Dr. Amitabha Das

spinal tumour

1

What is a spinal tumour?

A spinal tumour is an abnormal growth of cells in the spine.

If cells in the spine grow and multiply abnormally to cause a spinal tumour, this is called a primary tumour.

If abnormal cells have spread to the spine from a tumour in another part of the body, this is called a secondary tumour or a metastasis (‘secondaries’ or metastases when talking about more than one).

2

What are the different types of spinal tumours and where do they occur?

Primary tumours are graded by doctors according to the speed at which they are growing. Slower-growing tumours are given lower grades (grades 1 and 2) and faster-growing tumours are given higher grades (grades 3 and 4).

The grading system was devised by the World Health Organisation.

Depending on the grade, doctors will refer to a tumour as being ‘non-malignant’ or ‘malignant’. The grade of a tumour will also help doctors to decide on the most appropriate treatment.

A) Non-malignant Spinal Tumours
Low grade spinal tumours can grow but they do not spread and they do not cause secondary tumours to grow in other parts of the body. However, these tumours can grow to a considerable size, causing damage by putting pressure on the tissue around them in the spine.

Historically, the term ‘benign’ has been used to refer to grade 1 and grade 2 spinal tumours. However, increasingly this term is not being used. This is because, by definition, a ‘benign condition’ is one that doesn’t cause harm whereas in fact all spinal tumours have the potential to cause significant harm, even if they are slow growing and less aggressive when they are discovered. In this publication, we will use the term ‘non-malignant’ to describe low grade spinal tumours.

B) Malignant Spinal Tumours
High grade spinal tumours are referred to as ‘malignant’ spinal tumours. Malignant spinal tumours are cancerous. They do spread and destroy the tissue surrounding them. The rate at which they invade the surrounding tissue depends on how malignant they are. They can also cause tumours to grow in other parts of the body, although this is unusual for spinal cord tumours.

Primary spinal tumours can be non-malignant or malignant depending on their grade. Doctors do not grade secondary (metastatic) spinal tumours because, having spread from a malignant tumour elsewhere in the body, they are always malignant. The most common spinal tumours are malignant metastases that have spread to the spine from malignant primary tumours in other parts of the body. Malignant primary tumours in the prostate, breasts, lungs, kidneys and bowel are the most common sources of malignant metastases in the spine.

The brain and spinal cord are covered by a protective outer membrane (a layer or a ‘skin’) called the dura. Tumours that occur outside the dura are called extradural tumours. Tumours can also occur inside the dura (non-malignant spinal tumours usually occur inside the dura). Tumours that occur inside the dura but outside of the spinal cord are called intradural extramedullary tumours. Less commonly, tumours can grow inside the spinal cord itself. These are called intramedullary tumours.

Any section of the spine can be affected by tumours, from the top of the neck down to the coccyx (tail bone).

Secondary (metastatic) tumours in the bone are the most common type of spinal tumour. Primary bone tumours are rare.

3

What causes Spinal Tumours?

We do not yet know what causes primary spinal tumours and we do not know why some are malignant and some are not.

Secondary (metastatic) spinal tumours are always caused by a cancerous tumour spreading from another part of the body.

4

What are the symptoms of a Spinal Tumour?

The symptoms of a spinal tumour depend on factors such as the size of the tumour, its exact location within the spine and which section of the spine is affected.

People might not experience all of the main symptoms of a spinal tumour but they are likely to experience more than one of them. A) Back Pain

The most commonly experienced symptom of a spinal tumour is pain in or near the spine. Often the pain is not relieved by resting and it might get worse when you lie down or go to bed. Pain that starts in the back before radiating around the body is a sign that nerves could be affected. This type of radiating pain might be caused by a tumour but it is not necessarily the case. Pain spreading down an arm or leg from the spine is a common symptom of a slipped disc.

Spinal tumours are rare and it is important to note that aches in the neck or general backache are most likely to be due to wear and tear in the joints or discs or caused by a problem like a slipped disc.

B) Unusual sensations and weakness

Tumours can cause pressure in the spine and compress (squeeze and press on) the spinal cord. This is called spinal cord compression. When the spinal cord is compressed, messages (nerve impulses) cannot be transmitted properly to and from the brain.

You might experience weakness or a change in sensation (unusual feelings) in one of your arms or legs or in the lower half of your body. These unusual sensations are called paraesthesia.

The unusual feelings (paraesthesia) that people experience can include numbness, pins and needles, a heightened sensitivity to touch and temperature and pain that is often described as ‘burning’. Gentle pressure or touch, such as the feeling of clothing against the skin, might cause discomfort or pain (a medical condition called allodynia) and moderate temperatures can feel extreme. Some people might altogether lose the ability to tell the temperature of water or objects. Sometimes, it can feel like there is a tight band around the body where the unusual sensations begin.

Worsening numbness, tingling, weakness or paralysis (inability to move) of the arms or the legs should be taken seriously. Sometimes these symptoms can be experienced in both arms as well as both legs. This is a possible sign of a problem in the cervical section of the spine (the neck).

Unusual feelings only affecting the feet are a possible sign of problems with the longest nerves within the peripheral nervous system.

Any type of tumour can cause spinal cord compression, however metastatic (secondary) tumours cause approximately 85% of cases (in every 100 people with spinal cord compression, 85cases will be caused by a metastatic tumour). This is referred to specifically as metastatic spinal cord compression (MSCC) and is considered a medical emergency. People with breast, lung, prostate or bone cancer are at the greatest risk of their cancer spreading to the spine and causing MSCC. It is crucial that the pressure on the spinal cord caused by the tumour(s) is relieved quickly, to reduce the risk of permanent damage to the cord (see Possible treatments and Other treatments and approaches sections).

Spinal cord compression can be caused by other problems such as a back injury, an abscess, a slipped disc or other conditions causing inflammation. Your doctors will rule out these other causes of spinal cord compression during the tests and investigations you have.

C) Bladder or Bowel Problems

If spinal tumours press on the spinal cord (spinal cord compression) they can cause bladder and bowel problems. People will usually have already experienced unusual sensations or weakness in their legs before bladder or bowel problems develop.

Bladder or bowel problems can include incontinence (a loss of control of bowel movements or passing urine), needing to go to the toilet with increased frequency or urgency, or difficulty emptying the bladder or bowel. You should seek medical attention if you experience these symptoms, especially if your sexual function is also affected.