There is a certain type of lesions, which form in the tissues of spinal cord and can be both, benign and malignant – those are called spinal tumors. There is a broad spinal tumors classification. Symptoms, their severity as well as spinal tumors treatment options depend on several factors. Below we are going to discuss types of tumors, symptoms they cause, as well as available treatment options in more details.
Spinal tumours develop within the spinal canal or within the bones of your spine. It may be benign or cancerous. Tumours that develop in the bones of the spine (vertebrae) are known as vertebral tumours. While tumours that develop within the spinal cord itself are known as spinal cord tumours. The 2 main types of tumours that may affect the spinal cord:
- Intramedullary tumours: Develop in the cells within the spinal cord itself (such as astrocytomas or ependymomas)
- Extramedullary tumours: Develop within the supporting network of cells around the spinal cord. Even though they don’t start in the spinal cord itself, they may affect spinal cord function by causing spinal cord compression and other problems. Some examples that can affect the spinal cord are schwannomas, meningiomas and neurofibromas
Tumours that developed in other parts of the body can metastasize to the vertebrae, the supporting network around the spinal cord or the spinal cord (rare) itself. Spinal tumours or growths can lead to pain, neurological problems and sometimes even paralysis. A spinal tumor can be life-threatening and cause permanent disability even if it’s non-cancerous.
Spinal tumors classification
Three common types of spinal tumours that cause back pain are vertebral column tumours, intradural-extramedullary tumours and intramedullary tumours.
Vertebral Column Tumours
- Primary tumours: Develop in the vertebral column and grow from the bone or disc elements of the spine. Typically occurs in younger adults. This is the most common malignant bone tumor. Most of these tumours are quite rare and normally grow slowly.
- Metastatic tumours: They often metastasize from cancer in another part of the body. These tumours typically produce pain that doesn’t improve with rest and may worsen at night. This condition is normally accompanied by other signs of serious illness such as weight loss, fever/chills/shakes, nausea or vomiting.
- Women: Most frequently spread from cancer that originates in the breast or lung
- Men: Frequently spread from cancer that originates in the prostate or lung
Develop within the spinal canal (under the membrane that covers the spinal cord) but on the outside of the nerves. These tumours are usually benign and slow growing. However, they may cause symptoms of pain and weakness. Most of these spinal tumours are:
- Meningiomas: Develop in the membranes surrounding the spinal cord and are usually benign but may be malignant. These tumours are more common in middle age and elderly women.
- Nerve sheath tumours (schwannomas and neurofibromas): Arises from the nerve roots that come off the spinal cord. It is usually benign and slow growing. The tumour may take years before any neurological problems occur.
These tumours grow from inside the spinal cord or inside the individual nerves and normally develop from cells that provide physical support and insulation for the nervous system (glial cells). They often develop in the neck. These tumours tend to be benign. However, surgery to remove the tumour may be difficult. The most common types of intramedullary tumours are: Astrocytomas and Ependymomas.
Could My Back Pain Be Spine Cancer?
It is natural to wonder whether or not the pain might be a sign of spinal cancer if you experience severe back pain. Back pain from expansion of the bone or from weakening the bone may be a result of a tumour. It can result in spinal fractures, compression (pinching) of the nerves, or spinal instability. The best way to find out if it could be cancerous is to get assessed by a doctor immediately.
SPINAL TUMOURS SYMPTOMS
Depending on the location, type of tumor, and your general health, the symptoms may vary. Tumours that have spread to the spine from another site often progress quickly. Primary tumours normally progress slowly over weeks to years. Tumours in the spinal cord usually cause symptoms (sometimes over large portions of the body). Tumours that developed outside the spinal cord may grow for a long time before causing any nerve damage. Symptoms are:
- Abnormal sensationsor loss of sensation:
- Particularly in the legs (knee or ankle, with or without shooting pain down the leg)
- Cold sensation (legs, fingers or hands, or coolness of other areas)
- Back pain:
- Worsen over time
- In any area (commonly in the middle or low back)
- Normally severe and not relieved by pain medication
- Worse when lying down
- Worse with strain, cough, sneeze
- Extend to the hip, leg, or feet (or arms) or all extremities
- Muscle weakness(decreased muscle strength not caused by exercise):
- Causes falls
- Especially in the legs
- Makes walking difficult
- May get worse (progressive)
- Fecal incontinence
- Urinary incontinence
- Muscle contractions (twitches, or spasms)
- Muscle function loss
SPINAL TUMOURS TREATMENT OPTIONS
The goal of spinal tumour treatment is to eliminate the tumour completely. However, it might be complicated by the risk of permanent damage to the spinal cord and surrounding nerves. Your age and overall health must also be taken into account when determining the type of treatment. The type of tumour and whether it developed from the structures of the spine or spinal canal or has spread to your spine from somewhere else must also be considered when determining a treatment plan. Treatments include:
Spinal tumours may sometimes be discovered before they show symptoms. This is often the case when a patient is being evaluated for another condition. When small tumours are found to be benign and aren’t growing or pressing on surrounding tissues, observing them may be all that’s needed. This is the case in older patients where surgery or radiation therapy may impose special risks. Your doctor will likely recommend periodic CT or MRI scans to monitor the tumour during observation.
Surgery is the treatment of choice especially for tumours that can be removed with an acceptable risk of spinal cord or nerve injury damage. Neurosurgeons are able to reach tumours that were once considered inaccessible with newer techniques and instruments. High-powered microscopes used in microsurgery make it much easier to distinguish tumours from healthy tissue. Functions of the spinal cord and other important nerves during surgery can also be monitored thus minimizing the chances of being injured.
Very high frequency sound waves might be used during surgery to break up tumours and remove the fragments in some instances. Unfortunately, not all tumours can be removed completely even with the latest technological advances in surgery. A combo treatment of surgery and radiation therapy or chemotherapy or both may be required when the tumour is not fully removed. It may take weeks or longer to recover depending on the procedure. There may be temporary loss of sensation or other complications including bleeding and damage to nerve tissue.
Normally used after surgery to remove remnants of tumours. Inoperable tumours or tumours where surgery is too risky are treated this way. It may also be the first line of treatment for tumours that has spread from another part of the body. It may also be used to relieve pain or when surgery poses a great risk. Medication may also be used to help ease some of the side effects of radiation such as nausea and vomiting.
Based on the type of tumour that you have, treatment may be modified to help prevent damage to surrounding tissue from the radiation and increase the effectiveness of the treatment. Modifications may be as simple as changing the dosage of radiation to using sophisticated techniques like a 3-D conformal radiation therapy. Proton beam therapy is a specialized type radiation therapy that may be used to treat some vertebral tumours such as chordomas and chondrosarcomas and some childhood cancers.
Stereotactic radiosurgery (SRS)
High dose of precisely targeted radiation is delivered. Computers may be used to focus radiation beams on tumours with sharp accuracy from multiple angles. There are different types of technology used in radiosurgery to deliver radiation to treat spinal tumours such as a Gamma Knife machine. Even though SRS has certain limits on the size and specific type of tumours that can be treated, it can prove to be quite effective where appropriate. Growing research supports its use for the treatment of spinal and vertebral tumours. However, further study is required to determine the best technique, radiation dose and schedule for SRS.
Drugs are used to destroy cancer cells or prevent them from growing. Chemotherapy might be beneficial for you, either alone or in combination with radiation therapy. Your doctor will determine this after assessing your condition. Some side effects may include fatigue, nausea, vomiting, increased risk of infection and hair loss.
As surgery, radiation therapy as well as tumours themselves may cause inflammation inside the spinal cord; your doctors may prescribe corticosteroids to reduce the swelling, either after surgery or during radiation treatments. Corticosteroids may reduce inflammation but they are usually used only for short periods to avoid serious side effects such as:
- Muscle weakness
- High blood pressure
- Increased susceptibility to infection
DIAGNOSING SPINAL TUMOURS
As spinal tumours are not common and their symptoms resemble those of more common conditions, they may be overlooked. It’s important that your doctor is aware of your complete medical history and perform both general physical and neurological exams. If a spinal tumour is suspected, the following tests can help to confirm the diagnosis and pinpoint the tumour’s location:
- Spinal magnetic resonance imaging (MRI): A powerful magnet and radio waves are used to produce images of your spine. It accurately shows the spinal cord and nerves and produces better pictures of bone tumours than CT scans. A jab of contrast agent may be injected to help highlight certain tissues and structures. Some patients may feel uncomfortable inside the MRI scanner or they may find the loud thumping sound to be disturbing. You will usually be given earplugs to help with the noise. Some scanners are even equipped with televisions or headphones. If you feel very anxious, ask your doctor for a mild sedative to help calm you down. A general anaesthetic may be necessary in certain situations.
- Computerized tomography (CT): A narrow beam of radiation is used to produce detailed images of your spine. It may sometimes be combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see.
- Biopsy: This is the only way to determine the precise nature of a tumour. The results will help to determine the treatment options. Depending on your overall health and the location of the tumour, the sample may be obtained differently. A fine needle may be used to withdraw a small amount of tissue or the sample may be obtained during surgery. These procedures may have significant risks and should only be performed at a centre that specializes in spine tumours.