survival rate of spinal cancer is up to 40% when treatments are instituted. Some forms may have as low as 8% survival rate and others as high as 84% depending on the location, type and prognostic factors of the patient.
Updated and proofreaded by Justine on 26/8/2012
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FAQs
What is the life expectancy of spinal cancer? ›
Median survival of patients with spinal metastatic disease is 10 months. Spinal metastasis is one of the leading causes of morbidity in cancer patients. It causes pain, fracture, mechanical instability, or neurological deficits such as paralysis and/or bowel and bladder dysfunction.
What is the most common tumor to metastasize to the spine is? ›Lung, prostate, and breast cancers are the three most common cancers that tend to spread to the spine.
Where does spinal cancer usually start? ›Intramedullary tumors begin in the cells within the spinal cord itself, such as gliomas, astrocytomas or ependymomas. Extramedullary tumors grow in either the membrane surrounding the spinal cord or the nerve roots that reach out from the spinal cord.
What kind of cancer starts in the spine? ›Tumors that affect the vertebrae have often spread (metastasized) from cancers in other parts of the body. But there are some types of tumors that start within the bones of the spine, such as chordoma, chondrosarcoma, osteosarcoma, plasmacytoma and Ewing's sarcoma.
How curable is cancer in the spine? ›If treatment is needed, these tumors can usually be cured if they can be removed completely with surgery. Radiation therapy may be used along with, or instead of, surgery for tumors that can't be removed completely.
How long can you live with spinal compression cancer? ›MSCC is considered an oncologic emergency occurring in 5–10% of all cancer patients during their disease. The majority of patients have a short survival of only a few months.
Which cancers most commonly metastasize to bone? ›- Breast cancer.
- Kidney cancer.
- Lung cancer.
- Lymphoma.
- Multiple myeloma.
- Prostate cancer.
- Thyroid cancer.
Mean overall survival was 84 months for chordoma patients and 104 months for sarcoma patients. The investigators found no factors that affected overall survival. The mean local progression-free survival was 56 months for chordoma patients and 73 months for sarcoma patients.
Which are the top five primary cancers that metastasise to the spine? ›The most common cancers that spread to the spine are lung, breast, prostate, kidney, and colon. Biopsies are often done to confirm tumor type. Spinal metastases can be treated by surgery, radiation, and chemotherapy, in addition to pain medications.
Does spine cancer hurt all the time? ›Spinal tumor pain typically does not diminish with rest or activity avoidance, and it may intensify at night, causing disturbed sleep.
What are the symptoms when cancer spreads to the spine? ›
- Back or neck pain, often worse at night.
- Decreased ability to feel cold, heat and pain.
- Deformed spine.
- Difficulty with balance or walking.
- Bladder or bowel control problems.
- Numbness, tingling, or weakness in the arms, legs or chest.
- Paralysis.
Blood tests are not used to diagnose brain or spinal cord tumours. However, they are routinely done to provide a baseline before any planned treatment. They can provide helpful information about your general health, how other organs are functioning, other medical conditions and the possible risks of treatment.
How quickly does spinal cancer spread? ›Tumors that have spread to the spine from another site 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.
What are the final stages of spinal cancer? ›As the disease progresses, spinal cancer symptoms may grow to include weakness, inability to move the legs and, eventually, paralysis.
How painful is bone cancer in the spine? ›Pain in the area of the tumor is the most common sign of bone cancer. At first, the pain might not be there all the time. It may get worse at night or when the bone is used, such as when walking for a tumor in a leg bone. Over time, the pain can become more constant, and it might get worse with activity.
What is the most common early symptom of spinal cord tumor? ›Spinal tumor pain
Back pain is the most common symptom of both benign (noncancerous) and malignant (cancerous) spinal tumors. Pain from spinal tumors in your middle or lower back is more common, as tumors are more likely to develop in those regions of your spine.
When the tumor can't be removed completely, surgery may be followed by radiation therapy or chemotherapy or both. Recovery from spinal surgery may take weeks or longer, depending on the procedure. You may experience a temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.
Does spinal cancer spread to the brain? ›Cancers that Spread to the Brain or Spine
Cancer that starts in one area of the body can metastasize, or spread, to the brain or spine. Cancers that commonly spread to the brain include melanoma and lung, breast, and colon cancers.
Spinal cord tumors and vertebral tumors can be cancerous or noncancerous, but either form can result in disability and even death.
How long can you live after spinal cord compression? ›Most MSCC patients have a limited life span of only a few months3-5 and will not live long enough to develop a recurrence or a progression of MSCC in the previously irradiated spinal region. However, a considerable proportion of MSCC patients live much longer, even a few years.
Which organ gets the most metastasis? ›
The lungs. The lungs are the most common organ for cancers to spread to. This is because the blood from most parts of the body flows back to the heart and then to the lungs. Cancer cells that have entered the bloodstream can get stuck in the small blood vessels (capillaries) of the lungs.
What is the life expectancy of someone with bone metastases? ›Most patients with metastatic bone disease survive for 6-48 months. In general, patients with breast and prostate carcinoma live longer than those with lung carcinoma.
What are the four 4 most common sites of metastasis? ›| Cancer Type | Main Sites of Metastasis |
|---|---|
| Bladder | Bone, liver, lung |
| Breast | Bone, brain, liver, lung |
| Colon | Liver, lung, peritoneum |
| Kidney | Adrenal gland, bone, brain, liver, lung |
- Surgery for Adult Brain and Spinal Cord Tumors.
- Radiation Therapy for Adult Brain and Spinal Cord Tumors.
- Chemotherapy for Adult Brain and Spinal Cord Tumors.
- Targeted Drug Therapy for Adult Brain and Spinal Cord Tumors.
Patients with metastases to the spinal cord often have pain or discomfort that is worse at night or with bed rest. However, those patients with lesions involving the long bones, such as the arms and legs, have pain with activity or movement. In this case, some relief is usually achieved with rest.
Which is the most malignant type of spinal cord tumor? ›The most aggressive form of astrocytomas are known as glioblastomas; the least aggressive are termed pilocytic. Because these tumors warp around the nerve sheath, your doctor may need to use radiation therapy to treat them.
What are the top 5 deadliest cancers? ›- Prostate Cancer.
- Pancreatic Cancer.
- Breast Cancer.
- Colorectal Cancer.
- Lung Cancer.
Cancer in the spine may be fatal, depending on the stage of the cancer when it was diagnosed, or whether it is metastatic (spread) from other organs. Cancer in the spine occurs when abnormal cells grow out of control in the spinal cord or the bones, tissues, fluid, or nerves that make up the spinal column.
What is Stage 4 spinal cancer? ›Grade IV: This type of tumor is the most malignant, with cells that are very abnormal. It grows and spreads quickly into others areas of the brain. Surgery is unable to reach all of these areas without harming the brain, so other types of treatment are often needed.
Where do most spinal tumors grow? ›The most common of these types of tumors develop in the spinal cord's arachnoid membrane (meningiomas), in the nerve roots that extend out from the spinal cord (schwannomas and neurofibromas), or at the spinal cord base (filum terminale ependymomas).
Does spinal cancer spread fast? ›
The symptoms of spinal cancer may occur very slowly. Other times, they occur quickly, even over a matter of hours or days. Metastatic spinal tumors, which have spread to the spine from another location in the body, such as the prostate or kidneys, often progress quickly.
What are the chances of surviving spinal cancer? ›Brain and Spinal Cancer Prognosis and Survival Rates
According to the American Society of Clinical Oncology, the average five-year survival rate for patients with a malignant brain or spinal tumor is 36%. The 10-year survival rate is about 31%.
More than 90 out of 100 people (more than 90%) with ependymoma that start in the spine survive for 5 years or more. These statistics for adults with ependymoma are for relative survival. Relative survival takes into account that some people die of causes other than cancer.
How long does it take for spinal cancer to spread? ›Tumors that have spread to the spine from another site 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.
Does spinal cancer affect the brain? ›Spinal tumors can affect the brain in several ways. Growth in the spinal canal can block the flow of the cerebrospinal fluid or CSF. This can raise the pressure inside the skull (intracranial pressure), which can harm the brain.
Is cancer in the spine terminal? ›Cancer in the spine may be fatal, depending on the stage of the cancer when it was diagnosed, or whether it is metastatic (spread) from other organs. Cancer in the spine occurs when abnormal cells grow out of control in the spinal cord or the bones, tissues, fluid, or nerves that make up the spinal column.