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Spinal Tumors
Spinal tumors are relatively rare spinal problems. They may be classified as either benign or malignant depending on the tendency for the tumor to spread. Malignant tumors are known to metastasize (spread) via arteries, veins, the lymphatic system, and directly. The most common malignant tumors in the spine spread from the breast, prostate, lung, or kidney to the spinal column. Spinal tumors can be dangerous when they cause spinal canal compression, which may lead to neurologic dysfunction (e.g. paralysis) or when then destroy portions of the spine leading to spinal instability.
Many patients will present with back pain as the primary symptom. Pain from a spinal tumor is often worse at rest or at night and may or may not be related to activity. Other symptoms may include weakness, numbness, paraparesis (slight paralysis), spinal deformity (e.g. scoliosis, kyphosis) or even fever.
Treatment
A coordinated approach, combining the multifaceted expertise of a pathologist, oncologist, angiographer, neuroradiologist, and spinal surgeon, is required during the patient’s treatment. Such factors as the patient’s prior treatment, the type of tumor, spinal deformity, neurologic deficit, bony involvement, and the patient’s life expectancy are all weighed prior to any course of action.
Some tumors, especially those that are aggressive in nature, may require removal, which may be partial or complete depending on the stage or the disease and the type of tumor. Other tumors may require the application of non-operative treatment such as radiation, bracing, chemotherapy, or embolization. In some cases, the tumor may require both non-operative treatment as well as surgery. Pain may be relieved through the use of analgesics (pain medication) or through direct removal or compressed nerves or stabilization of the spine.
A pain management consultant may be required to help manage severe pain. To reduce swelling that may occur around the tumor, steroids may be prescribed. Bracing may be necessary to help control pain and to provide spinal stability. Chemotherapy and/or radiation may shrink tumors. Chemotherapy treatment can be administered either intravenously or orally. To ensure that healthy cells are preserved while destroying the cancerous cells, the dose and frequency of radiation (radiotherapy) is carefully calculated.
When is surgery required?
*Non-operative treatment fails to relieve pain
*When a progressive neurologic deficit is observed
*When an open biopsy is required for diagnosis
*When tumor resection may help to reduce neurologic damage
*When vertebral destruction is evident, leading to significant spinal instability
Surgical decision making includes consideration of the risk of infection and/or wound healing problems:
*The patient’s nutritional health, immunity, and pulmonary status are all carefully evaluated.
*Healing would be compromised if the patient has recently experienced chemotherapy or radiation, thus lowering the white blood cell count and lessening the body’s ability to fight the infection.
*Appetite can be greatly affected by cancer, leading to significant weight loss and a deterioration of general health.
*Healthy lung function is required to adequately oxygenate blood to help wound healing.
Whether the course of treatment prescribed is operative or non-operative, periodic physician visits are required. Remember the goal in cancer treatment is to maintain the quality of life to the greatest degree possible given the circumstances of the disease. |
