SPINAL CORD TUMORS – Types, Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluation and Management

Spinal cord tumor is a cancerous growth in the spinal cord which may be benign or malignant. If the tumor presses against the spinal cord or nerve roots urgent medical attention is needed as the compression of the nerves can lead to paralysis even if the tumor is benign. Spinal cord tumors often originate in other parts of the body and travel (metastasize) to the spinal cord.

TYPES OF SPINAL CORD TUMORS

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

1. Intramedullary tumors are located within the nerves of the spinal cord. There are several different types of cancer of the spinal cord, but the most common are astrocytomas and ependymomas.

2. Intradural extramedullary tumors start inside the coverings of the spinal cord, but outside the cord itself. Meningiomas and nerve sheath tumors such as schwannomas, are the most common types of inntradural extramedullary spinal tumors.

3. Extradural spinal tumors. Some tumors start in the bones of the spine (primary bonne tumor). There are several different types of primary bone tumors. Benign tumors include chordomas and osteomas. Malignant tumors include osteosarcomas, chondrosarcomas and fibrosarcomas.

4. Secondary bone cancers. Some cancers can spread into the bones of the spine (vertebrae) from elsewhere in the body. They are known as secondary bone cancers. The most common primary cancers to spread to the vertebrae include lung, breast, lymphoma and prostate cancer. Myeloma is a cancer of the plasma cells that commonly affects the vertebrae.

 

CAUSES AND RISK FACTORS

The cause of tumors that start in the spinal cord or the membranes (meninges) covering the spinal cord is unknown. Some primary spinal tumors occur with genetic defects. Research is being carried out into possible causes.

 

CLINICAL MANIFESTATIONS

Symptoms are caused by pressure on the spinal cord and nerve roots. Pressure on the spinal cord may cause the following:

• Back and neck pain that progressively worsens
• Numbness, tingling and weakness or paralysis in either the arms or legs, or both
  
• Decreased sensation
  
• Erectile dysfunction
  
• Loss of bladder and bowel control
  
• Clumsiness and difficulty in walking
  
• Muscle contractions or spasms
  

Pressure on the spinal cord may also block the blood supply to the cord, resulting in death of tissue, fluid accumulation, and swelling. Fluid accumulation may block more of the blood supply, leading to a vicious circle of damage. Symptoms due to pressure on the spinal cord can worsen quickly.

Pressure on spinal cord roots can cause pain, numbness, tingling, weakness in areas supplied by the compressed nerve root. Pain may radiate along the nerve whose root is compressed. If compression continues, the affected muscles may waste away. Walking may become difficult.

 

DIAGNOSTIC EVALUATION

The first test to diagnose brain and spinal column tumors is a neurological examination. Special imaging techniques such as computerized tomography, magnetic resonance imaging and positron emission tomography are also performed. Laboratory tests include the electroencephalogram and the spinal tap. A biopsy helps doctors diagnose the type of tumor.

 

MANAGEMENT

The goal of treatment is to reduce or prevent nerve damage from pressure on the spinal cord. The treatment for a spinal tumor depends on a number of things, including age, general health, and the position, size and type of tumor.

1. Surgery: The aim of the surgery is to remove the tumor without weakening the spine. 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. A surgical technique called a decompressive laminectomy is sometimes performed to relieve pressure within the spinal canal. Part of several vertebrae and some of the tumor are removed.
   
2. Radiotherapy: Radiotherapy uses high-energy rays to destroy the cancer cells while doing as little harm as possible to normal cells. It is usually given from outside the body known as external radiotherapy. It is used to treat spinal tumors that have not seen completely removed with surgery, or if the tumor comes back after initial treatment.
   
3. Chemotherapy: Chemotherapy is the use of anti-cancer (cytotoxic) drugs that destroy cancer cells. Chemotherapy is only occasionally used for certain types of spinal tumors. Research is looking at ways of developing this type of treatment.
   
4. Steroids: Steroids are chemicals, naturally produced in the body by the reproductive organs, and the adrenal glands above the kidney. They help control and regulate how the body works. Steroids can be given as tablets or by injection, and can reduce the swelling that often surrounds spinal tumors. They may be used before or after surgery; or before, during or after radiotherapy.
   

SPINAL CORD TUMORS – Types, Causes and Risk Factors, Clinical Manifestations, Diagnostic Evaluation and Management