What are spinal cord tumors
Spinal cord tumors can occur within or near the spinal cord (cervical, thoracic, and lumbar). and be benign or malignant (cancer). Of all cases of primary central nervous system (CNS) cancer, only 22% occur in this location
Spinal cord tumor subtypes
Tumors of the spinal cord can be categorized as:
- Primary tumors – in general, they are rare and comprise approximately 0.04% of all tumors and 10% of all bone tumors. By definition, they originate from cells at that site, either from the spinal cord or from nearby structures, such as the meninges. They can be malignant or non-malignant; and
- Secondary or metastatic tumors – they are metastases from a cancer that originated elsewhere in the body, so they are always malignant.
Another way to classify spinal cord tumors is by location. They can be:
- Intramedullary tumors – arise within the spinal cord itself. The most common intramedullary tumors are gliomas, especially ependymomas and low-grade astrocytomas, and usually occur in younger patients.
- Extramedullary intradural tumors – arise within the dura mater but outside the spinal cord. The most common tumors in this group are meningiomas and nerve sheath tumors; and
- Extradural tumors – these are lesions that usually compress the spinal cord or cauda equina and may even invade the dura mater. Extradural tumors are usually metastatic and usually arise in the vertebral bodies.
Symptoms and signs of spinal cord tumors
- Weakness or numbness of the upper and/or lower limbs (difficulty writing or lifting the arms and legs, for example);
- Bowel and bladder problems (such as urinary retention and constipation)
- Difficulty walking;
- Back pain that gets progressively worse (unrelated to physical activity and worsens when the person lies down); and
- Diminished sensation in the region.
Diagnosis of spinal cord tumors
Diagnosis of a tumor located in the spinal cord may occur late, mainly because the first signs and symptoms are mild and often lead to delay in seeking medical attention. Patients with “warning signs” should be properly evaluated with imaging and laboratory tests to confirm the diagnosis.
The following are the procedures used to detect the disease.
Imaging exams, which can be:
- X-ray – X-rays of the spine allow assessment of overall spinal alignment and bone integrity, and can demonstrate a bone-forming or bone-destroying lesion if it is large enough;
- Magnetic resonance imaging (MRI) – is often recommended because it is necessary to accurately define the size and extent of the tumor and whether it has spread into the spinal canal;
- Computed tomography (CT) – may be requested and allows the visualization of details of the anatomy of the region; and
- Bone scintigraphy – a test that is often ordered when cancer is suspected to have metastasized to the bone and determines if there are other lesions in the bones throughout the body.
Biopsy is needed to confirm the exact type of tumor, especially if it is a primary tumor. It may require surgery, but in some cases, an imaging-guided needle biopsy may be enough to reach the tumor and extract a tissue sample to make a specific histological diagnosis.
Treatment of a cervical spine tumor depends on several factors, such as the patient’s age and associated medical conditions, the histological type of the tumor and whether it is primary or metastatic, and the severity of symptoms related to its location.
Metastatic tumors of the cervical spine are more likely to cause instability and/or neurological impairment and are most often treated surgically. Certain benign spinal tumors and cysts may not need treatment if they do not cause any symptoms.
Surgical resection followed by radiotherapy (with or without chemotherapy, depending on the histological type of the disease) is usually the protocol for well-localized malignant spinal cord tumors. If removal is not possible, radiotherapy is used directly to relieve pressure on the spinal cord.
Non-surgical options include observation, chemotherapy, and radiation therapy. Asymptomatic or mildly symptomatic tumors that do not appear to be changing or progressing can be observed and monitored with regular MRI scans. Some tumors respond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumors that are inherently radioresistant, and surgery may be the only viable treatment option.
It is important to emphasize that when neurological deficits occur due to spinal cord compression, corticosteroid treatment should be initiated immediately to reduce the edema and preserve spinal cord function. The action must be fast because many deficits can quickly become irreversible.
The patient’s recovery depends on how quickly treatment is started and the extent of the disease.
There are no known effective initiatives to prevent this type of cancer.