Spinal Cancer - Risk Factors, Types, Symptoms, Diagnosis, and Treatment

What Is Spinal Cord?

The spinal cord is one of the two components (another component is the brain) of the central nervous system, which regulates functions like:

• Control body movements and functions.

• Helps in transmitting signals to your brain.

• Helps in managing reflexes.

The spine comprises 33 bones called vertebrae, divided into five sections :

1. Cervical spine section.

2. Thoracic spine section.

3. Lumbar spine section.

4. Sacrum bone.

5. Coccyx bone.

What Is Spinal Cancer?

Spinal cancer (spinal cord cancer) refers to a condition in which abnormal cell growth is seen in the spinal canal or the vertebrae. Spinal cancer commonly involves:

• Inside spinal cord (intramedullary).

• Inside tissues (meninges) covering the spinal cord (extramedullary - intradural).

• In between the tissues (meninges) and bones of the spine (extradural).

• In the bony vertebrae.

Spinal tumors can be either benign (non-cancerous) or malignant (cancerous). Primary spinal tumors originate in the spine, and they are mostly benign. Metastatic spinal tumors occur mainly from the spread of tumors from the spine to other parts of the body, although they may directly originate from the spine. They are mostly malignant and occur more commonly in patients than primary spinal tumors.

What Are the Risk Factors of Spinal Cancer?

The exact cause of spinal cancer is unknown. Some study suggests that defective genes in the body play a role in causation; however, it is not proven whether such genetic defects are either inherited or develop over time. Lifestyle factors like tobacco usage, alcohol consumption, etc., are related to the development of many cancers, including those that originate or metastasize to the spine. Let us see some more risk factors that are not conclusively associated with spine cancer but are believed to be influential risk factors. That include:

• Childhood exposure to high levels of electromagnetic radiation.

• Due to hereditary conditions such as;

1. Neurofibromatosis: Neurofibromatosis is a genetic disease that causes tumors in the brain, spinal cord, and nerves. It is of three types: type 1, type 2, and type 3 (also known as schwannomatosis).

2. Von-Hippel - Lindau syndrome: It is an inherited disorder that causes tumors and cysts to grow in the brain, spinal cord, eyes, inner ear, adrenal gland, pancreas, etc.;It is caused due to changes in the VHL gene.

• Weakened immune system.

What Are the Different Types of Spinal Cancer (Spinal Cord Tumors)?

Spinal tumors can be classified based on their location within the spinal cord. This includes;

• Intramedullary Tumor: These tumors are grown inside the spinal cord. Some of the

common types of intramedullary tumors include;

1. Ependymoma: The most common spinal tumor that begins in ependymal cells.

2. Astrocytoma: The most common spinal cord tumor in children.

3. Hemangioblastoma: A benign tumor that occurs in the brain stem or spine.

4. Lipoma: Fatty lump seen between the skin, and underneath the muscle layer.

• Extradural Tumors: It is also known as epidural tumors, which develop inside the spinal column and involve vertebrae but usually don't affect the spinal cord. The epidural is the area surrounding the outer dura membrane that protects the spinal cord.

• Intradural- Extramedullary Tumors: These tumors are located outside the spinal cord but within the dural sheath.

What Are the Signs and Symptoms of Spinal Cancer?

The symptoms of spinal cancer may vary depending on the severity of the condition, size, location of the tumors in the spinal cord, and its tendency to metastasize. Metastatic tumors often show clearer signs and symptoms than primary tumors.

Tumor compressing over the spinal cord results in tingling sensation and numbness over the legs and arms. Pain is the most common symptom that occurs due to a tumor compressing the sensitive nerve endings. Some of the most common signs and symptoms include:

• Back pain and neck pain are common early symptoms that often radiate to other parts of your body. It usually worsens at night.

• Pain at the site of the tumor.

• Neurologic problems like:

1. Radiculopathy (pinching of a nerve root in the spinal column).

2. Myelopathy (spinal cord compression).

• Muscle weakness, tingling sensation, numbness in arms and legs.

• Difficulty in walking.

• Bowel or bladder dysfunction.

• Finding difficulty in standing erect.

• Paralysis occurs at the severe stage of the disease.

When Should You Consult a Doctor?

Consult the doctor if there are any unusual changes in health. Sometimes a condition with cancer-related symptoms is misinterpreted as cancer. However, a proper and early diagnosis can help to delineate whether the condition is cancer or not. One must consult a doctor if he experience any spine cancer-related symptoms with the following characteristics.

1. If it is persistent or progressive.

2. If you have a familial history of cancer.

3. If the symptoms get worse at night.

4. Unusual back pain that does not resolve with rest.

How to Diagnose Spinal Cancer?

Spinal cancer does occur rarely, and its symptoms resemble those of common conditions. An early diagnosis helps in delineating the condition. If the doctor suspects any spinal tumor, then the following diagnostic measures might be asked to get done.

1. MRI (Magnetic Resonance Imaging): MRI uses a powerful magnetic field and radio waves that give accurate images of your spine, spinal cord, and nerves that help in diagnosing the condition better. It is the most reliable diagnostic tool for detecting spinal tumors. It gives accurate details on the site, the extent of the tumor, and even pinpoints metastatic changes associated with the tumor.

2.Computed Tomography Scan: CT scan of the spine helps in assessing the spine for a herniated disk, tumors, the extent of injury, etc. It gives a more detailed view than X-rays.

3. X-rays: X-rays provide images of the vertebrae and other spinal structures and tissues.

4. Biopsy: Biopsy in spinal cancer is a minimally invasive approach where a CT scan is used as a guide to place a thin needle into the tumor, and a small amount of tissue sample is excised and sent to a pathologist for microscopic examination. It gives a definitive diagnosis of the condition.

5. Myelography: In myelography, a contrast dye is injected into the spinal canal through a hollow needle, followed by an X-ray fluoroscopy that records images formed by the dye. The procedure is generally done by a radiologist. It checks for problems in the spinal canal and helps in treatment planning.

What Are the Treatment Options?

The treatment planning depends on various factors that include:

• Age of the patient.

• Overall health.

• Tumor size, the extent to which it is involved, and the metastatic spread of the tumor.

The goals of treatment comprise:

• To relieve pain.

• To maintain or improve the function of the spine and spinal nerves.

• To improve the health of the patient.

Let us see the various treatment options used to treat spine cancer:

• Surgery: Surgical treatment for spine cancer is often risky due to the tumor's close proximity to nerves and other vital structures, leading to nerve injury, infection, bleeding, etc. Minimally invasive therapies are used to treat spine cancer to stabilize the spine and repair the vertebral fracture. Some of the minimally invasive therapies include:

1. Vertebroplasty: It refers to a procedure in which a block of special bone cement is injected into the collapsed vertebra to stabilize the spine before surgery or radiation therapy. It is proven to be effective in easing pain and improving the quality of life in patients with vertebral metastases.

2. Kyphoplasty: It is used in treating spinal compression fractures. In this, a hollow needle is used to make a small incision through the skin of the vertebral body. Followed by this, a balloon-like device is inserted into the compressed vertebrae. The balloon-like device is inflated to expand the vertebrae; then, it is deflated and removed. After this, a cement compound is injected into the space. This compound hardens and stabilizes the vertebrae.

• Radiation Therapy: In radiation therapy, high-dose X-rays are used to kill cancer cells and shrink the tumor size.

• Chemotherapy: Chemotherapy uses anticancer drugs to kill cancer cells. Some of the chemo drugs used to treat brain and spinal cord tumors include;

1. Cisplatin.
2. Etoposide.
3. Cyclophosphamide.

• Stereotactic Radiosurgery: It is a non-surgical, non-invasive procedure that uses focused radiation beams to treat tumors and other functional abnormalities of the brain, spinal cord, etc.,

Conclusion:

Spinal cancer is a rare condition, and its symptoms resemble those of common conditions and often go undiagnosed at an early stage. If you find any unusual changes in your health, then it is highly appreciable to consult your doctor and get an early diagnosis.