Spinal Cord Tumors

A spinal cord tumor, also called an intradural tumor, is a tumor that begins within the spinal cord or the covering of the spinal cord. The two main types of intradural tumors are intramedullary tumors and extramedullary tumors. Intramedullary tumors begin in the cells within the spinal cord itself, these include gliomas, astrocytomas, or ependymomas. Extramedullary tumors either grow in the membrane surrounding the spinal cord or the nerve roots that reach out from the spinal cord itself and can affect spinal cord function by causing spinal cord compression and other problems. Types of extramedullary tumors that can affect the spinal cord include meningiomas, neurofibromas, schwannomas, and nerve sheath tumors. In some cases, tumors from other parts of the body can spread to the spinal cord or other parts of the spine.

Spinal cord tumors can lead to pain, neurological problems, and even paralysis. They can be life-threatening and even cause permanent disability. Treatment for a spinal cord tumor can include surgery, radiation therapy, chemotherapy, or other medications. These tumors can cause different signs and symptoms, especially as they grow. Signs and symptoms of a spinal cord tumor may include pain at the site of the tumor due to growth, back pain that often radiates to other parts of the body, less sensitivity to pain, heat, and cold, loss of bowel or bladder function, difficulty walking that sometimes leads to falls, back pain that gets worse at night, loss of sensation or muscle weakness, especially in the arms or legs, and varying degrees of muscle weakness in different parts of the body.

There are many causes of back pain, and most of them aren’t due to a tumor. However, early diagnosis and treatment is important for spinal cord tumors, so it is imperative to see a doctor if back pain is persistent or progressive, not activity-related, gets worse at night, if the individual has a history of cancer or develops new back pain, or if the patient has other symptoms of cancer such as nausea, vomiting, or dizziness. Seek immediate medical attention for progressive muscle weakness or numbness in the arms or legs or changes in bowel or bladder function.

What Are Spinal Canal/Spinal Cord Tumors?

Spinal canal and spinal cord tumors are unusual growths of cells either in the spinal cord or the spinal canal. The spinal cord is the long sheath of nerves that run from the brain down the back and allow the brain and body to communicate. The spinal canal is the fluid-filled opening down the middle of the vertebrae, or back bones, that houses the spinal cord.

Tumors contain cells that may multiply quickly, in contrast to healthy cells. Many spinal cord/spinal canal tumors are benign, but some can be malignant, or cancerous.

Spinal cord tumors include:

  • Astrocytomas
  • Ependymomas
  • Meningiomas
  • Lipomas
  • Schwannomas (nerve sheath tumors)

Spinal canal tumors include:

  • Metastatic tumors — tumors that spread from another cancer site
  • Schwannomas

Often, no cause can be found for spinal cord tumors. Cancer-causing environmental factors may be responsible for some. Others are associated with immune system deficiencies. A few genetic syndromes can cause spinal cord/spinal canal tumors, as well.

Spinal canal tumors are often related to cancers in other parts of the body. For instance, schwannomas in the spinal cord nerve sheathe may move into the spinal canal. Most commonly, metastasis from other organ cancers leads to spinal canal tumors.

What Are the Symptoms of Spinal Canal/Spinal Cord Tumors?

People with spinal cord or spinal canal tumors may first experience back pain that isn’t associated with activity, posture or injury. This pain may get worse at night. As the spinal tumor presses on the spinal cord or the nerves branching out of it, symptoms may include:

  • Pain (back and/or neck pain, arm and/or leg pain)
  • Muscle weakness or numbness in the arms or legs
  • Difficulty walking
  • General loss of sensation
  • Difficulty with urination
  • Change in bowel habits
  • Paralysis to varying degrees
  • Spinal deformities
  • Pain or difficulty with standing

Once tumors have presented obvious symptoms relating to the spine, it is because cancer has moved from another location in the body, such as a kidney or breast, to the spine. This is tumor is now metastasized. While the word “metastasized” sounds intimidating, there are many options today for patients facing this diagnosis.

Symptoms vary from patient to patient, and doctors classify spinal cancer according to the location in the body.

Spinal cancer is graded in the following ways:

Grade I (grade 1 spinal cancer): The tumor grows slowly and rarely spreads into nearby tissues. It may be possible to completely remove the tumor with surgery.

Grade II (grade 2 spinal cancer): The tumor grows slowly but may spread into nearby tissue or recur.

Grade III (grade 3 spinal cancer): The tumor grows quickly, is likely to spread into nearby tissue, and the tumor cells look very different from normal cells.

Grade IV (grade 4 spinal cancer): The tumor grows and spreads very quickly, and the spinal tumor cells do not look like normal cells. Metastatic brain disease is almost always grade IV.

Types of Spinal Cancer

  • Hemangioblastoma - A hemangioblastoma is a benign (non-cancerous) vascular tumor located along the spine.
  • Hemangioma - Spinal hemangiomas are benign tumors often found in the mid-back (thoracic) and lower back (lumbar).
  • Meningioma - A meningioma is a tumor that grows in the protective lining of the brain and spinal cord.
  • Metastatic tumors - A metastatic tumor is a cancerous (malignant) growth that spreads from another part of the body.
  • Neurofibroma - Neurofibromas are benign (non-cancerous) tumors of the peripheral nerves.
  • Schwannoma - A schwannoma is a spinal tumor that arises from the lining of the nerve cells of the spine.
  • Vascular malformation - A vascular malformation is an abnormal collection or tangle of blood vessels on, in, or near the spinal cord.

How Does a Doctor Diagnose Spinal Canal/Spinal Cord Tumors?

If a doctor suspects a spinal tumor, they will first review symptoms and the patient's medical history and perform a physical exam. Radiological tests such as an X-ray and bone scan may be ordered to check for tumors of the bone, a CT scan for a detailed image of the vertebrae and spinal canal or an MRI to examine the soft tissue inside the spinal canal. A biopsy test (tissue sample) can determine whether a tumor is cancerous.

What Treatments Are Available for Spinal Canal/Spinal Cord Tumors?

Many spinal cord/spinal canal tumors can be removed surgically. Spinal surgeons will use a combination of imaging studies to carefully plan the surgery, aiming to minimize any nerve damage.

Some tumors are treated with radiation or chemotherapy. This is most often the case for advanced metastatic tumors, when the aim of treatment is palliative.

If a spinal cord/spinal canal tumor is benign, a doctor may recommend watchful waiting. Regular imaging tests will monitor if changes occur.

Is Surgery An Option?

Neurosurgeons employ minimally invasive surgical techniques and 3-D technology to take diagnostic images of the spine or brain for safety and accuracy.

When performing minimally invasive spinal surgery, a neurosurgeon may be able to use small incisions and tubes to remove the tumor with fewer impacts on muscle tissue. This technique may help reduce pain and speed up recovery, while allowing the neurosurgeon to decompress the nerves of the spinal cord and access hard-to-reach tumors in and around the spinal cord.

Minimally Invasive Surgery

Intraoperative neuronavigation uses an advanced MRI system to map areas of the brain responsible for important functions. The map then allows us to precisely plan surgery to help avoid damage to those important areas.

Intraoperative electrophysiology “brain mapping” (also called motor mapping and language mapping) is like GPS for the brain.

Non-surgical Intervention

Chemotherapy

Doctors may deliver chemotherapy locally to the brain during surgery. Because chemotherapy is administered as close as possible to the brain tumor edges at the resection area rather than systemically, this technique may help to reduce typical chemotherapy-related side effects.

Radiation Therapy

Doctors may also use intraoperative radiation therapy (IORT) to deliver radiation directly to the area where a tumor has been removed. This may help avoid damage to surrounding normal structures, particularly the scalp and the skin on the scalp.

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