Spine Cancer

As with other types of cancer, cancers of the spine are a result of abnormal growth and uncontrollable multiplication of the cells. Vertebral cancers arise from the bony vertebrae of the spine, whereas cancers arising from the nervous tissue of the spinal cord are called spinal cord cancers.

Spine cancer can either be primary or secondary. Primary spine cancers originate from the cells in the spine. Secondary spinal cancer is a result of the spread (metastasis) of cancer from other organs, such as the breast, lung and prostate, to the spine. Secondary spinal cancer is more common than primary spinal cancer. Multiple myeloma is a cancer that often metastasizes to the spine.

Spinal tumours can be categorized by their location within the spine. There are 3 categorizations:

• Intradural-extramedullary – inside the dura (a thin covering of the spinal cord), but outside of the actual spinal cord
  • Tumours that develop here could be from a covering of the spinal cord, called the arachnoid membrane. They could also develop from the nerve roots that extend out of the spinal cord, or at the spinal cord base
• Intramedullary – inside the spinal cord itself
  • Tumours that develop here are from cells of the spinal cord itself
• Extradural – outside the dura (a thin covering of the spinal cord)
  • Tumours that develop here are most commonly due to metastatic cancer. Tumours can also develop from the bony vertebrae or from cells covering the nerve roots, but this is less common.

While tumours that affect the vertebrae are mostly due to metastasis, there are some types of tumours that start within the bones of the spine itself. Some examples of these are chordoma, chondrosarcoma, osteosarcoma, plasmacytoma and Ewing’s sarcoma.

Spinal cancers are a relatively rare disease. The formation of benign, non-invasive tumours is more common. However, these benign tumours are still dangerous. They can affect the function of the nervous system by pushing on the spinal cord or nerves. This could lead to the loss of movement and sensation below the tumour, and may also affect bladder and bowel functions. If untreated, the damage could be permanent. They can also cause pain, vertebral fractures or spinal instability as they grow within the bone and disrupt its function.

Tumours in the spine can cause different signs and symptoms as they grow. They can affect the bones of the spine, the spinal cord and nerves and blood vessels in the spine.

• Back pain
  • Often spread to other parts of the body
  • Worsens at night
  • At the sight of tumour growth
  • Not activity related
  • Persistent gets worse over time
• Loss of sensation
• Muscle weakness
• Difficulty walking, could lead to falls
• Lower sensitivity to pain and temperature
• Problems with urination and defecation
• Paralysis, mild to severe

While back pain is a symptom of the presence of spinal tumours or spinal cancer, there are many causes to back pain that might not be due to the tumour. However, early diagnosis is important for cancers in the spine, so it is important to discuss with your doctor if you experience the symptoms listed above. If you have a history of cancer and back pain is a new development, or you experience nausea, vomiting or dizziness, please consult your doctor.

• Exposure to high levels of electromagnetic radiation especially during childhood
• Family history of the following genetic disorders:
  • Neurofibromatosis type 1 (NF1)
  • Neurofibromatosis type 2 (NF2)
  • Tuberous sclerosis
  • Von Hippel-Lindau disease
  • Li-Fraumeni syndrome
• Having a weakened immune system

Cancers in the spine may be missed because the symptoms that arise could resemble conditions that are more common. It is important to discuss with your doctor should you experience any symptoms.

The following tests can be used to confirm the presence of cancer or tumours in the spine.

Magnetic resonance imaging (MRI) and computerised tomography (CT) of the spine produces accurate images of the spine, spinal cord and nerves. Sometimes a contrast dye may be injected as well to make the detection of abnormalities in the spine easier to see. This allows the doctor to detect any abnormal changes in the spine, as well as to find the precise location of the tumour.

A biopsy may also be taken in order to check for the presence of cancer, and also to determine how aggressive it is likely to be. This involves taking a small amount of tissue from the tumour for examination.

Treatment options for spine cancer depends on what the stage and grade of the cancer is, and also the age and general health of the individual.

While the goal of spine cancer or tumour treatment is to remove the tumour completely, this is often complicated by the risk of damage to the spinal cord or the nerves. However, if surgery is required, there are newer techniques and instruments available that increase the precision and accuracy of surgery.

Sometimes, the tumour is discovered before it causes symptoms. If these small tumours are not cancerous and are not growing and affecting the function of surrounding tissue, monitoring its progression may be sufficient. This may involve periodic MRI or CT scans.

Treatment is multidisciplinary, personalised and precise and there are a variety of treatment options available. These may include the following, and possibly in combination:

• Surgery
• Radiation therapy including:
  • External Beam Radiation Therapy
  • Stereotactic Body Radiation Therapy
  • Proton Beam Therapy
• Chemotherapy

Once the diagnosis is made the consultation with an oncologist is essential in order to understand which treatment options are the most suitable.