Introduction to spinal cord tumours
The spinal cord is a channel connecting the brain with the body. It helps pass messages, sensory information and motor commands from the brain to every part of the body. An injury to the spinal cord can disrupt this vital flow of information and affect sensations, movement and coordination, leading to life-threatening conditions. It is, therefore, necessary to understand spinal cord tumours, their symptoms, causes and how timely diagnosis can help save this vital organ.
Spinal cord tumours begin in the spinal cord or its covering. Tumours are the abnormal growth of cells affecting the bones of the spine called vertebrae and also the tissues surrounding the spinal cord. Spinal cord tumours often occur due to cancer that spreads from other areas to the spine.
Spinal cord tumours can be benign or malignant. If these grow, they can damage the tissues in the spinal column. Tumours that first form on the spine are primary spinal tumours. Tumours that result from cancer spreading from other areas to the spine are metastatic or secondary spinal tumours.
Types of spinal cord tumours (Benign)
The types of spinal cord tumours depend on their location and if they are benign or malignant. The following are the different spinal cord tumour types based on where they form within the spinal column:
Intramedullary spinal cord tumours originate within the spinal cord itself, leading to the invasion and destruction of the grey and white matter. The common types of these tumours are:
Ependymoma: This is the most common type of spinal cord tumour. It begins in the ependymal cells lining the central canal of the spinal cord. These cells help direct the flow of fluid within the spinal canal.
Astrocytoma: This spinal cord tumour is common in children. It arises from astrocytes. Astrocytes are star-shaped cells in the brain and the spinal cord that assist in proper nerve cell function.
Hemangioblastoma: This tumour can occur in any area of the spinal cord. Hemangioblastoma forms from blood vessels connected to the brain and the spinal cord.
Intradural-Extramedullary tumours (Benign)
These tumours occur in the outermost layer of the spinal cord called the dural sheath. Common types of these tumours are:
Meningioma: This tumour begins in the thin membranes covering the spinal cord (meninges). It is common in women and appears in the upper portion of the back.
Neurofibroma: This tumour occurs in the protective covering of the spinal cord and nerves. It is associated with neurofibromatosis, a condition characterised by nerve tumours in the central nervous system and skin.
Myxopapillary Ependymoma: This tumour develops in the ependymal glia, the tissue surrounding the spinal cord.
Other are metastatic tumor
Symptoms of spinal cord disorders
Spinal cord tumour symptoms depend on the type and location of the tumour.
Back or neck pain: Spinal cord tumours often cause back pain, primarily in the middle or lower back. The pain gradually worsens over time, particularly at night, and does not improve with rest.
Radiating pain or numbness: Radiating pain is a common symptom of spinal cord tumours. It is characterised by shooting pain that extends from the spine to the hips, legs, feet or arms. Additionally, individuals may experience numbness or tingling in the arms, legs and chest. The specific symptoms depend on the location and size of the tumour.
Muscle weakness or paralysis: Muscle weakness or paralysis is a common symptom of spinal cord tumours. The specific areas of the body affected depend on the nerves compressed by the tumour. This can make walking challenging.
Loss of sensation: Loss of sensation in the arms or legs is a common symptom of spinal tumours. The tumours exert pressure on the nerves, resulting in the loss of sensation. Nerve damage from these tumours can sometimes be permanent.
Changes in bowel or bladder function: Changes in bowel and bladder function are also common spinal cord tumour symptoms. These changes are typically caused by the location and size of the tumours. The compression of nerves below the tumour can result in a loss of sensation and impact bowel and bladder function.
Difficulty walking or maintaining balance: Pain and muscle weakness, which may be mild or severe, affects the legs. It results in difficulty walking or maintaining balance and coordination problems.
Diagnosis of spinal cord tumours
To confirm a spinal cord tumour, doctors order several tests apart from physical and neurological tests. These are:
Magnetic Resonance Imaging (MRI):Doctors order MRIs to diagnose the tumours of the spinal cord and the nerves and tissues surrounding the spine. MRIs use magnetic fields and radio waves to create detailed pictures of the spinal cord and the nerves. Contrast enhanced MRI Hepls in better diagnosis.
Stereotactic biopsy: This is a surgical procedure where a thin needle is inserted into the spine to extract spinal tissue to observe under a microscope for a spinal cord tumour.
Open surgical biopsy: An open surgical biopsy is performed as an open surgery, typically when another surgical procedure is planned. It involves the removal of either a part or the entire tumour by the doctors.
Treatment of spinal cord tumours
Treatment for spinal cord tumours depends on factors such as their location, type and size. The primary goals of treatment are to alleviate pain, preseve spinal function and improve the overall quality of life.
In the case of primary spinal tumours, complete tumour removal is pursued when it causes symptoms, taking into account the patient's age and overall health.
For patients with metastatic spinal tumours unresponsive to radiation or chemotherapy, surgery is recommended as an option by doctors for spinal cord decompression.
Tumour resection (complete or partial removal): In tumour resection, the spinal bones are removed to access the spinal canal. The surgeons open the tissue-lined compartment that contains the spinal cord and nerves. Once the spinal cord is exposed, the surgeons remove the tumour.
Decompression (relieving pressure on the spinal cord): This is a metastatic spinal cord surgery. It helps relieve the pressure on the spinal cord and nerve roots. This procedure also helps create enough space to allow high-dose radiation without injuring the spinal cord.
External beam radiation therapy: This therapy involves high doses of X-rays used to destroy or shrink the tumour cells. It is an effective treatment for eliminating pain and other spinal tumour symptoms.
Stereotactic radiosurgery: Stereotactic radiosurgery is a non-surgical procedure where narrow beams of radiation are aimed at the tumour. This procedure ensures the least amount of exposure to the surrounding tissue.
Systemic chemotherapy: Systemic chemotherapy uses a large group of drugs to kill the cancer cells. It travels through the blood to all the cells and aims at slowing the growth of the tumour and stopping it from spreading.
Intrathecal chemotherapy: In this type of chemotherapy, anticancer drugs are injected into the fluid-filled space between the thin layer of tissue covering the spinal cord. This treatment is administered through a procedure called lumbar puncture.
Molecularly targeted drugs: This therapy uses drugs to target specific molecules in the cancer cells. These drugs stop the growth of the cancer cells and restrict the harm to surrounding areas. It also helps in reducing the chances of cancer recurring.
Immunotherapy: Immunotherapy aims at stimulating the immune system to attack the abnormal cells. It is a new therapy that is capable of shrinking spinal cord tumours. Experimental drugs are used in immunotherapy during clinical trials.
Early diagnosis of spinal cord tumours helps in providing timely treatment. For people who experience back pain that gets worse at night and other spinal tumour symptoms, it is important to consult a doctor at the earliest. Doctors develop a personalised treatment plan that includes chemotherapy, radiation therapy and spinal cord surgery to relieve the pain and improve the spinal function and the individual's quality of life.
Frequently Asked Questions
1. Is surgery the only treatment option for spinal cord tumours or are there non-surgical alternatives?
Surgery is a common treatment for spinal cord tumours, but non-surgical options such as radiation therapy and chemotherapy may also be considered.
2. How does the prognosis of spinal cord tumours vary based on factors such as tumour type, location and treatment?
The prognosis of spinal cord tumours varies based on whether the tumour is primary or secondary and benign or malignant. An early diagnosis has higher hopes of a better outcome.
3. Are spinal cord tumours hereditary and is there a genetic predisposition?
Rarely, primary spinal cord tumours can have a genetic predisposition, particularly if there is a family history of neurofibromatosis type 2 or Von Hippel-Landau disease. Genetic testing is recommended in such cases.
4. Can spinal cord tumours occur in children and how are they managed differently in adults?
Spinal cord tumours are common in childhood cancers after leukaemia. The treatments for adults are different from that for children. The treatment for adult patients includes active surveillance, surgery, radiation therapy, chemotherapy and targeted therapy. These are followed by supportive care to lessen the side effects of the treatment.
5. Can spinal cord tumours metastasise (spread) to other body parts?
Spinal cord tumours rarely have the potential to metastasize and spread to other parts of the body.