By: Dr. Michael K. Landi, MD, FACS
A spinal tumor is an abnormal growth of cells in the spine. If any cells in the spine grow and multiply abnormally to cause a spinal tumor, this is called a primary tumor. If abnormal cells have spread to the spine from a cancerous tumor in another part of the body, this is called a secondary tumor or a metastasis.
Benign and malignant spinal tumors
Benign spinal tumors are non-cancerous. They are always primary tumors (that is, they start in the spine and they do not spread into and invade the tissue surrounding them in the same way as malignant tumors. Benign tumors can grow to a considerable size, creating pressure on and damaging the tissue surrounding them in the spine. Benign spinal tumors usually occur inside the membrane surrounding the spinal cord and nerves (the dura). Tumors within the dura are called intradural tumors. Benign spinal tumors are not often found in the bones of the spine (the vertebrae). Consequently, they rarely disturb the strength of the bone structure of the spine.
Malignant spinal tumors are cancerous. They spread into and invade the tissue surrounding them.
What causes spinal tumors?
We do not yet know with any certainty what causes primary spinal tumors and we do not know why some are benign andsome are malignant. Secondary spinal tumors are always caused by a cancerous tumor in another part of the body. Clear risk factors have not been established for spinal tumors in the way that, for instance, smoking has been established as a clear risk factor for lung cancer.
Are there warning signs?
No, there are no warning signs before the onset of symptoms. Some benign tumors grow very slowly over several years and can reach a large size before they are detected. Malignant tumors tend to grow more quickly and will usually have been present for a shorter time when they are discovered. The onset of symptoms does not tell us how long the tumor has been there or whether it is benign or malignant.
Depending on the location and type of spinal tumor, various signs and symptoms can develop, especially as a tumor grows and affects your spinal cord or on the nerve roots, blood vessels or bones of your spine. Spinal tumor symptoms may include:
• Back pain, often radiating to other parts of your body
• Loss of sensation or muscle weakness, especially in your arms or legs
• Difficulty walking, sometimes leading to falls
• Numbness, “pins and needles” sensations
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis that may occur in varying degrees and in different parts of your body, depending on which nerves are compressed
• Back pain is a common symptom of both noncancerous and cancerous spinal tumors. Pain may also spread beyond your back to your hips, legs, feet or arms and may become more severe over time in spite of treatment.
• Spinal tumors progress at different rates. In general, cancerous spinal tumors grow more quickly, whereas noncancerous spinal tumors tend to develop very slowly
When to see a doctor
There are many causes of back pain, and most back pain isn’t caused by a spinal tumor. But because early diagnosis and treatment are important for spinal tumors, see your doctor about your back pain if:
• It’s persistent and progressive
• It’s not activity related
• It gets worse at night
• You have a history of cancer and develop new back pain
Seek immediate medical attention if you experience:
• Progressive muscle weakness or numbness in your legs
• Changes in bowel or bladder function
TREATMENTS FOR SPINAL TUMORS
The aim of surgery is to remove the tumor without damaging the spinal cord or the nerves surrounding the tumor. Surgery is most commonly used to treat benign spinal tumors but it might be used to treat some malignant tumors. Surgery is not suitable for everybody and you might be advised against it because of the risks associated with your individual situation. Your medical team will discuss the best treatment options with you. The surgery is carried out by a neurosurgeon who specializes in surgery of the brain and spine.
Radiation therapy is often used to treat malignant tumors. If you have had surgery, you will be given time to recover and for your wounds to heal before receiving radiation treatment. If you have been diagnosed with a primary cancer elsewhere in your body, you might also receive radiation therapy for this cancer. Radiation therapy treatment is planned and carried out by a radiation therapist who might also be an oncologist (a doctor who specializes in cancer).
Chemotherapy is the use of drugs to destroy tumor cells in a way which is similar to the use of antibiotics to kill bacteria.
Chemotherapy is mostly used for people with spinal tumors caused by primary cancers elsewhere in the body. There are different types of chemotherapy. Some are taken by mouth and others are given via a drip into a vein. Chemotherapy
is usually prescribed by an oncologist who has expertise in both radiation and chemotherapy.
Corticosteroids may be prescribed to reduce swelling in the spine. This helps to relieve pressure on the spinal cord and nerves and provides some protection from spinal cord compression. Steroids are usually given during a course of radiotherapy or before surgery.
For people with spinal tumors, pain-relief drugs may be prescribed for back or neck pain.