A spinal tumour is an abnormal mass of tissue within or surrounding the spinal cord and spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumours can be benign (non-cancerous) or malignant (cancerous). Primary tumours originate in the spine or spinal cord, and metastatic or secondary tumours result from cancer spreading from another site to the spine.
A thorough medical examination with emphasis on back pain and neurological deficits is the first step to diagnosing a spinal tumour. Radiological tests are required for an accurate and positive diagnosis.
- Computed tomography scan (CT or CAT scan)
- Magnetic resonance imaging (MRI)
After radiological confirmation of the tumour, the only way to determine whether the tumour is benign or malignant is to examine a small tissue sample (extracted through a biopsy procedure) under a microscope. If the tumour is malignant, a biopsy also helps determine the cancer’s type, which subsequently determines treatment options.
Non-mechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumours. Additional symptoms can include the following:
- Loss of sensation or muscle weakness in the legs, arms or chest
- Difficulty walking, which may cause falls
- Decreased sensitivity to pain, heat and cold
- Loss of bowel or bladder function
- Paralysis that may occur in varying degrees and in different parts of the body, depending on which nerves are compressed
- Scoliosis or other spinal deformity resulting from a large, but benign tumour
Nonsurgical treatment options include observation, chemotherapy and radiation therapy. Tumours that are asymptomatic or mildly symptomatic and do not appear to be changing or progressing may be observed and monitored with regular MRIs. Some tumours respond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumours that are inherently radioresistant (i.e. gastrointestinal tract and kidney), and in those cases, surgery may be the only viable treatment option.
Indications for surgery vary depending on the type of tumour. Primary spinal tumours may be removed through complete en bloc resection for a possible cure. In patients with metastatic tumours, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine and alleviating pain. Generally, surgery is only considered as an option for patients with metastases when they are expected to live 12 weeks or longer, and the tumour is resistant to radiation or chemotherapy. Indications for surgery include intractable pain, spinal-cord compression and the need for stabilization of impending pathological fractures.