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Tumor

Definition:

Abnormal growth of tissue that can occur in the spine itself (primary spinal tumor) or from metastases (spread of tumor from another location).  Most tumors in the spine are metastatic (and therefore malignant).

  • Common terms:  Cancer, bone tumor, nerve tumor, metastatic tumor

Pathophysiology:  In primary spinal tumors, there is abnormal growth of one of the normal structures (i.e. bone, cartilage, nerve,  nerve sheath, and blood vessels) that make up the spine. With the help of oncologists, radiologists, and pathologists, important characteristics about the tumor is determined. One important characteristic to determine is whether the tumor is benign (little or no ability to spread) or malignant (ability to spread through the bloodstream). Metastatic tumors to the spine are usually the result of spread of cancer cells through the bloodstream from the primary site (i.e. breast, prostate, lung, etc).  Tumor growth within the spine can cause weakening of the bone and lead to fracture. Also, the tumor can grow causing compression of nerves resulting in pain, weakness, and even paralysis.

Symptoms:

  • Pain (both with activity and at rest)
  • Night pain
  • Weight loss
  • Excess fatigue
  • Pain in extremities (radiculopathy)
  • Weakness in extremities
  • Case example:  65F year old female with a history of breast cancer treated with lumpectomy and radiation five years ago has a four day history of increasing weakness and numbness in her legs.  MRI examination shows a tumor in the thoracic spine compressing the spinal cord.

Diagnosis: X-rays can visualize some tumors and fractures. MRI will help to visualize tumors in the spine and its surrounding structures and can help with the diagnosis of the tumor.  CT scan will help with visualization of the tumor and its effect on the surrounding bone and extent of bony destruction.

Treatments:

  • Non-operative:  Treatment of the tumor depends on the type of tumor and can range from regular observation to medical chemotherapy to radiation. Treatment of spinal tumors will often be performed with a multi-disciplinary approach involving a team of oncologists, radiation oncologists, pathologists, and surgeons.
  • Operative:   Surgical management of tumors depends on the type and location of the tumor and can range from kyphoplasty (for pathologic fractures of the vertebra) to wide dissection of the tumor and spinal reconstruction. Treatment of spinal tumors will often be performed with a multi-disciplinary approach involving a team of oncologists, radiation oncologists, pathologists, and surgeons.  The patient’s life expectancy and functional goals must be taken while making the treatment plan.

Evidence:

 Patchell RATibbs PARegine WFPayne RSaris SKryscio RJMohiuddin MYoung B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005 Aug 20-26;366(9486):643-8.

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