Tumor - spinal cord

Any type of tumor may occur in the spine, including:

• Leukemia
• Lymphoma
• Myeloma

A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas.

Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metatastasis) are called secondary spinal tumors.

The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects. A spinal tumor is much less common than a primary brain tumor .

Spinal tumors can occur:

• Inside the cord (intramedullary)
• In the membranes (meninges) covering the spinal cord (extramedullary - intradural)
• Between the meninges and bones of the spine (extradural)

Or, tumors may extend from other locations. Most spinal tumors are extradural.

As it grows, the tumor can affect the:

• Blood vessels
• Bones of the spine
• Meninges
• Nerve roots
• Spinal cord cells

It may press on (compress) the spinal cord or nerve roots (similar to spinal cord trauma ), invade normal cells, or block blood vessels and lead to a lack of oxygen (ischemia).

The symptoms depend on the location, type of tumor, and your general health. Tumors that have spread to the spine from another site (metastatic tumors) often progress quickly. Primary tumors often progress slowly over weeks to years.

Tumors in the spinal cord (intramedullary) usually cause symptoms, sometimes over large portions of the body. Tumors outside the spinal cord (extramedullary) may grow for a long time before causing nerve damage.

Symptoms may include:

• Abnormal sensations , loss of sensation:
  • Especially in the legs (may be in the knee or ankle, with or without shooting pain down the leg)
  • May worsen
• Back pain:
  • Gets worse over time
  • In any area -- middle or low back are most common
  • Is usually severe and not relieved by pain medication
  • Is worse when lying down
  • Is worse with strain, cough, sneeze
  • May extend to the hip, leg, or feet (or arms), or all extremities
  • May stay in the spine
• Cold sensation of the legs, cool fingers or hands, or coolness of other areas
• Fecal incontinence
• Inability to keep from leaking urine (urinary incontinence )
• Muscle contractions or spasms (fasciculations)
• Muscle function loss
• Muscle weakness (decreased muscle strength not due to exercise):
  • Causes falls
  • Especially in the legs
  • Makes walking difficult
  • May get worse (progressive)

A nervous system (neurologic) examination may find the location of the tumor.

The health care provider may also find the following during an exam:

• Abnormal reflexes
• Increased muscle tone
• Loss of pain and temperature sensation
• Tenderness in the spine

These tests may confirm spinal tumor:

• Antidiuretic hormone (ADH ) test
• Cerebrospinal fluid (CSF) examination
• Cytology (cell studies) of CSF
• Myelogram
• Spinal CT
• Spine MRI or lumbosacral spine MRI
• Spine x-ray

The goal of treatment is to reduce or prevent nerve damage from pressure on (compression of) the spinal cord.

Treatment should given quickly. The faster symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be taken seriously.

Treatments include:

• Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling.
• Surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord.
• Radiation therapy may be used with, or instead of, surgery.
• Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases.
• Physical therapy may be needed to improve muscle strength and the ability to function independently.

You can ease the stress of illness by joining a support group whose members share common experiences and problems.

The outcome varies depending on the tumor. Early diagnosis and treatment usually leads to a better outcome.

Nerve damage often continues, even after surgery. Although permanent disability is likely, treatment may delay major disability and death.

• Incontinence
• Life-threatening spinal cord compression
• Loss of sensation
• Paralysis
• Permanent damage to nerves, disability from nerve damage

Call your health care provider if you have a history of cancer and develop severe back pain that is sudden or gets worse.

Go to the emergency room or call the local emergency number (such as 911) if you develop new symptoms, or your symptoms get worse during the treatment of a spinal tumor.

DeAngelis LM. Tumors of the central nervous system and intracranial hypertension and hypotension. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 199.