A tumor is an abnormal growth of tissue. There are several types of tumors that can develop in or near the spine. There are many types of spinal tumors. They can involve the spinal cord, nerve roots, and/or the vertebrae (bones of the spine) and pelvis.
There are two classifications of spine tumors. A spinal tumor can be primary, meaning it comes from cells within or near the spine. Primary tumors of the spine are rare. More commonly a spinal tumor that is found is a secondary spinal tumor. This means that the tumor traveled there from somewhere else in the body.
Types Of Spinal Tumors
Malignant Spinal Tumors
Osteosarcoma occurs most often in children, adolescents, and young adults. Males are more likely to be affected than females. Treatment usually consists of removal of the tumor when possible as well as chemotherapy. Radiation therapy is not effective. Older persons with Paget's disease or who have had radiation therapy may develop this type of tumor.
Benign Spinal Tumors
Osteoid osteoma is the most common of the benign tumors involving the bone of the spine. It is usually found during adolescence. It may be discovered because of scoliosis or curvature of the spine. It may cause pain that does not ease up, and is worse at night. Anti-inflammatory medications are used for treatment. Sometimes removal of the tumor by surgery is necessary. A newer, less invasive treatment is called radio-frequency ablation. These tumors rarely recur (come back).
What Causes This Problem?
A primary spinal tumor means it comes from cells within or near the spine. They can involve the spinal cord, nerve roots, and/or the vertebrae (bones of the spine) and pelvis.They can be benign (non-cancerous) or malignant (cancerous). In general, benign tumors do not invade other tissues. Malignant tumors may invade other tissues and organs in the body. Although primary spinal tumors often contain a number of abnormal genes their cause remains unknown. In some cases the tumors run in families.
Tumors in the spine become a problem when they compress the spinal cord or nerves. This can lead to serious complications such as paralysis and loss of bladder and bowel control. Others can destroy the vertebral bone that supports the spinal cord making it unstable.
Nerve roots on either side of each spinal segment are made up of bundles of motor and sensory nerves that come from the spinal cord. Nerves are covered by protective cells called Scwhann cells. A form of spinal tumor involving the Schwann cells is called a Schwannoma.
A secondary spinal tumor is more common. This means that the tumor traveled there from cancer somewhere else in the body. These secondary or metastasized tumors are always cancerous. These cancer cells travel and cause tumors that usually involve the vertebrae or bony portion of the spine. They may come from melanoma (skin cancer), cancer in the lung, breast, prostate, kidney, or thyroid gland for example.
What Does A Spinal Tumor Feel Like?
Sometimes the tumors are found before they cause any symptoms. The symptoms will vary depending on where the tumor is located and what tissues are involved.
At times, pain, bowel or bladder problems, sexual dysfunction, change in sensation, or muscle weakness of the arms or legs may alert you to the problem. This often means that the tumor is compressing the spinal cord or nerve root. Tumors that originate in the spinal cord itself may not cause pain. Pain that awakens you in the night or development of scoliosis (abnormal spine curve) may be a sign that the bone of the vertebra is being destroyed by a spinal tumor. Symptoms may have a gradual or rapid onset. Symptoms usually worsen without treatment.
How Will My Doctor Diagnose The Problem ?
Diagnosis begins with a thorough history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities. This will include questions about pain, feelings of numbness or weakness, change in bowel or bladder function, and whether you have noticed any changes in the way you walk. Your doctor will want to know if have been diagnosed with any type of cancer in the past.
During the physical exam, sensation of the skin, muscle strength, and reflexes are tested. Your doctor may ask you to walk to see if there are any changes in your walking pattern. In addition to having lab work done, there are several procedures that can help your doctor diagnose a spinal tumor
Computed tomography (CT) scan may be ordered when an MRI is unavailable. Dye will be introduced into the spinal canal fluid so that the spinal cord and nerve root anatomy are identified better. When dye is injected for this purpose, the technique is called a myelogram.
X-rays of the spine may be ordered when there is the likelihood of metastasized tumor from cancer elsewhere. It can show only changes in the bones. Many primary spinal tumors do not affect the bone when they are in the early stage.
Bone scans can be used to detect fracture, bone infection, or cancer. A radioactive tracer, technetium (Tc), is injected into your vein. Where there is an increase in metabolic activity, such as is the case with cancer, the Tc will be more concentrated. Spinal tumors may be malignant, or metastasized from cancer somewhere else in the body. It is helpful to use a scan to see if there are other areas in the body where the cancer may be.
A biopsy helps determine the type of the tumor. A biopsy may require surgery. Sometimes it can be performed using a needle while using CT for guidance. A piece of the tumor is removed and looked at under a microscope.
What Treatment Options Are Available?
The type of treatment will depend on symptoms, general health, the results of imaging studies, and a biopsy if done. Many times a combination of surgical and non-surgical treatments are required. If your treatment involves radiation or chemotherapy, you will be asked to see an oncologist (a doctor that specializes in cancer). Early diagnosis and treatment of a spinal tumor is important. If undiagnosed, the damage caused by the tumor can become permanent.
Sometimes watching the tumor for growth is all that is necessary if significant symptoms are not present. The tumor is monitored with repeat imaging such as MRI. Not all spinal tumors can be removed by surgery due to their location.
A back brace or corset may help to stabilize the spine. This should also reduce pain. It may need to be custom made to fit you.
Medications such as corticosteroids may be prescribed. They are used to decrease the swelling in the spinal cord that can cause compression. They may be taken temporarily or long-term to relieve symptoms. Analgesics such as narcotics may also be used. Medications that diminish the blood supply to the tumor have shown some success. Bisphosphonates are medications more commonly used for osteoporosis. They may be used to treat tumors that can destroy bone in the spine.
Embolization is a term used when the blood supply to a tumor is interrupted. This is done by burning the blood vessel(s). Several types of spinal tumors are treated using this method.
Chemotherapy is used if the primary tumor is a malignant or cancerous tumor. Chemotherapy is also recommended when the tumor is a secondary tumor that has traveled from another area in the body and invaded spinal tissue.
Radiation therapy may also be used to treat tumors that cannot be removed by surgery. Stem cell transplant may be used for aggressive cancers such as Ewing's sarcoma.
Surgery may be the only treatment for a primary spinal tumor that is non-cancerous. As much of the tumor is removed as possible without causing neurological problems. A decompression refers to removing bone around the spinal cord or spinal nerves in order to take pressure off these structures. Neurological damage during surgery has been improved with the use of newer techniques. These techniques include ultrasonic aspirators, and microsurgery.
Ultrasonic aspirators use sound waves to destroy the tumor. It also sucks up the pieces of tumor. Microsurgery uses a microscope for a better view of the operation site. This helps to minimize any damage to surrounding healthy tissue.
If the spine needs to be stabilized or fused as a result of removing a tumor in bone, metal hardware may be required. Metal plates, cages, rods, or screws may be used. The bone may be additionally supported by bone graft or bone cement.
The amount of time you will be hospitalized depends on the type of surgery required. After surgery, activity such as sitting and walking will be allowed as well as activities that do not require stretching of the spine or straining. Lifting is limited during the initial recovery period. You may be required to use a brace or corset after surgery to help with stability.
Radiation is often used following surgery to kill remaining tumor cells. It usually begins one to two weeks following surgery. Radiation lasts only 15-20 minutes per day for two to six weeks. You can expect recovery and improvement in symptoms between two weeks and several months following surgery. You may need pain management during your recovery, or possibly on a more long-term basis.
Physical and occupational therapy may be beneficial to help restore any lost strength, coordination, or other skills.
Your surgeon will require you to have periodic follow-up. New lab tests and imaging studies may be required. Sometimes the tumor will grow back and need to be removed again.
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