What are spine tumours?

Spine tumours are abnormal growths of tissue found in and around the spine. Tumours in the spine may be primary (begin in the spine) or secondary (metastatic – move to the spine from other locations). The most common cancers that move to the spine are breast, lung, renal and prostate.

What are metastatic spine tumours?

Metastatic is a term that describes cancer that has spread from its primary site to other places in the body. Metastatic spine tumours are abnormal growths of tissue that are found in and around the spine, but that began in another location in the body. The skeletal system is the third most common site of metastases.

Most often cancer that moves to the spine is not fatal, although it can cause pain and compress nerves. Nerves that are compressed can cause weakness or paralysis of the arms or legs. Treatment of spine tumours is focused on maintaining quality of life. 
 
Where are spine tumours located?

The majority of spine tumors are located in the center of the back. But they also occur in the lower back or neck region.  The location of the tumor determines the symptoms experienced.

What are the symptoms of spine tumours?

Some patients have no symptoms. The most common symptom, however, is pain. Patients may experience persistent back or neck pain. Other complaints may include numbness, tingling or weakness in the arms or legs, problems walking and maintaining balance or problems with bowel and bladder function. 

How is a spine tumour diagnosed?

The most common test is a magnetic resonance imaging (MRI) of the spine, which will show the soft tissues and nerves of the spinal column. Plain X-rays will show vertebral fractures, common when the tumor invades the spinal bones. A computerized tomography (CT) scan shows the bones more clearly and can help to determine the extent of the bony disease. Other tests include CT scans of the chest, abdomen and pelvis or a positron emission tomography (PET) scan to determine where else the cancer may be.


What are the treatments for spine tumours?

The type of treatment that is best for you depends on the type of your tumor, the location of the tumor and how much tumor is in the spine. Your options may include:

No medical treatment

Managing your pain

Surgery

Radiation and/or chemotherapy

Vertebroplasty (injecting bone cement into spine bones to make them strong)


When is surgery necessary?

The role of surgery for metastatic spine tumors is to improve or maintain quality of life. There are a number of reasons why surgery would be a good treatment option for spine tumors:

Surgical cure, if tumor can be removed

Control of tumor growth by surgical removal, sometimes accompanied by radiation and/or chemotherapy

Alleviation of symptoms by reducing pressure on nerves and stabilizing spine to prevent deformities, collapse or paralysis

The goal is usually to reduce the severity of symptoms, including:

Reduction of pain

Restoration of spine stability to improve mobility

Preservation of neurological function

Alteration or change in prognosis


How do I know if I am a candidate for surgery?

The following are factors that determine if you are a candidate for surgery:

Medically stable

Expected survival of three months or more

Extent of systemic disease


What are the surgical options?

The type of surgery your doctor recommends will depend on the type of tumor, its location and the symptoms you are experiencing. If you have weakness, numbness or paralysis of arms and legs or a change in bladder or bowel function, an open surgical procedure may be necessary. 

Closed procedure (vertebroplasty) – Using a needle, the surgeon injects special cement into the vertebral body damaged by the tumor.

Open procedures – These procedures may be done with a surgical incision on the front or back
o Decompression:  to remove bone that has the tumor and to increase the space around the spinal cord and nerves
o Stabilization:  application of screws, rods or cement to stabilize the spinal column
o Combination: both of the above procedures; may be staged one or more days apart

How long is the recovery period after surgery?

Your length of stay in the hospital will vary by the extent and type of surgery. A typical hospital stay after spinal tumor surgery is 5 to 10 days, although each person will respond differently and recover differently. 

Following surgery, you may need help with activities of daily living. This is referred to as rehabilitation. Rehabilitation may be done in an inpatient setting, which means you are admitted to a rehab unit or hospital. It can also be done as an outpatient, which means you could receive therapy in your home or be transported to a rehab facility during the week.


What are the other treatment options?

The non-surgical treatment options for spinal tumors are observation, radiation therapy and chemotherapy.

Observation – Tumors that cause mild or no symptoms and do not appear to be progressing may be observed and monitored with regular MRIs.

Radiation therapy – If you are a candidate to receive radiation therapy to the spine, you will be evaluated by a radiation oncologist who specializes in radiation treatments. Radiation therapy, if indicated, may be delayed to allow time for healing after surgery.  This will be determined by your doctors.

Chemotherapy – Usually, chemotherapy for spinal tumors is not indicated. If you require chemotherapy for systemic cancer, you will be referred back to your original oncologist to make determinations regarding chemotherapy.


What is a Spinal Cord Tumour (SCT)?

Most SCT are benign or slow growing tumors. Malignant tumors account for less than 10% of all these tumors. Most tumors are amenable to surgery and adjuvant radiation and chemotherapy are withheld.


What are my treatment options?

The only treatment for these tumors is a laminectomy (removal of the bone) and an attempt for a radical or gross total resection. Biopsy of these tumors is not justified unless the differential diagnosis is not conclusive.


How soon should I get treatments?

Since the majority of these tumors are slow growing or benign, treatment is not urgent for the majority of cases. One should research a center or surgeon who specializes or performs frequent operations. A cause for urgency is when the symptoms such as motor weakness or pain are rapidly worsening.


Is this a risky operation?

Yes, this is operation can be risky but at most centers who perform surgery in these region the risks are minimal.


What the medical future for the SCT?

At this time research is in spinal cord regeneration following injury. For SCT there is no medical therapy that will treat these tumors.


Are brain tumors and SCT tumors related?

Spinal cord tumors are similar to brain tumors. Both arise from the central nervous system. Both areas have similar tumors

What role does radiotherapy have in treating these tumours?

The role of radiotherapy should only be reserved for tumors which are malignant or those tumors which are not surgically operable. This accounts for very few tumors. Radiography should not be administered for intramedullary ependymomas.

 

How functional will I be after Spinal cord tumour?

Depending upon your functional status prior to surgery, most patients remain the same or get slightly worse for a temporary period of time. However, the majority of patients 2/3 to 3/4 will stay the same or improve in function following surgery.


How often do Spinal Cord Tumours re-occur?

It is quite unusual for spinal cord tumors to recur. Ependymomas usually do not recur. Astrocytomas or gangliogliomas can recur. This accounts for a small percentage of all tumors. The chance for recurrence can be 30% in 10 years.


Can Spinal Cord tumours spread?

Unless malignant most spinal cord tumors do not spread or seed within the central nervous system or in the body.


How many people are diagnosed with Spinal Cord Tumors each year?

Spinal cord tumors are relatively uncommon and account for around 1/1,000,000 individuals per year


What about pain, before and after surgery?

Most of the pain before surgery should improve with the operation. However following surgery some patients develop new numbness or tingling pain which sometimes is worse than the pain before surgery. These type of burning sensation is more common following epemdymomas than astrocytomas. It will subside over several months, but some patients may require medicine to help control this type of pain.

 

How do patients describe post surgical pain (not the pain from incision), but the central pain? What are treatment options for it?

The central pain is described as being hypersensitive or burning type pain. It more commonly occurs in patients with ependymomas. There are several medications which help this type of pain and research in spinal stimulation for severe pain.

 

What causes Spinal Cord Tumors?

No one is certain the cause of spinal cord tumors. There is an association of spinal cord tumors with neurofibromatosis.

 

I’ve been diagnosed with an spinal cord tumor. Where do I find a qualified neurosurgeon who specializes in this?

You need to speak to several surgeons and see how many procedures they have performed in this region.

 

What can I do to prepare for my surgery?

There is no special preparation necessary except to have an optimistic outlook and intense physical therapy

 

I’ve been diagnosed with a Spinal Cord Tumor and have no medical insurance. What should I do?

There are resources for patients with no insurance. You should talk to social workers in your area.

 

I have HMO Insurance, how can I get the surgeon I want?

Most HMOs will allow to go you to go out of network to see an expert. It will take several letters from your primary physician and out of network surgeon.

 

How often are MRI’s done after my spinal cord tumor is removed?

MRI should be done at 3 months,6 months and then annual for several years and then biannual or every three years but it depends upon histology and extent of resection.

 

What is the difference between Intramedullary and Extramedullary? Can a list of tumor types be categorized as to which are “extra” and which “intra”?

Intramedullary are tumors which arise from the spinal cord tissue itself. Extramedullary tumors are those tumors which arise outside of the spinal cord from nerves or coverings and push or compress the spinal cord.

Intramedullary: Astrocytomas, Gangliogliomas, Cavernomas, Hemangioblastomas, Ependymomas.

Extramedullary: Meningiomas, Schwannomas, Neurofibromas and other bone tumors

 

How often have you found syrinx associated with Intramedullary tumors? Even if the syrinx is decompressed during resection of tumor, can the remaining cavity continue to cause neurological deficits?

Cysts are present in 50-70% of all spinal cord tumors. Once the tumor is removed the cyst should decompress. Some patients may have some problems from the cyst re-accumulation however this is quite small.

 

What is the long-term outcome for patients with spinal cord tumors?

The long term outcome is good to excellent.

 

What kind of research is being done today on Spinal Cord Tumors?

The research for Spine Cord Tumors is about new surgical techniques only.

 

Will the nerve damage I have now ever get better?

Sometimes it will but others it will not.

 

How can it be determined if my tumor is benign or malignant?

Although most SCT are benign the only way for certainity is the microscopic examination by a pathologist after the tumor is removed.

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Will I need any treatments after surgery?

Since most tumors are benign the only treatments necessary is physical and occupation therapy.

 

How soon should I start treatment?

These treatments are started in the hospital and then may continue as an outpatient or inpatient program.

 

How functional will I be after surgery?

In most cases the patients are out of bed in 1-2 days and then ambulating with assistance by day 3 or 4. Aside from the pain, the limitations vary from one person to another.

 

How does surgery affect respiration?

Surgery should not affect your respirations unless the tumor is located high in the cervical spine. In these cases there is a small chance of some respiratory compromise.

 

The back part of my vertebrae was removed to access my spinal cord and not returned. How will this affect me? Should I use precautions when physically active?

There are no limitations or precautions following removal of the vertebrae. However, in very young patients and particularly children there is a concern for progression of a spinal deformity which needs to be monitored.

 

What is a metastatic spinal tumor?

A metastatic spinal tumor can occur when cancerous cells have spread from a primary location in the body, such as the breast, lung, or prostate, and grow in the vertebrae of the spine or the spinal cord.


How do I recognize metastatic spinal tumor symptoms?

Metastatic spinal tumors can weaken or fracture the vertebrae, causing varying levels of pain, from mild to severe. The onset of pain may be mild but increase rapidly. Using X-ray and MRI images of your spine, your physician can help you understand if a metastatic spinal tumor is the cause of your back pain.


What are the potential benefits of radiofrequency (RF) ablation therapy?

A minimally invasive procedure using radiofrequency ablation therapy allows a physician to reduce the size of metastatic spinal tumors in a single treatment, thereby providing patients with rapid pain relief. The STAR™ Tumor Ablation System brings this therapeutic option to metastatic spinal tumors that have historically been difficult to access and treat in a minimally invasive procedure.


Are there spine tumor ablation risks that should concern me?

As with all surgical procedures, radiofrequency (RF) ablation therapy does have risks. These risks depend on the patient’s overall health. To determine if you are a candidate for RF ablation therapy, please consult with your doctor.


Is RF ablation therapy right for me?

You’ll need to talk with your physician and, together, determine if you are a good candidate for radiofrequency (RF) ablation therapy.


How long does ablation therapy take?

The entire procedure often takes less than 90 minutes.


How soon after the procedure can I resume my normal activities?

Recovery times for a minimally invasive procedure, such as radiofrequency ablation using the STAR Tumor Ablation System, are measured in hours and days rather than weeks and months. However, recovery time for each patient will vary. Your physician will monitor your progress and, together, will help you determine when you can safely return to your normal activities.