Spinal Tumors

Symptoms

The symptoms depend on the location, type of tumor and the patient's general health. 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.

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)
• Back pain that gets worse over time, is often in the middle or lower back, is usually severe and not relieved by pain medicine, gets worse when lying down or straining (such as during a cough or sneeze), and may extend to the hips or legs
• Cold sensation of the legs, cool fingers or hands, or coolness of other areas
• Fecal incontinence
• Inability to keep from leaking urine (urinary incontinence)
• Muscle contractions, twitches or spasms (fasciculations)
• Muscle function loss
• Muscle weakness in the legs that causes falls, makes walking difficult and may get worse

Metastatic tumors usually produce pain that does not get better with rest, may be worse at night and is often accompanied by other signs of serious illness (such as weight loss, fever, chills, shakes, nausea or vomiting).

Causes and Risk Factors

There are four common types of spinal tumors that can cause back pain: vertebral column tumors, intradural-extramedullary tumors (in the membranes called meninges that cover the spinal cord), intramedullary tumors (inside the spinal cord) and extradural tumors (between the meninges and bones of the spine). There are also a small number of spinal tumors that occur in the nerves of the spinal cord itself, which most often are ependymomas and other gliomas.

Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metastasize) are called secondary spinal tumors. Tumors may spread to the spine from the breast, prostate, lung and other areas.

The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with certain inherited gene mutations.

As a tumor grows, it can affect blood vessels, vertebrae of the spine, the meninges, nerve roots and spinal cord cells. The tumor also may press on the spinal cord or nerve roots, causing damage. With time, the damage may become permanent.

Diagnosis

If any tumor is found in the spine and there is no other known cancer, a complete examination of all common organs where cancer develops is usually warranted. Evaluation may include:

• Medical history
• Physical examination
• Neurological examination
• Radiographic studies of the spine, chest and GI system to screen for tumors
• MRI and CT scans to examine the spine
• Cerebrospinal fluid examination
• Cytology (cell studies) of cerebrospinal fluid

Treatment

The goal of treatment is to reduce or prevent nerve damage caused by pressure on the spinal cord.

Treatment should be given quickly. The more quickly symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be thoroughly investigated.

Treatments include:

• Corticosteroids (dexamethasone) — May be given to reduce inflammation and swelling around the spinal cord.
• Emergency surgery — May be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord.
• Radiation therapy — May be used with, or instead of, surgery.
• Chemotherapy — Has not been proven effective against most spinal tumors, but may be recommended in some cases, depending on the type of tumor.
• Physical therapy — May be needed to improve muscle strength and the ability to function independently.

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