What are spinal cord tumors
Spinal cord tumors can occur inside or near the spinal cord (cervical, thoracic, and lumbar) and can be benign or malignant (cancerous). Of all primary Central Nervous System (CNS) cancer cases, about 3% are found overall, while in children, this proportion rises to approximately 4%. Of primary spinal cord tumors, 22% are malignant, while 78% are benign.
Subtypes of spinal cord tumor
Spinal cord tumors can be categorized as:
- Primary tumors – By definition, they originate from cells in that location, either from the spinal cord or from nearby structures, such as the meninges. They can be malignant or non-malignant; and
- Secondary or metastatic tumors – they are metastases from a cancer originating in another part of the body, so they are always malignant.
Another way to classify spinal cord tumors is by their location. They can be:
- Intramedullary tumors – arise within the spinal cord itself. The most common intramedullary tumors are gliomas, especially ependymomas and low-grade astrocytomas, and tend to occur in younger patients.
- Intradural extramedullary tumors – arise within the dura mater but outside the spinal cord. The most common tumors in this group are meningiomas and nerve sheath tumors; and
- Extradural tumors – are lesions that often compress the spinal cord or cauda equina and may even invade the dura mater. Extradural tumors are usually metastatic and often arise in the vertebral bodies.
Symptoms and signs of spinal cord tumors
- Weakness or numbness in the upper and/or lower limbs (difficulty writing or lifting arms and legs, for example);
- Intestinal and bladder problems (such as urinary retention and constipation);
- Difficulty walking;
- Progressively worsening back pain (unrelated to physical activity and worsening when lying down); and
- Decreased sensitivity in the region.
Diagnosis of spinal cord tumors
The diagnosis of a tumor located in the spinal cord can often be delayed, primarily because the initial signs and symptoms are mild and may lead to a delay in seeking medical attention. Patients with “warning signs” should be adequately evaluated with imaging and laboratory tests to confirm the diagnosis.
Learn about the procedures used to detect the disease below.
Imaging tests, which may include:
- X-ray – Spinal X-rays allow evaluation of the overall alignment of the vertebral column and bone integrity and can demonstrate a large enough bone-forming or bone-destroying lesion if present;
- Magnetic Resonance Imaging (MRI) – Often recommended because it is necessary to accurately define the size and extent of the tumor and whether it has spread to the spinal canal;
- Computed Tomography (CT) – May be requested and allows visualization of detailed anatomy of the region; and
- Bone Scintigraphy – A test often requested when there is suspicion of metastatic cancer to the bone and determines if there are other lesions in the bones throughout the body.
Biopsy, which is necessary to confirm the exact type of tumor, especially if it is a primary tumor. It may require surgery, but in some cases, a biopsy using a needle guided by imaging examination may be sufficient to reach the tumor and extract a tissue sample for specific histological diagnosis.
Treatment for spinal cord tumors
The treatment of a tumor in the cervical spine depends on several factors, such as the patient’s age and associated medical conditions, the histological type of the tumor and whether it is primary or metastatic, as well as the severity of symptoms related to its location.
Metastatic tumors of the cervical spine are more likely to cause instability and/or neurological compromise and are more often treated surgically. Certain benign spinal tumors and cysts may not require treatment if they are not causing any symptoms.
Surgical resection followed by radiation therapy (with or without chemotherapy, depending on the histological type of the disease) is usually the protocol adopted for well-localized malignant spinal cord tumors. If removal is not possible, radiation therapy is used directly to relieve pressure on the spinal cord.
Non-surgical options include observation, chemotherapy, and radiation therapy. Asymptomatic or mildly symptomatic tumors that do not appear to be changing or progressing may be observed and monitored with regular MRIs. Some tumors respond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumors that are inherently radioresistant, and surgery may be the only viable treatment option.
It is important to note that when neurological deficits occur due to compression of the spinal cord, corticosteroid treatment should be initiated immediately to reduce edema and preserve spinal cord function. Action should be swift, as many deficits can become irreversible quickly.
The patient’s recovery depends on the promptness of treatment initiation and the extent of the disease.
Prevention
There are no known or effective initiatives to prevent this type of cancer.
