Spinal Cord Cancer: Types and Prognosis

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

What is cancer of the spinal cord, and what is the cause? How to recognize it (symptoms)? What is the vital prognosis for this rare condition? Is healing possible?

 

In this popular article, you will learn everything you need to know about spinal cord cancer, from its screening to the various possible treatment options.

Definition

 

What is spinal cord cancer? Also called intradural tumor, it is a mass that grows in the Spinal canal or in vertebrae  spine. 

 

Spinal cord tumors can be classified into 3 different types depending on where they grow in the spinal cord: 

 

 

The main types of intradural tumors are:

 

1. Intramedullary tumors originate from cells of the spinal cord itself (such as gliomas, astrocytomas or ependymomas).
2. Extramedullary tumors develop either in the membrane surrounding the spinal cord or in the nerve roots that branch off from the spinal cord. Although they do not come from the spinal cord as such, this type of tumor can affect the function of the spinal cord, in particular causing compression of the spinal cord. Examples of extramedullary tumors include meningiomas, neurofibromas, or even schwannomas.
3. Any type of tumor from one area of ​​the body can spread to the vertebrae, or even to the spinal cord. We then speak of metastases. The most common cancers that cause metastases in the spine are lung, breast and prostate cancers.

 

Causes

 

The cause of most spinal cord cancers is unknown. Some of them can be attributed to exposure to certain carcinogens.

 

Lymphomas, which are cancers that affect lymphocytes (a type of immune cell), are more common in people with weakened immune systems.

 

 

As there appears to be a higher incidence of spinal tumors in particular families, it is believed that there is most likely a genetic component to this condition.

 

Symptoms of the disease

 

Back pain, particularly in the middle or lower back, is the most common symptom associated with spinal cord cancer. This pain is not specifically attributable to injury, stress or physical activity (non-mechanical pain).

 

The pain is often increased at night, or even at rest. In terms of location, it can originate from the spine but can extend to the hips, legs, feet or arms.

 

 

Most often, it gets worse over time despite the use of treatment such as medication, physical therapy, stretching, or exercise. This is because the pain is non-mechanical, and therefore does not respond to conventional strategies for relieving back pain.

 

Depending on the location and type of tumor, other signs and symptoms may occur, particularly when the tumor compresses the spinal cord, nerve roots, or blood vessels.

 

 

 

Here is a list of symptoms that may be experienced:

• Loss of sensation or muscle weakness in the legs, or arms
• Pain and/or neurological symptoms (such as tingling or numbness) in the arms and legs
• Difficulty walking, which can cause falls
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis
• Scoliosis or other deformity of the spine (due to tumor)

 

Diagnostic

 

A thorough medical examination emphasizing back pain and neurological deficits is the first step in diagnosing spinal cord cancer.

 

On the one hand, a clinical examination makes it possible to clarify lumbar pain and neurological deficits. On the other hand, radiological tests are necessary for an accurate diagnosis:

• X-rays :  Spine X-rays can be used to identify a tumor, infection, fracture, etc. X-rays, however, are not the most reliable way to diagnose a tumor.
• Computed tomography (CT or CAT scan) : A scan offers more information related to bony structures. You can see the shape and size of the spinal canal, its contents and the structures around it.
• Magnetic Resonance Imaging (MRI): MRI has the ability to image the spinal cord, nerve roots and surrounding areas. You can observe irritation or compression of the marrow, or even a tumor.
• Bone scan:  This type of imaging is useful for identifying bone tumors, infection, or bone-related disease.

 

 

In short, the combination of the clinical examination but above all the tests ofmedical imaging clarify the diagnosis of spinal cord cancer. In addition, they give details of the identified tumor (malignant vs benign, type, size, etc.)

 

In addition, sometimes the doctor prescribes a biopsy to get more information about the tumor, and guide the treatment.

 

Treatment

 

Spinal cord cancer treatment decision-making is multidisciplinary. It takes into account the opinion and expertise of the orthopedic surgeon, medical oncologist, radiologist, and any other medical specialist.

 

 

The choice of treatment takes into consideration the patient, the tumor, and the expertise of healthcare professionals. We opt either for conservative treatment, surgery, or a combination of both.

 

Conservative treatments

 

Non-surgical treatment options include time observation, chemotherapy, and radiation therapy. Asymptomatic benign tumors that do not appear to change or progress over time can simply be observed and monitored via regular MRIs.

 

 

Some cancers respond well to chemotherapy, and others to radiation therapy. Unfortunately, there are so-called “radioresistant” tumors in the sense that they do not respond well to radiotherapy. In this case, surgery is the only viable treatment option.

 

surgery

 

Indications for surgery vary depending on the type of cancer. For example, some non-metastatic tumors originating from the spine can be removed by complete resection.

 

 

In the case of patients with metastatic tumors, treatment is mainly palliative. It aims to restore or preserve neurological function, stabilize the spine, and relieve pain.

 

In general, we opt for the operation when the tumor has not responded favorably to radiotherapy or chemotherapy, or if the metastatic cancer allows a vital prognosis of 3-4 months. On the other hand, certain situations (such as compression of the spinal cord or instability of the vertebrae due to a fracture) require surgery without delay.

Vital prognosis and healing

 

The vital prognosis of spinal cord cancer depends on several factors:

 

• Patient's age
• Overall health status
• Benign or malignant tumor
• Primary tumor vs metastatic cancer

 

 

In the case of primary tumors (cancer that originates from the spinal cord), the objective is to remove the tumor as quickly as possible. This promotes optimal healing and prevents the development of malignant tumors. Unfortunately, complete resection is not always possible due to the nearby nerve network (especially in the presence of an intramedullary tumor).

 

In the case of metastatic tumors, the goal is almost always palliative, with treatment aimed at providing the patient with a better quality of life and possibly an extended life expectancy. Fortunately, technological and medical advances allow relative control of the disease through radiotherapy and surgery.

 

 

Unfortunately, surgery in adults for various types of spinal tumors has been associated with a risk of major complications (up to 14% according to some studies). The most common complications are infections at the operated level, systemic infections and deep vein thrombosis. These risks are increased in patients with significant comorbidities.

 

Conclusion

 

Spinal cord cancer is a rare but potentially serious condition. Despite the fact that its exact cause is unknown, the fact remains that its early diagnosis is essential to improve the vital prognosis and recovery.

 

 

Spinal tumors can cause pain, as well as neurological disorders sometimes even leading to paralysis. The symptoms depend on the level reached, and the precise localization at the level of the spinal cord.

 

Treatment for a spinal tumor may include surgery, radiation therapy, chemotherapy, or other drugs.

 

Good recovery !