A spinal tumor is an abnormal mass of tissue that grows over a portion of the spinal cord or column. The tumor can be benign (non-cancerous) or malignant (cancerous). There are two types of spinal tumors: primary and secondary. Primary spinal tumors originate in the spine whereas secondary tumors are the result of metastatic cancer from another part of the body.
Spinal tumors are categorized by their location in the spine as well.
Intradural-Extramedullary : These tumors are located inside the dura (the thin covering of the spinal cord) but not actually inside the spinal cord. They are the second most common type of tumor, making up about 40% of all tumors. These tumors commonly occur as meningiomas (inside the membrane), schwannomas (nerve root), neurofibromas (nerve root), and ependymomas (base of the spinal cord). These tumors are generally benign, however, neurofibromas may become malignant over time if untreated.
Intramedullary: These tumors are located inside the spinal cord. They are the least common, making up less than 10% of all tumors. They commonly occur as astrocytomas and ependymomas. Another type, called a lipoma, is a rare congenital tumor commonly located in the cervicothoracic spinal cord. Intramedullary tumors are generally benign.
Extradural: These tumors are located outside the dura (the thin covering of the spinal cord). They are the most common of all the spinal tumors, making up about 55% of all spinal tumors. They are usually the result of metastatic cancer or schwannomas of the nerve roots.
Secondary Spinal Tumors: When it comes to secondary spinal tumors, those caused by cancer that has spread, certain cancers are more likely to spread to the spine. Metastatic lung, breast, and prostate cancers are the most likely to spread to the spine. In men, lung cancer is most likely to spread to the spine and in women, breast cancer is most common to spread. Other cancers include multiple myeloma, lymphoma, melanoma, sarcoma, gastrointestinal tract, kidney, and thyroid.
Pediatric Spinal Tumors: Spinal tumors in children differ from those in adults. Children have bones that have not fully developed and their spinal stability is different. This needs to be considered when choosing a treatment protocol.
Pediatric spinal tumors occur as:
- Osteoid osteoma
- Osteoblastoma
- Osteochondroma
- Osteosarcoma
- Ewing sarcoma
- Eosinophilic granuloma
- Aneurysmal bone cyst
- Chordoma
- Mesenchymal chondrosarcoma
- Giant-cell tumor of bone
- Fibroid dysplasia
- Fibroma
- Angiosarcoma
- Hemangioma
Symptoms
Spinal tumor symptoms depend on the type and location. The most common symptom, regardless if the tumor is benign or malignant, is back pain in the middle or lower back. This pain isn’t associated with a specific activity, injury or stress, but it may increase with activity and when lying down. The pain can spread to the back of the hips, legs, feet, or arms and can worsen over time.
Other symptoms include:
- Stiff neck or back
- Difficulty walking
- Decreased sensitivity to pain, heat, and cold
- Loss of bowel or bladder function
- Scoliosis or other spinal deformities
- Loss of sensation or muscle weakness in the legs, arms or chest
- Pain and neurological symptoms that increase with Valsalva maneuver
- Paralysis can occur in varying degrees and in different parts of the body (from compressed nerves)
Diagnosis
Your doctor will ask you a variety of questions to obtain a detailed family and personal medical history. They will perform a physical evaluation to check for pain and neurological symptoms. In order to confirm a tumor diagnosis, one or more imaging tests will be required. These can include X-Ray, CT or CAT, MRI, or a bone scan.
In some cases, if the tumor looks suspicious, a biopsy will be performed to test for malignancy. If the tumor is malignant, the biopsy will help in determining the type of cancer, which aids in the treatment protocol.
Treatment
Treating a spinal tumor largely depends on the type, location, and what symptoms it causes. Treatment decision-making usually involves a team of spinal surgeons, medical oncologists, radiation oncologists, and other medical specialists. Treatments usually involve surgical and nonsurgical approaches.
Nonsurgical
Nonsurgical approaches include observation, chemotherapy, and radiation therapy. Asymptomatic or mildly symptomatic tumors can be monitored periodically with MRIs. Some tumors respond well to chemo and radiation, while others will require a surgical approach.
Surgical
Primary (non-metastatic) tumors may be surgically removed, either entirely or partially. However, metastatic tumors are usually given palliative care, an approach aimed to preserve remaining function and alleviating pain.
If surgery is an option, the surgical approach is dependent on the location and type of the tumor. The surgeon may go in through the back of the spine (posterior), front (anterior), or both.
For a comprehensive evaluation from the experts at Brain2Spine Institute, call 727-828-8400.
