If you have severe back pain, it is natural to wonder whether or not the pain might be a sign of spinal cancer. Tumors in the spinal column may cause back pain from expansion of the bone or from weakening the bone, which in turn can result in spinal fractures, compression (pinching) of the nerves, or spinal instability.
Symptoms: The following general symptoms may be associated with a spinal tumor:
- Pain in the neck or back, followed by neurological problems (such as weakness or numbness of the arms or legs or a change in normal bowel or bladder habits) is most common
- Focal spine pain that is worse in the morning
- Pain that is severe when there is direct manipulation or compression of the affected area of the spine
- Pain that does not diminish with rest, and pain that may be worse at night than during the day
Back pain along with constitutional symptoms, such as loss of appetite, unplanned weight loss, nausea, vomiting, or fever, chills or shakes.
Primary Spinal Tumors
- Meningiomas that occur in the membranes surrounding the spinal cord and are usually benign but may be malignant. These tumors are more common in middle age and elderly women.
- Nerve sheath tumors (schwannomas and neurofibromas) that arise from the nerve roots that come off the spinal cord. Again, this type of tumor is usually benign and slow growing, and it may be years before any neurological problems occur.
- Intramedullary Tumors: Intramedullary tumors grow from inside the spinal cord or inside the individual nerves and often arise from the cells that provide physical support and insulation for the nervous system (glial cells). These tumors occur most often in the cervical spine (neck). They tend to be benign, but surgery to remove the tumor may be difficult.
- The two most common types of intramedullary tumors are astrocytomas and ependymomas.
Metastatic Spinal Tumors
Metastatic tumors most often, spinal tumors metastasize (spread) from cancer in another area of the body. These tumors usually produce pain that does not get better with rest, may be worse at night, and is often accompanied by other signs of serious illness (such as weight loss, fever/ chills/shakes, nausea or vomiting).
- In women, spinal tumors most frequently spread from cancer that originates in the breast or lung.
- In men, spinal tumors most frequently spread from cancer that originates in the prostate or lung.
If any tumor is found in the spine (and there is no other known cancer), a complete examination of all common organs where cancer develops is usually warranted. Evaluation may include:
- Complete medical history
- Complete physical examination
- Complete neurological examination
- Radiographic studies of the spine, chest and GI system to screen for tumors
- MRI and CAT scans to examine the spine.
- Treatments for each common type of spinal tumor is explained in more detail below.
- Treatment of Vertebral Column Tumors
Because most of these tumors arise from advanced cancer from another organ, the goal of spinal treatment is usually to:
- Control the severe pain that often occurs with these tumors (e.g. by removing pressure on the nerve roots)
- Preserve neurological function (e.g. by removing the pressure on the spinal cord)
- Fix structural instability in the spine (e.g. by reconstructing the unstable spine with a spinal fusion)
- Treating Intradural-Extramedullary and Intramedullary Tumors
These types of tumors are usually surgically removed. The goal of treatment is usually to:
- Totally remove the tumor
- Preserve neurological function
The spinal cord and nerves are highly sensitive and avoiding damage to these structures is a critical part of surgery. Monitoring techniques may be used throughout the surgery to determine the function of the spinal cord as the tumors are being removed (e.g. SSEP).
If the tumor cannot be completely removed (e.g. if it adheres to many spinal nerves), post-operative radiation therapy may improve outcome in some cases. If the tumor is metastatic, chemotherapy may also be helpful.
Following the surgery, it may take some time for the nerves to fully heal. Usually rehabilitation and time significantly helps improve a patient’s neurological function.