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Spinal Tumor

Spinal tumors, also called neoplasms, are abnormal growths of tissue found inside the spinal column. Tumors that originate in the spine are called primary tumors and are very rare. Primary tumors are either benign (non-cancerous) or malignant (cancerous). Benign tumors can cause pain and damage bone tissue, but are not as serious as malignant tumors which can spread cancer to other parts of the body.

Rectal cancer metastasizes to sacrum

Most primary tumors are caused by out-of-control growth among cells that reside in the spinal column or neural tissues. In a small number of individuals, primary tumors may be associated with a specific genetic disease such as neurofibromatosis, or from exposure to radiation or cancer-causing chemicals. However, the cause of most primary tumors remains a mystery. They are not contagious and, at this time, are not preventable.

Spinal tumors that are the result of cancer spreading from other parts of the body are called secondary or metastatic tumors. The spreading of cancer from one part of the body to another is called metastasis. All secondary tumors are malignant because they originated from cancerous tumors elsewhere in the body. Spinal tumors are also classified by the part of the spine where they are located. These classifications are called cervical, thoracic, lumbar and sacrum.

They are also classified by their location in the spine (anterior - in the front or posterior - in the back). While most malignant tumors arise from the anterior area, benign spinal tumors may arise from either the anterior or posterior areas. Once the tumor is classified as benign or malignant it may be given a numbered score that reflects how malignant it is. This score helps doctors determine how to treat the tumor and predict the likely outcome, or prognosis, for the patient.

Symptoms of Spinal Tumors

The primary symptom of a spinal tumor, and the one that brings most patients to seek medical advice, is non-mechanical back pain. Non-mechanical back pain is different from the more common mechanical back pain. Mechanical back pain due to muscle strains or disc injury usually worsens with activities such as sitting, bending, and walking and gets better with rest or lying down, whereas non-mechanical back pain is constant and is not improved by rest or lying down.

Other symptoms include：

• Sciatica
• Numbness
• Partial paralysis
• Spinal deformity
• Difficulty with bladder control
• Fever

Types of Spinal Tumors

There are 5 common types of primary benign tumors including:

• Aneurysmal Bone Cyst (ABC). These are not actually tumors; they are cysts that look and are treated much like tumors. ABCs occur most often in the posterior area of the lumbar spine. More women than men have these cysts and most are discovered when the patient is in her teens or twenties.
• Giant Cell Tumor (GCT). This very aggressive tumor is most often found in the sacrum and anterior areas of the spinal column. Patients are more likely to be women between the ages of 30 and 40.
• Hemanginoma. This type of benign tumor is usually found in the thoracic and lumbar areas of the spine and is more likely to affect women between the ages of 30 and 40. This tumor is usually benign and does not cause any problems in the majority of cases.
• Osteoid Osteoma. This type of tumor is relatively common, especially in males between 20 and 40 years of age. They are often located in the posterior area of the lumbar spine. These types of tumors sometimes cause spinal deformity.
• Osteoblastoma. These tumors are similar to osteoid osteomas but are larger, more aggressive and, fortunately, not as common. They are more likely to affect males between 20 and 30 years of age and are most often found in the posterior area of the lumbar spine.

• Chordoma. These are rare, slow-growing tumors typically found in male patients between the ages of 50 and 70. These types of tumors are most commonly found in the sacrum and surgical resection is mandatory. Because these tumors are often located very close to the nerve roots, surgery sometimes involves the removal of the involved nerves.
• Osteosarcoma. These tumors are rare but often appear in young male patients. They are usually highly malignant and easily spread to other areas of the body.
• Chondrosarcoma. These tumors are slow-growing and most likely found in the thoracic, lumbar and sacrum areas of the spine. Patients are more likely to be males over the age of 40. Some of these tumors cannot be removed surgically due to their position in the spine, but proper surgical resection is key to long-term survival of the patient. In addition, these tumors do not always respond well to chemotherapy or radiation.
• Plasmacytoma. These tumors are called round cell tumors due to how they look under a microscope. They can appear as one tumor or as multiple tumors. They are usually located on the thoracic or lumbar areas of the spine in males over the age of 50.
• Multiple Myeloma. These round cell tumors are the most common type of bone cancer in adults. Patients are usually older, between the ages of 50 and 80. These tumors usually respond well to chemotherapy and radiation.
• Lymphoma. These round cell tumors are most likely of the non-Hodgkin's type and are often found in multiple areas of the body. Patients are more likely to be between the ages of 40 and 60.
• Ewing's Sarcoma. This is a highly malignant round cell tumor most often found in children. Most are located in the sacrum area of the spine. Unfortunately, the 5-year survival rate is less than 20% for patients with this type of tumor.

Spinal tumors can also be caused by cancer that has spread from other areas of the body. How cancer is spread is still unclear. However, every year approximately 1 million new cases of cancer are diagnosed and the skeletal system, including the spine, is the 3rd most frequent area to which it spreads.

Any type of cancer can spread to the spine. The following types of cancer most frequently do so:

• Lung cancer
• Breast cancer
• Prostate cancer
• Thyroid cancer
• Kidney cancer

Diagnosis

Most patients seek medical help because they are experiencing pain. However, before suspecting a tumor, the doctor must first rule out any other possible causes of the patient's symptoms. First, the doctor will begin with a thorough medical history and physical examination of the outside of the body. The doctor will then use special imaging techniques to see the inside of the body. Imaging tests allow the doctor to see if a tumor is present. While imaging tests cannot tell for sure if a lump is cancerous, they often make it possible to avoid exploratory surgery.

Examples of imaging tests include:

• Radiographs (x-rays)
• Nuclear bone scan (radionuclide imaging)
• Magnetic resonance imaging (MRI)
• Computed tomography (or CT scan, formerly called CAT scan)

Radiographs are initially obtained, and a bone scan may be ordered early to rule out tumors or infections. A bone scan is mostly positive in tumors but positive bone scans may also be due to other disorders such as infections, advanced arthritis, etc. The most definitive and helpful imaging test of choice is MRI.

If the imaging test shows a tumor, a biopsy will be performed. A biopsy is a surgical procedure in which a sample of tissue is taken from the suspected tumor. This procedure helps the doctor diagnose the type of tumor and if it is cancerous.

Treatments for Spinal Tumors

Depending on the type of tumor, where it's located, and the patient's medical condition, treatments may include chemotherapy, radiation therapy and/or surgical removal of the tumor. However, surgical removal is not always possible if the tumor is located in an area of the spine that is difficult to reach. Sometimes, embolization is necessary as in the cases of aneurismal bone cysts, kidney cancer and multiple myeloma. This is a procedure that limits blood flow to the tumor.

Other times, a combination of treatments is used to ensure that cancer does not spread to other areas of the body.

Pain often can be controlled with analgesics and swelling can be treated with steroids. In some patients, bracing is necessary to increase spinal stability and reduce pain. If the tumor is cancerous, many patients also use a variety of complementary or alternative approaches including:

• Aromatherapy
• Art therapy
• Biofeedback
• Massage therapy
• Meditation
• Music therapy
• Prayer, spiritual practices
• T'ai chi
• Yoga

Keep in mind, there is no evidence to show that any of these therapies improve the prognosis or change survival rates.

Whether benign or malignant, a spinal tumor is a very serious medical condition. However, if diagnosed early, patients with spinal tumors have a better chance of a full recovery. Patients who are experiencing any of the symptoms listed in this article should seek medical help right away.

Reference Material

Kao-Wha Chang：Surgical ireatment of Metastation tumors of the Spine J orth Surg ROC 7：253-265, 1990

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