Spinal Tumour

What is a spinal tumour?

A spinal tumour is a swelling or lump formed from the abnormal multiplication of cells. A spinal tumour diagnosis can be scary, but not to worry, not all of them are cancerous. They can be benign (non-cancerous), or malignant (cancerous). Spinal tumours are extremely rare, with the chances of a person developing a malignant tumour of the brain or spinal cord in their lifetime being less than 1% [1]. 

There are different kinds of spinal tumours:

Primary spinal tumours develop within the spinal cord itself (benign or malignant).

  • Resulting from abnormal growth and multiplication of cells within the spine.

Secondary spinal tumours have spread to the spine from cancers in other parts of the body, and they are also known as metastases (singular: metastasis)

  • The most common types of cancers that bring about secondary tumours are lung cancer, breast cancer, malignant melanoma, kidney cancer and colon cancer.

Primary spinal tumours can be graded according to the rate at which they grow, with grades 1 & 2 indicating slower growth, and grades 3 & 4 indicating faster growth. The low grades (1 & 2) are considered benign primary spinal tumours, and the high grades (3 & 4) are considered malignant primary spinal tumours. 

Secondary spinal tumours are not graded, because they are always malignant.

What types of spinal tumours are there?

Spinal tumours can develop in various tissues in the spine, and can be classified into different kinds.

Extradural spinal tumours are the most common tumours, and they start in the bones of the spine. Examples of benign tumours are osteomas and osteoblastomas, and malignant tumours include osteosarcomas and chondrosarcomas.

Intramedullary tumours are found in the nerves of the spinal cord. If they happen to be malignant, the most common kinds of cancer of the spinal cord are astrocytomas and ependymomas.

Intradural extramedullary tumours start inside the coverings of the spinal cord, but are outside of the spinal cord, and they include meningiomas and schwannomas.

What does havin a spinal tumour feel like?

If you happen to have a spinal tumour, you are likely to experience one or more of the following symptoms:

Back pain and neck pain at or near the spine, which are the most common symptoms. The pain can be due to the spinal tumour pressing on spinal nerves or the spinal cord itself. The pain might not be relieved when lying down, or even get worse when you lie down.

Deformities like scoliosis and kyphosis can also develop from changes in alignment of the spine due to pressure from the tumour. You could experience sensitivity to temperature as well, as the tumour could affect your nerves.

Neurological problems can result from the tumour, like radiculopathy (pinching of nerve roots) and myelopathy (compression of the spinal cord). You might feel sudden weakness or change in sensation in your arms or legs, including tingling, numbness or pins and needles. You might even experience difficulty walking or paralysis in your limbs. 

Bladder and bowel problems might be experienced if spinal tumours press on the spinal cord, because the tumour presses on nerves that provide feeling and function to these organs.

What are the causes of spinal tumours?

Scientists are not yet clear on what causes primary spinal tumours to develop, and so if you have one, you could not have prevented it as it is not clear what causes it. Some might be due to exposure to cancer-causing agents, like radiation, or due to genetic factors like family history of spinal tumours.

In rare cases, primary tumours might have resulted from the presence of genetic diseases, namely neurofibromatosis 2 and Von Hippel-Lindau disease.

As for secondary spinal tumours, they are always caused by cancerous tumours that have spread from other parts of the body. 

How are spinal tumours diagnosed?

So, what happens if you think you have a spinal tumour? Tumours may or may not be symptomatic, and some turn up incidentally on scans when screening for other conditions. 

You should ideally visit a doctor if you have the symptoms of a spinal tumour. Though it might be unlikely that you actually have one, your doctor will be able to examine you and assess your symptoms, family and medical history and refer you to a neurosurgeon or spinal surgeon if necessary.

Primary spinal cord tumours are generally difficult to diagnose, due to the symptoms which can easily be confused with those with other conditions (more common and benign spinal diseases). 

X-rays might be done first, to ensure there are no other possible causes of your symptoms (infections, fractures etc). However, X-rays are not very reliable in ensuring the presence of tumours. 

CT scans may be performed in order to take images of your spine from different angles. MRI scans may be done (a scan without radiation used), for diagnostic purposes, to produce much more detailed images of tumours. MRI scans will assess the location of the tumour and also your risk of cord compression. 

A bone scan might be done in order to diagnose cancers in the bone, and in some cases a biopsy might need to be done to confirm the type of tumour you have, especially if it is a primary tumour. In a biopsy, a needle is used to reach the tumour to extract a sample for analysis.

How are spinal tumours treated?

There are lots of different treatment options available for you, if you happen to have a spine tumour. The way it is treated depends on a few factors, like how big it is and where it’s located, the type of tumour it is, and your overall health. 

Non-surgical treatments. Non-surgical treatments are considered the first-line treatments for many spine tumours. They range from medications to radiation therapy. Steroids may be recommended by your doctor, in order to reduce the swelling around the spine and back pain. Other prescription medicines can also provide relief, such as normal painkillers. Back braces might also be used to relieve back pain. Please remember to never self-medicate and always consult a doctor regarding which medicines are the most suitable for you.

Targeted drug therapy. Targeted drug therapy might also be used to target certain areas of the tumour and blocking the growth of cells.

Surgery. Surgery can be used to remove spinal tumours (minimally-invasive and open surgery), with the aim of removing as much abnormal tissue as possible. Minimally-invasive surgery refers to preoperative embolisation which involves the insertion of a catheter (small tube) into an artery in the groin that delivers tiny particles that block the blood vessels feeding the tumour, causing it to shrink in size. Open surgery can then be done to remove the tumour more easily, decreasing possible surgical risks.

Usually, benign tumours will not grow back once they’re removed, but in some cases, they do and might become cancerous. Even if all of the tumour cannot be removed in surgery, removing a large part of it will reduce the pressure on the spinal cord and help to relieve some symptoms. This is more likely to be the case for malignant tumours. From there, other treatments like chemotherapy or radiation therapy may be used to destroy the remaining cells.

In some cases, usually for non-malignant tumours, you might just be asked to “watch and wait”, or simply continue monitoring the tumour to keep an eye on it. Treatment might only start if your tumour’s growth becomes more aggressive or your symptoms worsen.

Living with Spinal Tumours

If you eventually happen to be diagnosed with a spinal tumour, it’s not the end of the world, even if it is cancerous. It might help you to use this time to talk to your doctors, family and friends and find the support you need to get through this.

Sources

  1. Key Statistics for Brain and Spinal Cord Tumors. (n.d.). American Cancer Society. https://www.cancer.org/cancer/brain-spinal-cord-tumors-adults/about/key-statistics.html
  2. Dr Michael Kaiser. (2019, July 15). Spinal Tumors Symptoms: 9 Signs to Look for. Neurosurgeons of New Jersey. https://www.neurosurgeonsofnewjersey.com/spinal-tumors-symptoms/
  3. Spinal Cancer and Spinal Tumors. (n.d.). Www.Hopkinsmedicine.org. Retrieved December 4, 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/spinal-cancer-and-spinal-tumors
  4. Spinal Cord Tumours. (n.d.). Www.Christie.Nhs.Uk. https://www.christie.nhs.uk/patients-and-visitors/your-treatment-and-care/types-of-cancer/spinal-cord-tumours
  5. Spinal Tumors – Types, Symptoms, Diagnosis and Treatment. (n.d.). Www.Aans.org. https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Tumors
  6. Spinal Tumours. (n.d.). Gloucestershire Spine Clinic. Retrieved December 4, 2020, from http://www.gloucestershirespineclinic.com/spine-conditions/spinal-tumours/
  7. Spinal Tumours. (2016, June 24). Brain and Spine Foundation. https://issuu.com/brainandspinefoundation/docs/bsf_spinal_tumour_a5_booklet
  8. USC Spine Centre. (n.d.). Spinal Tumors. Keck Medicine of USC. Retrieved December 4, 2020, from https://spine.keckmedicine.org/treatments-services/spinal-tumors/