Spine Tumours
Overview
A spinal tumour is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign (non-cancerous) or malignant (cancerous). Primary tumours originate in the spine or spinal cord, and metastatic or secondary tumours result from cancer spreading from another site to the spine.
Symptoms
Non-mechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumors. This back pain is not specifically attributed to injury, stress, or physical activity. However, the pain may increase with activity and can be worse at night when lying down. Pain may spread beyond the back to the hips, legs, feet, or arms and may worsen over time—even when treated by conservative, nonsurgical methods that can often help alleviate back pain attributed to mechanical causes. Depending on the location and type of tumor, other signs and symptoms can develop, especially as a tumor grows and compresses on the spinal cord, nerve roots, blood vessels, or bones of the spine.
Additional symptoms can include the following:
- Loss of sensation or muscle weakness in the legs, arms or chest
- Stiff neck or back
- Pain and/or neurologic symptoms (such as tingling) increase with Valsalva maneuver
- Difficulty walking, which may cause falls
- Decreased sensitivity to pain, heat and cold
- Loss of bowel or bladder function
- Paralysis may occur in varying degrees and in different parts of the body, depending on which nerves are compressed
- Scoliosis or other spinal deformity resulting from a large and/or destructive tumor
Causes
The cause of most primary spinal tumours is unknown. Some of them may be attributed to exposure to cancer-causing agents. Spinal cord lymphomas, which are cancers that affect lymphocytes (a type of immune cell), are more common in people with compromised immune systems. There appears to be a higher incidence of spinal tumours in particular families, so there is most likely a genetic component.
In a small number of cases, primary tumours may result from the presence of these two genetic diseases:
Neurotransmitters 2: In this hereditary (genetic) disorder, benign tumors may develop in the arachnoid layer of the spinal cord or in the supporting glacial cells. However, the more common tumours associated with this disorder affect the nerves related to hearing and can inevitably lead to loss of hearing in one or both ears.
Von Hippel-Lindau disease: This rare, multi-system disorder is associated with benign blood vessel tumours (hemangioblastomas) in the brain, retina and spinal cord, as well as other types of tumours in the kidneys
Diagnosis
A thorough medical examination with an emphasis on back pain and neurological deficits is the first step to diagnosing a spinal tumor. Radiological tests are required for an accurate and positive diagnosis.
- X-ray: The application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumours, infections, fractures, etc. X-rays, however, are not very reliable for diagnosing tumors.
- A computed tomography scan (CT or CAT scan) is a diagnostic image created after a computer reads X-rays. A CT/CAT scan can show the shape and size of the spinal canal, its contents, and the structures around it. It is also very good at visualising bony structures.
- Magnetic resonance imaging (MRI) is a diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology. An MRI can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumours.
- Bone Scan: A diagnostic test using Technetium-99. It is helpful as an adjunct for the identification of bone tumours (such as primary bone tumours of the spine), infections, and diseases involving abnormal bone metabolism.
Radiology studies noted above provide imaging findings that suggest the most likely tumour type. In some cases, however, a biopsy may be needed if the diagnosis is unclear or if there is concern for malignancy vs. benign tumour type. If the tumour is malignant, a biopsy also helps determine the cancer’s type, which subsequently determines treatment options.