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. It is approximately estimated that 24,000 cases of central nervous system cancer, which can affect the spinal cord or brain, are diagnosed per year.
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.
Understanding the condition, thorough and timely check-ups can decrease the chance of developing such a disease. Remember that even though the chance of having spinal cancer is relatively low, you still shouldn’t rule out this possibility and consult a doctor if you experience back pain for a while.
In this article, we’ll cover the notion of spinal cord tumors, the types of such tumors, the diagnostic process, including the tests performed and some of the available treatment options.
What are spinal cord tumors?
“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.”
Spinal cord tumors are formations of abnormal growth from any of the spine tissues. Among the symptoms are those typical for other conditions as well, such as pain, numbness or weakness, tingling in some body parts. Difficulty walking, loss of sense of position, paralysis, scoliosis and abnormal gait are also spinal cancer signs.
The exact reason for developing such a tumor is still unknown, anyone can develop it, but it is not a common issue. People who already have a history of some other cancers are more prone to spinal cancer.
The tumors can start in the cells of the spinal cord, in the nerves or in the meninges that cover the spinal cord. Bones that make up the spinal vertebrae, cartilage, spinal discs and blood vessels can also be where the cancer starts.
Tumors can be located in different spinal regions. The ones located in the upper part of the spine have symptoms affecting arms, while tumors in the lower back can cause numbness in legs, troubled sexual function, and bowel or bladder control issues.
Types of spinal cord tumors
There is a classification of tumors based on their location and aggressiveness. There are primary and metastatic spinal tumors. The first type originates in the spine, while the second types are spread from other areas of the body. Primary tumors are quite rare and are usually non-cancerous. Metastatic spinal tumors are typically malignant. Among the types of cancer that can spread to the spine are: lung, breast and prostate cancers. Some tumors may look like cancer, but in reality they are cysts, plaques or similar masses.
Extradural, intradural and intramedullary tumors are differentiated based on their location in the spinal cord. Extradural tumors or epidural tumors form inside the spinal column in the epidural space, the membrane protecting the spinal cord. They can affect the vertebrae, but rarely the spinal cord itself. Intradural tumors form inside the membrane protecting the spinal cord, aka the dura. The third type of tumors involves those forming inside the spinal cord.
Benign epidural tumors include hemangioma, which is formed in blood vessels; osteoid osteoma, located in bones; osteoblastoma, also located in bones; osteochondroma, which is an overgrowth of cartilage and bone; giant cell tumor (GCT), which is formed by the fusion of severla cells.
Benign intradural tumors include meningioma, located in the dura; nerve sheath tumors on the peripheral nerve roots; glioma, that forms from glial cells; ependymoma and subependymoma; astrocytoma; hemangioblastoma.
How are spinal tumors diagnosed?
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
- Myelography, which is a diagnostic imaging test to assess the issues in the spinal cord, nerve roots, other tissues
“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.”
Apart from tests, your doctor collects your full medical history to understand if there were cases of cancer, especially spinal cancer in your family among close relatives. It is also very important to determine whether you already had a history of past cancer, as it increases the chance of developing spinal cancer. Usually, a doctor also performs a physical examination to rule out some other possible conditions. Neurological examination, especially pain and function assessment, can also narrow down the list of possible conditions. For example, the pain and other symptoms can be caused by issues in nerves rather than cancer. A biopsy may be necessary to confirm the exact type of tumor. During this procedure, a needle may be used to reach the tumor and extract a sample.
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 various treatments, which can improve pain, extend life and even result in a cure. The exact treatment plan will be determined based on several factors, such as the type of the tumor, its location and position in the spinal cord, the age, and overall health condition of the patient.
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. There are also a number of new advances in therapeutic radiology, for example, targeted proton therapy.
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 have 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.