Spinal Tumors


Spinal tumors occur in thebones forming the spine and the spinal canal or in nerves or other soft tissues. The origin of the tumor basically includes two types. Primary tumors; arising from the cells contained in the spine and spinal cord. Metastatic tumors develop in other parts of the body (breasts, prostate, lungs, etc.) and then spread into the spine. Another classification includes tumors that are outside the dura mater (extradural), that are between the dura mater and spinal cord (intradural extramedullary), and that are inside the spinal cord (intramedullary). 90% of tumors outside the dura mater are the metastatic tumors. Metastatic tumors are the most common in men at the age of between 45 and 65.

Symptoms

Spinal and spinal cord tumors present symptoms depending on the location. The most common complaint is the pain in the back. The pain aggravates at night and does not usually subside by resting. Chronic symptoms of disease, e.g. fever, weight loss, and fatigue could occur. If the tumor in the neck and a tumor-related compression is present, loss of strength of both arms and legs and tingling might appear. If the tumor is in the back and lumbar region, weakness, numbness and inability to walk could occur only in the legs. Depending on the location of the tumor, urinary incontinence, uncontrolled defecation, loss of sexual functioning, impaired reflexes, nearly total numbness, and being bedbound could present. Loss of strength in children is common, e.g. inability to walk, weakness, and fall attacks. Another complaint in children is curvature of the spine which we call scoliosis.

Diagnosis

Anamnesis(history taking) and physical examination performed by specialists are the first steps in making diagnosis. The patients might have a previous or current cancer history. The second stage includes imaging methods, e.g. direct radiography, CT, and MRI, and scintigraphy or PET can be used to make diagnosis and identify the metastasis of tumor.

If the tumor is unable to be identifed by an imaging method, a biopsy is required to find out its type and origin. Depending on the location of the tumor, biopsy can be performed along with local anesthesia guided by various imaging methods such as CT or USG, or an open biopsy can be performed under general anesthesia.

Treatment

Depending on the type and location of the tumor, the methods such as surgical intervention, radiotherapy, and immunotherapy can be used in combination or alone. Monitoring alone could be an option for some patients. This kind of decision usually requires a spinal surgeon, radiologist and oncologist to work together. Benign tumors not resulting in compression can be periodically followed up. Especially, the tumors presenting with neurological symptoms or causing a fracture or having a risk to cause a fracture should be removed by a surgical procedure. The options, e.g. radiotherapy, chemotherapy, and immunotherapy, can be used before or after the surgical procedure depending on the type of the tumor.


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