What Is Spinal Cancer?

The spinal cord is part of the central nervous system: it is a simple column tissue that extends from the base of the brain to all the way down the back. Cells in the CNS often divide and grow in a controlled and structured manner. However, when the process gets out of control, a lump or a tumor is found. Spinal cancers are primarily divided into two types, and not all of them are malignant.

•  “Primary” spine cancer develops inside the spinal column. They are comparatively rare, usually benign (noncancerous), and represent a portion of spinal tumors. Malignant tumors might also originate within the spine, although they are usually spread from elsewhere within the body. It’s unclear what causes tumors to develop within the medulla spinalis of the membranes (meninges) covering the spinal cord.
• “Metastatic” spinal tumors are the ones that are spread to the spine from alternative areas of the body. If a tumor finds its way around in the body, it’s malignant. About thirty to seventy percent of patients develop metastatic spinal cancer, most commonly from lung, breast, and prostate cancers.

Where Does It Form?

The spine is made of different types of tissues. It spans the entire back, from under the neck and into the pelvis. All types of tissues are susceptible to form cancer. Going from the outermost layers, here are some of the tissues that develop tumors and cancer in the spine:

• Bones of the spinal vertebrae, as well as the marrow inside
• The cartilage that is responsible for protecting the joints in the vertebrae
• Spinal discs that provide a cushioning effect in the space between the vertebrae
• Essential nutrient-supplying blood vessels
• Peripheral nerves exiting the vertebrae
• Dura mater, pia mater, and arachnoid mater — three layers of membranes that enclose the spinal cord
• Spinal cord

Nerve cells transmit signals and are rarely idle enough to form tumors, but if the tumors press on nerve cells, it could damage and destroy them. These nerve cells are supported by the Glial cells. They maintain the nerves by constantly repairing them by adding an insulating fatty substance called myelin. It forms a protective layer around the nerves like a rubber covering around an electric wire.

Despite how protected the spine is, cancer may start in any of these regions or be spread from a different part of the body.

Types of Spinal Tumors

1. Intradural-extramedullary tumors: Starting in the dura layer of the tissue lining of the spinal cord, they show tendencies to compress nerves when they grow larger. Although many of them are noncancerous, some may prove difficult to get rid of and may become malignant if returned. According to the American Association of Neurological Surgeons (AANS), Forty percent of the cases are found here.
2. Intramedullary tumors: Starting inside the bundle of nerves that compose the spinal cord, usually in glial cells. If neurofibromatosis type 2 runs in the family, a person increases their risk of developing glial cell tumors. Often benign, they tend to be dangerous if they reappear in the body. These make up about five percent of the cases.
3. Extradural tumors: Also known as vertebral tumors, they make up Fifty-five percent of the cases and are situated just outside of the dura of the spinal cord. Breast, prostate, renal, lung, thyroid, and gastrointestinal cancers commonly metastasize into the spine, as easily as the beginning stages of cancer.

Symptoms of Spine Cancer

The symptoms of back cancer depend on the type of the tumor, the size, the location, and the patient’s health history, among others. The pace of cancer development is highly unpredictable as it may gradually occur in time or swiftly, within hours or days. Vertebral tumors that spread from a different part of the body often tend to progress quickly.

The most noticeable characteristic of back cancer is pain, but it’s often dismissed until it’s too late. The pain is caused due to the tumor pushing on sensitive nerve endings or causing instability in the spinal column.

If the tumor continually presses into the spinal cord, it leads to irreversible damage. It begins with a tingling or numbness in the arms or legs, and with time, the person may become clumsier due to their loss of sensation throughout the body due to lower back pain cancer. As cancer takes over, the person becomes weaker and will eventually face paralysis.

The symptoms of spinal cancer are subjective. The common signs of cancerous tumors in the spine and vertebrae include:

• Back or neck pain
• Arm or leg pain
• Muscle weakness
• Loss of sensation
• Difficulty walking
• Loss of bowel or bladder function
• Spinal deformities (hunchback)
• Paralysis
• Pain or difficulty standing
• Instability in the spine
• Damage to the spinal cord due to fractures or spinal collapse
• Death from tumors that restrict the spinal cord

What to Expect At an Oncologist Appointment

An oncologist diagnoses spinal cancer after a physical exam, blood tests, and imaging, usually MRIs and CT scans. A biopsy is then taken and tested to confirm the diagnosis. After confirming the diagnosis, further, a number of examinations called the workup can be expected. This is performed to identify the tumor type, staging ( the size, spread, and level of threat), and if the patient has any history or signs of neurological or other physical deficits.

The following step is to sketch a treatment plan. It may involve surgery, or nonsurgical treatments may be opted based on the results of the workup. The treatments include chemotherapy, radiation surgery, or any combination of these three. The decisions are driven by the cancer type and the person’s medical history. Not every cancer lesion on the spine responds to all the treatments, and so the specialist narrows down which treatments or a combination of treatments will provide the desired result.

Patients suffering from acute or progressive neurological deficits such as weakness in the arms or legs are referred to a spine specialist. These patients do not respond to chemotherapy or radiation therapy and require urgent care and often surgery.

Available Treatments

Surgery

Spinal cancer treatment sometimes involves surgery. Similar surgical strategies used for brain tumors are applied for spinal column tumors. Spinal surgeries earlier were relatively large operations. Due to the advancements in technology, the surgeries are now performed with minimal invasion. Minimal invasion spinal surgeries help the patient get back on their feet and return to normal sooner. The process allows maintenance of nutritional health and faster treatment.

Chemotherapy

Both primary and metastatic spinal cancers are treated with a creative yet aggressive approach. The selection of the drugs and delivery methods depend on the individuals’ needs. The drugs may be orally consumed or injected into the vein. In some cases, they may be administered directly into the cerebrospinal fluid. Chemotherapy is often paired with radiation therapy or other spinal cancer treatments.

The treatment targets rapidly dividing cancer cells in the body. However, some healthy cells in the body also divide rapidly, like those in the hair follicles, mouth, bone marrow, and stomach. When these healthy cells are damaged, side effects may result in:

• Hair loss
• Nausea and vomiting
• Diarrhea
• Increased risk of infection (from low white blood cell counts)
• Fatigue (from low red blood cell counts)
• Easy bruising and bleeding (from low blood platelet counts)

Radiation

Spinal cancer radiation therapy is commonly used after surgical resection of a tumor. This is done to destroy microscopic tumor cells that were not removed. This is often the case for metastatic tumors as they leave a trail that can go unnoticed.

External radiation therapy is a commonly used treatment where the area radiated focuses on the tumor and the area surrounding it. In the case of metastatic spinal tumors, the radiation is spread through the entire spine.

Interventional Radiology

Doctors can visualize tumors and perform real-time image-guided interventional procedures with interventional radiology. Doctors can take biopsies, deliver targeted treatment, provide palliative treatment, and monitor the patient’s response to treatment.

Doctors often perform procedures like kyphoplasty or vertebroplasty to rebuild the cracked or collapsed vertebrae using minimal invasion. This process is short with low recovery time and may help to:

• Relieve pain
• Restore height
• Strengthen the vertebra
• Reduce spinal deformity
• Stabilize fractures

Targeted Therapy

For cancer in the spine, targeted therapy works to target specific pathways or abnormalities in cells responsible for the tumor growth. It is likely and often combined with other treatments and is a safe option for patients who have recurring tumors. A Monoclonal antibody is used to stop angiogenesis, a process that stops the formation of new blood vessels, which become a breeding ground for the tumor cells.