Persistent back pain can be alarming for many reasons, but it seldom signals the serious diagnosis of cancer of the spine, according to Kaixuan Liu, MD, PhD, founder and Medical Director of Atlantic Spine Center. Spinal cancer is relatively rare, affecting about 1 in 140 men and 1 in 180 women in their lifetime, according to the American Cancer Society. This year, it is estimated that 24,000 cases of central nervous system cancer, which can affect the spinal cord or brain, will be diagnosed.
More often, cancer that spreads from another part of the body, such as the breast, lung or prostate gland, may migrate to the spine. But these tumors are not considered cancer of the spine – they are metastases of the primary cancer, Dr. Liu notes. However, any cancer in the spinal cord can cause back pain, he explains, particularly in the middle or lower back.
“If your back continues to hurt but you can’t attribute it to injury, stress, or physical activity, pay close attention and let your doctor know,” Dr. Liu advises. Most likely, the pain is due to one of a number of possible spine conditions – not cancer of the spine. “But it pays to know the signs, since like other back problems, spinal cancer can also include weakness, numbness or tingling of the arms or legs,” he adds. “A portion of the spine may also become deformed and there may be difficulty walking or changes in bowel or bladder habits.”
Diagnosing cancer of the spine
How do doctors distinguish cancer of the spine from other medical causes of back pain? An accurate diagnosis often involves using a variety of imaging tests and tools. Dr. Liu says these include:
- X-rays, which show the structure of spinal vertebrae and the outline of spinal joints
- MRI, CT, and PET scans, which produce images to determine the precise location of spine tumors
- Nuclear bone scans, which inject a small amount of radioactive material into blood vessels to determine if spine tumor tissue has spread into surrounding bones
- Lumbar puncture, which inserts a needle into the lower spine to collect fluid for lab examination
- Angiography, which obtains detailed, 3-dimensional images of blood vessels surrounding the spine
“Needless to say, it’s crucial to know exactly where a spinal tumor is located and also to understand how aggressive its cell type is,” Dr. Liu explains. “By performing a comprehensive set of tests, doctors are able to more accurately stage a tumor and develop a personalized, tailored treatment plan for each patient with cancer of the spine.”
Improved treatment options
Recent years have seen improved treatment options for spinal cancer. While still a challenging diagnosis, patients with cancer of the spine can typically expect a blend of many various treatments, which can improve pain, extend life and even result in a cure. According to Dr. Liu, treatment choices include:
Surgery: If a cancerous tumor is limited to one part of the spine, doctors may be able to remove it completely, potentially curing the patient. Sometimes, surgery is performed to relieve symptoms from cancer of the spine, such as the compression of spinal vertebrae or nerves or the buildup of cerebrospinal fluid.
Chemotherapy: Depending on the tumor type, chemotherapy drugs taken by pill or injected into the vein can aggressively attack cancerous cells.
Radiation therapy: Aiming beams of radiation at tumor cells on the spine can not only potentially destroy the cancer, but relieve pain. Sometimes, radiation therapy is given after surgery to attack any tiny remaining cancer cells left behind.
Interventional procedures: Compression fractures caused by spinal cancer can be treated with interventional procedures such as kyphoplasty or vertebroplasty, which cause spine disfigurement and pain.
Targeted therapy: Certain newer drugs can aim at specific mutations or developing blood vessels in cancer cells, proving especially effective at eradicating tumors. These targeted drugs are often combined with chemotherapy.
Overall, there’s reason to be optimistic about the future despite challenges presented by cancer of the spine, Dr. Liu says.
“Advances in imaging tests, surgical techniques and other technology surrounding the diagnosis and treatment of spinal cancer has led to better options for patients and better outcomes,” he says. “Tumors involving the spine are still rare, but being educated is part of fighting back.”
Read about controlling cancer pain with our Interventional Pain Management options.