Spine cancer is the abnormal or uncontrolled growth of tissues or cells in and around the spinal column such as in spinal cord, nerves, muscles, cartilage, or bones. Like tumours elsewhere in the body, spinal tumours may arise there (these are termed primary tumours); or they may have lodged in the spine after spreading (metastasising) from elsewhere in the body (secondary tumours).
Spinal tumours can either be cancerous or non-cancerous i.e. benign or malignant. Some of the commonly occurring benign spinal tumours are osteoma, osteoblastoma, hemangioma, neurofibroma and osteochondroma.
Most commonly occurring malignant spinal tumours are:
- Primary cancers: chondrosarcoma, Ewing's sarcoma, lymphoma, osteosarcoma, and multiple myeloma.
- Secondary cancers: from kidneys, lungs, and breasts, prostate gland or melanomas on the skin.
Signs and symptoms
People with spine cancer observe persistent and chronic back pain; numbness, burning and tingling sensation; loss of sensation in legs, feet, arms or hands; difficulty in balancing; and sometimes loss of bladder or bowel control.
Spine cancer can be diagnosed by neurological examination which can sometimes identify the exact location of the tumour. Other tests which may be done to confirm the spinal tumour include cerebrospinal fluid (CSF) examination, needle biopsy, and radiological examinations such as myelogram, spine computed tomography (CT) scan, magnetic resonance imaging (MRI scan), and spine X-ray. In addition to these tests, isotope bone scan and positron emission tomography (PET) scan can also be done if indicated.
For pain and inflammation, medicines such as analgesics, corticosteroids and anti-inflammatory drugs are prescribed. External braces are also used which provide support and control pain. Non-surgical treatments will provide temporary relief and are not recommended for long-term.
Other treatments include chemotherapy, radiation therapy and surgery, which may provide longer-lasting or even permanent relief.
- Surgery: This may be recommended in order to remove the tumour if it is confined only to one portion of the spine. While performing surgery, risk of damage to the nearby nerves or spinal cord can occur. Surgical resection may be combined with radiation therapy or chemotherapy to remove residual cancer cells.
- Radiation therapy: This is done either after surgery for malignant spinal cancer, or alternatively to treat spinal cancer which is not operable. An advanced form of highly focussed radiotherapy is termed Stereotaxic Radio Surgery (SRS). In this painless therapy, an intense radiation beam is computer-directed to the targeted areas of the spinal cord.
- Chemotherapy: This is the administration of one or more anti-cancer drugs to destroy the tumours. Some of the commonly used drugs are methotrexate, doxorubicin, cyclophosphamide, carboplatin, ifosfamide. These drugs are either given orally, or injected into the vein or muscle, or injected directly to the affected site (including injection into cerebrospinal fluid if cancer affects the spinal cord or spinal nerves).
Complications observed after cancer surgery can include damage to spinal cord or nerves, with consequent disabilities such as sensation loss and/or paralysis. Complications associated with chemotherapy and radiation therapy include hair loss, infections, dry mouth, loss of weight, nausea and vomiting, and diarrhea.
Dr. Brazenor will take a number of factors into consideration before recommending surgery, especially for cancer of the spine. Important factors which must be weighed include the type of tumour to be treated, your age and general health, and the degree to which the cancer has spread.
Dr. Brazenor will always explain your non-surgical option (if there is one), as well as the surgical option along with its success rate, failure rate and risks. If surgery is possible for cancer of the spine, usually it must be done as early as possible.