Neurological Diseases: Cancer in Spine

How common is Cancer in Spine (or spinal cancers)?

Cancer in spine is not an uncommon condition. There are many cancers from other areas of body like prostate, breast, lung etc have a predilection to spread to the spine, and some cancers may arise within the spine itself.

Classification & Types

Like any other areas of the body the spinal tumors are classified into two types;

• Primary and
• Secondary

The primary tumors arise from the spine itself whereas the secondary tumors reach the spine from somewhere else (metastatic spinal tumors). The metastatic spine tumors are invariably cancerous where as the primary-tumors are either benign or cancerous (malignant).

Most of the spine tumors are metastatic in nature. The following cancers frequently spread to the spine;

• Breast
• Lung
• Prostate
• Gastrointestinal
• Genitourinary etc.

The term spinal tumor may be used only for those tumors arising from the bony spine or sometimes for all the tumors occurring in that area including bony spine, spinal cord, meninges (covering of the spinal cord) etc.

Tumor Location

The primary spinal tumor may arise from any of the above structures. Various sarcomas, chondromas, multiple myeloma, meningiomas, ependymomas, astrocytomas of spinal cord are some of the primary tumors in this area.

The metastatic spinal cancers favor the epidural space and/or the vertebrae generally. These patients usually present with an epidural mass or growth. Compression of the spinal cord can occur. Of course the primary or secondary spinal tumors may be found in any compartment of the spine including intramedullary, intradural extramedullary, extradural or epidural space, in the spinal bones etc.

Spine is considered as the 3rd commonest site for metastasis from tumors of other organs; liver & lung are the first two.

How does patient present?

Symptoms may vary from patient to patient. The symptoms are similar to many other spine area pathologies including back pain, radiculopathy symptoms (pain that starts in the neck or back then radiates to arms, legs or abdominal areas), numbness or tingling sensation in these areas, weakness of limb muscles, bowel bladder symptom etc. A mass in the spine or back area may be seen.

Constitutional symptoms like weight loss may be seen too.

If tumor is secondary then there are usually the manifestations related to the primary tumors. For example lung cancer patient may present with cough, blood in the sputum etc.

Diagnosis

The following neurology tests are generally required to clinch the diagnosis;

• Imaging studies of the spine (x-rays, CAT scan or MRI )
• A biopsy of the lesion (mass or growth)
• ESR/CRP
• Sometimes an EMG/NCS (electromyography and nerve conduction study)
• Tests for the primary tumors (if spinal tumor is metastatic)

Treatment

The treatment for cancer in spine depends on various factors like type, size, location of the tumor etc, the following are the general treatment guidelines;

• Steroids (dexamethasone usually)
• Radiation therapy
• Chemotherapy
• Surgical resection of the tumor
• Symptomatic treatment like strong pain killers (e.g. opioids)
• Treatment for the primary tumor (if the spinal tumor is metastatic)

A neurologist is commonly involved in the care of patients who have tumors in their spine.



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