A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells.
One way to describe a spine tumor is by whether it is primary or metastatic:
- A primary tumor is one that originated in the area in the area in which it is found.
- A metastatic tumor is one that develops as an extension of another cancer (such as lung, breast, colon, or kidney).
Another way to describe a tumor is by whether it is benign vs. malignant:
- A benign spinal tumor usually has definite borders and clean edges and does not infiltrate into healthy tissue. A benign tumor is not cancer, but it may need to be removed if it’s causing symptoms or creating pressure on the spine. Benign spine tumors include meningiomas, schwannomas, osteoid osteomas, and osteoblastomas.
- A malignant tumor is a cancerous growth that spreads and infiltrates into other tissue. Malignant spine tumors include chondrosarcomas, Ewing sarcomas, and osteosarcomas.
Spinal tumors may be referred to by the region of the spine in which they occur. These basic areas are cervical, thoracic, lumbar and sacrum. Additionally, they also are classified by their location in the spine into three major groups: intradural-extramedullary, intramedullary and extradural.
- Intradural-extramedullary: These are tumors that occur outside the spinal cord but within its protective covering. These tumors are often meningiomas, Schwannomas, or neurofibromas. Like intramedullary tumors, these tumors are often benign, but they can be difficult to remove surgically and may recur after treatment.
- Intramedullary: These tumors grow in the spinal cord itself, or in the nerves extending from the spinal cord, usually in the upper spine or neck (called the cervical spine). They are often astrocytomas, ependymomas, or hemangioblastomas. Intramedullary tumors are usually benign but can also be difficult to remove due to their location.
- Extradural: These are the most common type of spinal tumors, forming outside the spinal cord and the dura in the bones and cartilage of the vertebrae. Some extradural tumors, such as osteosarcomas, osteoblastomas, and osteoid osteomas, arise from the vertebrae themselves (primary), but extradural tumors are more often metastatic tumors that spread from cancers of the lung, breast, prostate, and kidney.
Non-mechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumors. This back pain is not specifically attributed to injury, stress or physical activity. However, the pain may increase with activity and is often worse at night. Pain may spread beyond the back to the hips, legs, feet or arms and may worsen over time even when treated by conservative, nonsurgical methods that can often help alleviate back pain attributed to mechanical causes. Depending on the location and type of tumor, other signs and symptoms can develop, especially as a malignant tumor grows and compresses on the spinal cord, the nerve roots, blood vessels or bones of the spine. Impingement of the tumor on the spinal cord can be life-threatening in itself.
Additional symptoms can include the following:
- Loss of sensation or muscle weakness in the legs, arms or chest
- Difficulty walking, which may cause falls
- Decreased sensitivity to pain, heat and cold
- Loss of bowel or bladder function
- Paralysis that may occur in varying degrees and in different parts of the body, depending on which nerves are compressed
- Scoliosis or other spinal deformity resulting from a large, but benign tumor
A thorough medical examination with emphasis on back pain and neurological deficits is the first step to diagnosing a spinal tumor. Radiological tests are required for an accurate and positive diagnosis which includes – X-ray, CT scan, MRI
After radiological confirmation of the tumor, the only way to determine whether the tumor is benign or malignant is to examine a small tissue sample (extracted through a biopsy procedure) under a microscope. If the tumor is malignant, a biopsy also helps determine the cancer’s type, which subsequently determines treatment options.
Treatment options include surgery, radiation, chemotherapy, or a combination of all three depending on the unique circumstances associated with each individual tumor.
Tumors that are asymptomtic or mildly symptomatic and 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 (i.e. gastrointestinal tract and kidney): in those cases, surgery may be the only viable treatment option.
Multiple surgical treatment options are available ranging from surgery to correct spinal deformity or neural compression to interventional techniques where cement is injected into the bone to help strengthen the spine.