What is a spinal cord tumor?

A spinal tumor occurs in your spinal canal or the bones of your spine. When a tumor begins within the spinal cord, such as within the covering of the spinal cord (dura), it is known as an intradural tumor, or a spinal cord tumor. A vertebral tumor involves the bones of the spine (vertebrae).

Spinal cord tumors can also be classified into one of three different types based on their association to the meninges of the spinal cord.

These are the major intradural types:

Intramedullary tumors arise from the cells inside the spinal cord, typically gliomas, astrocytomas, or ependymomas.

Extramedullary tumors arise in either the protective membrane surrounding the spinal cord or the nerve roots extending out from it. Because they do not originate in the spinal cord itself, extramedullary tumors can sometimes interfere with spinal cord function by compressing or otherwise directly threatening or disrupting it. Among the extramedullary tumors are several types of meningiomas, neurofibromas, schwannomas, and nerve sheath tumors.

Metastatic deposits from other cancerous sites can be deposited in the vertebrae that support the spinal cord or, occasionally, in the spinal cord itself.

Spinal tumors or masses may cause pain and neurological disturbances, including paralysis. A spinal tumor can be lethal and permanently disabled.

A spinal tumor is treated by surgical removal, radiation, chemotherapy, or other drug therapy.

What are spinal cord tumor symptoms?

Spinal cord tumors vary in signs and symptoms, especially as they grow. The tumors can affect your spinal cord or the nerve roots, blood vessels, or the bones in your spine.

Here are signs and symptoms that may include:

• Pain at the site of the tumor due to the increase of the tumor growth
• Back pain that may radiate to different parts of your body
• Reduced sensitivity to pain, heat, and cold
• Loss of function in the bowel or bladder
• Decreased or dropped gait, which may lead to falls
• Worsening nocturnal back pain
• Loss of sensation or muscle weakness in the arms and legs
• Sudden weakness in any part of your body that may range from mild to severe
• Back pain is one of the most common early symptoms of spinal tumors. Pain may also spread beyond your back to your hips, legs, feet, or arms and worsen over time — even with treatment.
• Spinal tumors progress at varying rates according to the type of tumor.

What causes spinal cord tumors?

Not known is why most spinal tumors occur. Doctors believe genetic defects are at fault. Yet it remains often unclear whether such a defect is passed down through generations or crops up spontaneously. They may be triggered by something in the environment, for instance, from exposure to specific chemicals. However, in some cases, spinal cord tumors are coupled with known syndromes inherited at birth, including neurofibromatosis two and von Hippel-Lindau disease.

What is the diagnosis of a spinal cord tumor?

Spinal tumors may sometimes be missed because they're not so frequent, and their symptoms mimic those of far more common disorders. That is why your doctor needs to know all your medical history and should conduct both general and neurological physical exams.

If the doctor has a suspicion that there is a spinal tumor, the tests to be conducted may confirm or even reveal where the tumor is:

• Spinal MRI: This method produces finely detailed, cross-sectional pictures of your spine, spinal cord, and nerves using radio waves and a strong magnetic field.
• MRI: It is used as a test of choice for most spinal cord tumors and its coverings. You may receive a special dye called a contrast agent injected into the vein in your hand or forearm. Some people find the inside of the MRI scanner claustrophobic, or the thumping noise makes it very disturbing. However, earplugs are commonly provided to help with the noise, and some machines contain televisions or headphones. If you feel that you are subject to a great deal of anxiety, you might request a mild sedative, and in extreme cases, a general anesthetic is required. MRI scanner technician reassuring patient during the scan.
• Computerized tomography (CT): This procedure employs a narrow radiation beam to create high-resolution pictures of your spine. Sometimes, it is used with an injected contrast dye to outline abnormal changes in the spinal canal or spinal cord. A CT scan is relatively rarely used as an initial attempt to obtain a diagnosis of tumors in the spine.
• Biopsy: A small portion of the tissue can be studied under a microscope to identify a spine tumor precisely. The results of the biopsy enable the specification of the appropriate therapy.

What are treatments for spinal cord tumors?

Ideally, the objective of this treatment would be to eradicate the tumor, but the risk of causing permanent damage to your spinal cord and nerves might jeopardize that objective. Doctors have to take into consideration your age and your general health. All these considerations are taken into account in deciding what kind of treatment is to be used. The decision of whether it's a benign tumor or a malignant tumor needs to be considered while determining the course of the treatment, and whether the tumor begins within your spine or spinal canal or moves there from elsewhere in your body.

Treatment options for most spinal tumors include:

Monitoring:

Some spinal tumors are recognized before they are symptomatic — often when you're being assessed for another reason. Sometimes, mere observation will suffice if the small tumors are not growing or impinging on surrounding tissues.

While under observation, your doctor will recommend periodic CT or MRI scans at appropriate intervals to monitor the tumor.

• Surgery: This can be the preferred management strategy for lesions that can safely be resected with no more than an acceptable risk of spinal cord or nerve damage.

Advanced neurosurgical techniques and instrumentation allow access to lesions considered unreachable by old techniques. High-powered microscopes during microsurgery overcome the challenges of distinguishing the tumor from the healthy tissue surrounding it.

Doctors can also monitor the function of the spinal cord and other vital nerves during the surgery, hence reducing the possibility of damaging them. Occasionally, during surgery, very high-frequency sound waves are utilized in order to break up tumors, and remove the fragments.

However, with modern technology in surgery, all tumors cannot be completely resected. For completely removed tumors, radiation therapy, chemotherapy, or both may be given after surgery.

Spinal surgery may take weeks or more to heal post-surgery. Generally, you have a temporary loss of sensation or complications post-surgery, such as bleeding and damage to your nerve tissue.

• Radiation therapy can eradicate any remaining tumor cells after surgery or treat a tumor that cannot be removed or where removal would pose too significant a risk. Drugs also may help alleviate some of the side effects of radiation, including nausea and vomiting. Sometimes, the treatment plan is adjusted to minimize the damage to the healthy tissue and to make it more effective. Adjustments may range from merely the amount of radiation to be administered to an advanced technique such as 3-D conformal radiation therapy.
• Chemotherapy: Chemotherapy is one of the most common treatments for many types of cancer. It involves drugs that kill cancer cells or stop them from growing. You and your doctor will be able to decide if chemotherapy would be helpful for you, either alone or in combination with radiation therapy.
• Possible side effects: fatigue, nausea, vomiting, susceptibility to infection, and hair loss.
• Other medications: Since surgery and radiation therapy, as well as tumors themselves, can cause inflammation in the spinal cord, doctors may administer corticosteroids to reduce the swelling, either after surgery or during the process of radiation treatments.

Although corticosteroids may depress inflammation, they are used only for a short period to avoid some serious side effects, including muscle weakness, osteoporosis, high blood pressure, diabetes, and susceptibility to infection.

What are the risks and complications of spinal cord tumors?

Spinal cord tumors occur more frequently in people who have:

• Neurofibromatosis 2: In this hereditary disorder, benign tumors grow on or near the nerves associated with hearing. This can result in progressive loss of hearing in one or both ears. Some individuals having neurofibromatosis 2 develop the tumors inside the spinal canal.
• Von Hippel-Lindau disease: This is a rare, multisystem disorder involving blood vessel tumors, or hemangioblastomas, of the brain and retina and spinal cord and other types of tumors, including kidney or adrenal glands.

Complications:

Spinal tumors can compress spinal nerves, thus denying a patient the ability to move or feel anything below the level of the cancer. This can sometimes lead to bowel and bladder dysfunction. Nerve damage is permanent.

However, it can be addressed in time, and with aggressive treatment, further loss of function may be prevented and nerve function regained. A tumor that is pressing against the spinal cord itself might be potentially life-threatening depending on where it is located.

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