What is a spinal tumor?

Spinal tumors are abnormal growths of cells on or within the spinal column and cord.

Your backbone, or spine, includes that long, flexible column of bones protecting the spinal cord from the base of your skull to the back of your tailbone, the bottom portion of your pelvis.

Your spinal cord is a long, cylindrical structure running down the center of your backbone from your brainstem—in other words, the bottom of your brain—down to your lower back. It contains clusters of nerve cells that transmit signals from your brain to the rest of your body and vice versa.

Spinal tumors can occur:

Inside your spinal cord (intramedullary).
In the tissues-meninges-covering your spinal cord (intradural-extramedullary).
Between your meninges and the bones of your spine (extradural).
In the bony vertebra of your spine.
Spinal tumors may be benign or malignant. If the cancer grows, it could damage different tissues of your spinal column.
Primary spinal tumors are those that originate first in your spine or spinal cord. Secondary spinal tumors, or spinal metastases, develop when other tissue in your body is already infected with cancer that then moves to your spine. In contrast, spinal metastases are much more common than primary spinal tumors.

How do you know you have spinal tumors?

The symptoms of spinal tumors vary. First, they depend on:

Where your tumor is located and along your spinal column.
The size of the tumor
The type of tumor

Some spine tumors do not cause any symptoms at all since they are tiny and will not compress and irritate any of the surrounding structures, but as they grow, they may start to cause some pain.

Pain due to a spine tumor:

The most frequent symptom of benign and malignant spinal tumors is pain in the back area. Spinal tumor pain is more common in the middle and lower back regions because there is a higher likelihood that tumors will occur in such areas. Pain from a spinal tumor, in general:

It is not precisely linked to an injury, stress, or physical activity but may worsen with strain, such as exercise, sneezing, or coughing.
Itching and deep.
It begins slowly and progresses gradually.
It persists at night, sometimes disturbing sleep.
With time, it becomes sharp and intrusive even when resting.
Does not respond to conservative pain management therapies and drugs.
Spinal tumors can also cause radicular pain that emanates from your backbone to the hips, legs, feet, or arms. Radicular pain often feels stabbing and shooting.

Other symptoms of spinal tumors:

Depending on the location and the type of the spinal tumor, other symptoms besides pain may develop. This is mostly when it grows and pushes on the spinal cord or your nerve roots, blood vessels, or spine bones.

Other symptoms of spinal tumors include:

Tingling, numbness, and loss of feeling in your arms, chest, or legs.
Weakness in the arms, legs, or chest muscles.
Twitches or spasms of muscles.
Stiff back or neck.
Loss of bowel and bladder control (bowel incontinence and urinary incontinence).
Difficulty in walking, leading to falls.
Scoliosis or other deformity of the spine due to a large and destructive tumor.
Paralysis can vary in degree and part of the body affected, depending on which tumor compresses nerves.

What causes spinal tumors?

The cause of a spinal tumor depends on whether it is primary or secondary, also referred to as metastatic.

Primary Spinal Tumor Causes:

Scientists understand the cause of most primary spinal tumors. Some are due to exposure to carcinogenic chemicals or substances. Most people with spinal cord lymphomas - cancers that occur in a particular type of immune cell - have weakened immune systems. Spinal tumors can sometimes be hereditary; scientists believe there is at least some genetic relationship.

Causes of secondary spinal tumors:

By definition, secondary (metastatic) spinal tumors are due to cancer that originated elsewhere in your body and metastasized to your spine.

Metastases most often occur when cancer cells are released from the primary tumor and enter the bloodstream or the lymphatic system. Both systems are fluid-conveying systems throughout the body, so they can carry cancer cells from one part to another.

Metastases can also occur, especially when you have a primary tumor in another part of your body that frees its cancer cells into the circulation and progressively forms secondary growths elsewhere in your body, including your liver, lungs, or bones.

The spinal column is usually susceptible to metastasis because of its rich blood supply and proximity to the lymphatic and venous drainage systems.

How are spinal tumors diagnosed?

Primary spinal tumors are commonly symptom-free. The healthcare provider often finds them as incidental while performing an imaging test for some other reason. Individuals who have symptomatic spinal tumors generally relate their back pain to some perceived or seeming injury of some sort that occurred in the recent past. If you have pain in your back, then see your healthcare provider. Just as with any cancer, it may be vital for you to consult your healthcare provider even if back pain is what brings you into their office.

The health care professional will question you regarding your symptoms, as well as your medical history. They will also conduct a neurological check to note the following symptoms:

Sensitivity down your spine.
Loss of sensation to pain or temperature.
Abnormal reflexes
Muscle weakness.
Tests ordered for diagnosis of your tumor

What tests would be done to diagnose a spinal tumor?

Besides a physical and neurological examination, your doctor will require several tests to be conducted to confirm the existence of a spinal tumor. Some of the tests are:

Imaging tests: Spine X-rays are one of the first imaging tests that may be prescribed for cancer patients who start suddenly feeling sharp back pain. This is because metastatic spinal tumors often arise in the bony portion of your spinal column. The other investigations that your doctor may order to view your spinal cord, nerves, and surrounding spine bony and soft tissue are MRI and/or CT scans. Suppose your doctor suspects that the spinal tumor is metastatic. In that case, other parts of your body might be examined with the help of imaging tests to identify the tumor's original location.
Biopsy: It is the removal of a tissue sample from the tumor so that the doctor can find out whether the cancer is benign or malignant. Your doctor may ask for it. A pathologist examines the biopsy and finds out if it's growing and spreading and, if so, how fast it is spreading. If the tumor is malignant, a biopsy also determines the exact type of cancer, which determines your treatment plan.
Bone scan: A small amount of radioactive substance is injected into a vein, and imaging that follows observes your bones, tracing the movement of the radioactive material. This helps detect whether areas in your spine appear abnormal.
Blood tests: The doctor may perform some blood tests to determine whether you have abnormal levels of certain substances in your blood, including calcium and alkaline phosphatase. Your body periodically releases these substances in the bloodstream each time bone tissue breaks down, and this could be due to cancer.

How is a spinal tumor treated?

There is a very individualized approach to the treatment of spinal tumors based on tumor location, size, and type. Your care goals for the metastatic spinal tumor are as follows:

Your pain should be relieved as much as possible.
The functioning of your spine and spinal nerves should be preserved or improved.
You will improve the quality and duration of your life.
The goals of primary spinal tumor treatment include trying to remove the tumor if it's symptomatic in origin entirely.

Many different types of healthcare professionals are involved in the treatment plan for spinal tumors. These may include, but are not limited to:

Neurologists.
Spinal surgeons.
Medical oncologists.
Radiation oncologists.
Orthopaedists.
Urologists.
Vascular surgeons.

Which medicines and other treatments for spinal tumors?

For any metastatic (secondary) spinal tumor, treatment will depend on the specifics of the case; other therapy options include:

Your healthcare team will likely use a multidisciplinary approach to treat a metastatic spinal tumor, which may include

Chemotherapy: The chemotherapy drugs can kill cancer cells in your spine and also other parts of your body. You may get chemotherapy injected into a vein or as an oral pill. Sometimes, healthcare providers administer chemotherapy before surgery to shrink the size of the tumor.
Radiation: Administering high doses of X-rays kills the tumor cells or shrinks the tumor. When it has been shrunk to such a size, it may be smaller and diminish or eliminate pain or other symptoms.
Stereotactic radiosurgery: Non-surgical, noninvasive procedure in which concentrated narrow beams are delivered to a tumor, minimizing damage and radiation exposure to surrounding tissues.
Surgery: All surgeons will not perform surgery for a patient with metastatic spinal tumors unless the patient will survive three to four months or longer and cannot be medically managed by radiation or chemotherapy alone. Surgery can relieve pain and other symptoms, preserve neurologic function, and stabilize the spine. Your surgeon may suggest an open procedure or a minimally invasive one. In some cases, your surgeon may decide to do a vertebroplasty or a kyphoplasty procedure in which bone cement is injected into your spine after removal of the tumor. Both methods help in the support and stabilization of the spine, improve mobility, and reduce pain. Up to 10% of all patients with symptomatic spine metastases can be treated through surgery.
Monitoring is done through tracking the growth and spread of cancer in your body through repeated imaging tests.

Treatment of primary spinal tumors:

If you have a benign tumor that is asymptomatic or mildly symptomatic and does not appear to be changing or worsening, your oncologist may monitor it with periodic MRIs.

Depending on the nature of the spinal tumor, surgery could be curative because it may remove all the primary tumors. For instance, a complete en bloc resection-the removal of the cancer in a single piece, leaving no residual cancer-is possible for some forms of the primary tumors in the spine. For other forms of tumors, especially intramedullary, where the cancer arises inside the spinal cord, such a complete removal by surgery is not possible without significant neural damage.

If your spinal tumor is malignant, you'll also require cancer treatments, as mentioned above.

How can I prevent spinal tumors?

Spinal tumor prevention approaches depend on the type — primary or secondary (metastatic).

Preventing primary spinal tumors:

Primary spinal tumors cannot, unfortunately, be prevented.

In a few instances, primary spinal tumors can be caused by particular genetic disorders, including:

Neurofibromatosis Type 2 (NF2): In this hereditary (genetic) condition, patients have a predisposition towards developing benign tumors within the arachnoid layer of their spinal cord or supporting glial cells.
Von Hippel-Lindau disease (VHL) is a rare genetic disorder characterized by the development of benign blood vessel tumors, known as hemangioblastomas, in the brain, retina, and spinal cord and other types of tumors in the kidneys or adrenal glands.
If you have a first-degree family member—a brother, sister, or parent—with one of these conditions, you should seek genetic counseling or testing to learn whether you, too, may have the condition. Cancers of the spine are best cured if they are diagnosed early.

Preventing secondary (metastatic) spinal tumors:

Not all secondary (metastatic) spinal tumors can be prevented. In fact, for many people, metastatic cancer is the first diagnosis they receive.

If a localized cancer has been diagnosed, the only effective way to prevent secondary spinal tumors is through adjuvant or neoadjuvant therapy. With adjuvant treatment, the primary tumor is hoped to be reduced in size. Cancer cells that have broken away from the primary tumor cannot form secondary metastatic tumors later.

Healthcare providers use various types of adjuvant therapy, and new ones are still under research.

What is the prognosis (outlook) for spinal tumors?

Your chances for recovery from a spinal tumor depend considerably on your age, general health status, and whether the cancer is benign or malignant and primary or metastatic. Your healthcare team is better able to give you an overview of what you might expect if you have a spinal tumor. Don't be afraid to ask questions.

In general, early diagnosis and treatment of a spinal tumor will significantly improve the outcome. If you suspect you have symptoms of spinal tumors, such as night-worsening backache, you should see your doctor.

Living With

How can I manage this condition?

If you have a spinal tumor, it is then crucial that you follow your treatment plan, as this will work as well as it can. You'll also need support for the physical, emotional, and social effects of living with back pain and cancer if these situations apply to you.