Spinal Tumors
Treatment for Spinal Tumors
The Department of Neurosurgery at Rutgers Health and RWJBarnabas treats spinal tumors with a dedicated team of board-certified physicians working together in a multidisciplinary approach. Our doctors are experts in the treatment of cancerous and non-cancerous spinal tumors and provide aggressive, focused treatment to preserve spinal cord function and improve the quality of life of our patients.
If you suspect you have a spinal tumor or if you would like a second opinion, contact us to learn more about how we can help.
Are Spinal Tumors Cancerous?
Spinal tumors form when cells grow too quickly, and they can be very harmful when they put pressure on the spinal column and/or cord. There are multiple spinal tumor types, and some are malignant (cancerous), while others are benign (non-cancerous). Sometimes the spine is the original site of the tumor, whereas other tumors metastasize, or spread, to the spine from their primary location. For instance, breast cancer may metastasize to the spine, and it is still breast cancer, because the cells present in the spine resemble breast cells, not spinal cells.
Whether a spinal tumor is benign or malignant, either is harmful. A benign tumor compresses the spinal cord and can cause permanent damage, as spinal cord injuries are irreversible.
Tumors can develop within the spinal canal or in the vertebrae (spinal column bones) and, more rarely, spinal tumors are found in the spinal cord. Spinal tumors are classified by grade on a scale from 1 to 4, based on whether they are non-cancerous or cancerous. The location of the tumor also impacts treatment methods and a patient’s prognosis.
Spinal growth and tumors can cause neurological problems and permanent spinal cord damage. These tumors, even when non-cancerous, can be life-threatening and lead to permanent disability.
There are basic differences in spinal cord tumors, and some fit into more than one category:
- Malignant spinal tumors: These are cancerous tumors, and may be primary or metastatic. These are the most aggressive spinal tumors, and have the potential to spread to other parts of the body. The most common spinal cancers include osteosarcomas, chondrosarcomas, multiple myeloma, lymphomas, chordomas, and ewing sarcomas.
- Benign spinal tumors: Benign tumors are non-cancerous. However, they can cause permanent damage or disability by pushing on the spinal cord and compromising its function. The most common benign spinal tumors include meningiomas, nerve sheath tumors, gliomas, hemangioblastomas, hemangiomas, osteoids, osteomas, osteoblastomas, osteochondromas, and giant cells tumors.
- Primary spinal tumors: “Primary” tumors are those that originate in the spinal column and/or spinal cord.
- Metastatic spinal tumors: These malignant tumors have spread to the site from their original site (for example, breast cancer that spreads to the bones is most likely to affect the spinal column and/or spinal cord. The stage of the tumor can be determined by the extent of the tumor’s growth, from stage I (locally situated) to stage 4 (far reaching beyond its original site).
Spinal Tumor Categories
The most common spinal tumor categories are:
- Intramedullary tumors: These begin within the spinal cord itself, and include gliomas, astrocytomas and ependymomas.
- Extramedullary tumors: These can either grow in the spinal cord membrane or the nerve roots reaching out from the spinal cord. These tumors do not grow within the spinal cord itself, but can cause spinal cord compression, reducing the functions the spinal cord performs. Examples of these tumors include meningiomas, neurofibromas, and schwannomas.
Signs and Symptoms of Spinal Cord Tumors
- Back pain at the site of the tumor that may radiate to other parts of the body, and may be worse at night
- Lack of sensation, numbness, and a reduced ability to feel hot and cold temperatures
- Difficulty walking, which can cause falls
- Partial paralysis or weakness in different parts of the body depending on where the nerve is
- Loss of bladder or bowel function
- Spinal deformity from larger, benign tumors
Causes of Spinal Tumors
It’s unclear why spinal tumors develop, but experts suspect defective genes may be to blame, although it’s unclear if these are congenital defects or if they develop over time. Exposure to toxic chemicals may also be a hazard. Certain rare, inherited conditions have known links to spinal tumors, such as neurofibromatosis 2 and Von Hippel-Lindau disease.
Spinal Tumor Diagnosis
Symptoms of spinal tumors may resemble other, more common conditions. Your doctor will take a complete medical history, and perform a physical and neurological exam. This may lead your doctor to request further tests to confirm a spinal tumor diagnosis, pinpoint its exact location, and provide the most effective treatment for your condition.
Spinal tumor diagnostic tools include:
- X-ray: These images show the vertebrae structure and the outline of the joints. The purpose of a spinal x-ray is often to rule out other causes of pain, such as infections, fractures, and so on. X-rays, however, are not a good diagnostic tool for spinal tumors.
- Spinal magnetic resonance imaging (MRI) scans: These imaging tests produce images of the spine, spinal cord, and spinal nerves. MRIs are the preferred test for tumor diagnoses.
- Computerized tomography (CT) scan: This is another imaging test sometimes utilized to detect spinal tumors, but not as commonly as MRI scans. CT scans provide detailed images of the spine.
- Biopsy: The only way to definitively diagnose the type of spinal tumor a patient has is to take an extracted tissue sample and study it under a microscope. A biopsy can determine malignancy and whether the tumor originated in the spine or spread from another location to the spine (this is called metastatic spinal cancer).
Spinal Tumor Treatment
When spinal tumors are diagnosed early and treated aggressively, it may be possible to regain nerve function and/or preserve remaining function. For those with whose tumors cause irreversible spinal cord injury, medical care may focus on symptom relief. We take a multidisciplinary approach to determining treatment of spinal tumors by incorporating the medical expertise of board-certified neurologists, neurosurgeons, oncologists, neuro-oncologists, radiation oncologists, and a medical support staff.
The goal of treatment is to totally eliminate the tumor, but this may be complicated, because removal can cause permanent spinal cord and nerve damage.
Monitoring
The “wait and see” approach may be the best option for tumors if there are no symptoms, and the tumor is not pressing on surrounding tissues and compromising their function. During this time, your doctor will recommend intermittent CT or MRI scans to check if the tumor has grown.
Surgical Treatment
Surgery may be recommended for either benign or malignant tumors, and surgical intervention to remove spinal tumors has greatly improved in recent years. Some of the most recent developments include better imaging tests, improved surgical tools and techniques, and more. Surgical treatment largely depends on the type of tumor and whether removal will improve quality of life, such as relieving pressure and pain. Some patients are not good candidates for surgical removal of spinal tumors, because doing so would further compromise spinal cord function.
Radiation Therapy
Radiation is used to treat metastatic spinal cancer and reduce compression of the spinal cord, and is often used in combination with surgery to eliminate any remaining tumor remnants. Patients who are not suited to surgical spinal tumor treatment may also be good candidates if their tumor is inoperable because the risks outweigh the potential benefits.
Your radiation oncologist will very carefully deliver beams of radiation to the spinal tissue to minimize the risk of radiation-induced damage, which can be progressive and irreversible. Primary spinal tumors, which originate in the spine, are often not suited for radiation therapy.
Stereotactic Radiosurgery
Radiosurgeries such as CyberKnife® and Gamma Knife procedures are recognized as state-of-the-art spinal tumor treatments. These are not actually surgical treatments, as they involve no incisions. Instead, these painless, noninvasive treatments deliver high doses of radiation to destroy tumors, and the risk of the healthy tissue being damaged is minimized. Prior to radiosurgery, patients receive CT scans to determine the tumor size, shape, and location.
Chemotherapy
This standard cancer treatment uses medications to destroy cancer cells with the goal of inhibiting their growth. Chemotherapy may be used in combination with radiation therapy.
Spinal Tumor Prognosis
The outlook for spinal tumors depends mainly on the patient’s age, overall health, and whether the tumor is malignant, benign, primary or metastatic.
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