The nervous system is composed of the brain, spinal cord and a network of nerves which control the functions and senses of the body. Nerve impulses travel up or down the spinal cord to communicate between the brain and the rest of the body. Your spinal cord is a long column of nerve fibres inside the bones of the backbone that stretches from the base of the brain down the lumbar area. Cells within the spine grow in controlled way, until the cells keep dividing uncontrollably and form a lump or tumour. Spinal cord tumours can be benign (noncancerous) or malignant (cancerous) but it can affect the spinal cord cells, blood vessels, meninges, nerve roots and bones of the spine. As the tumour grows it may press on the spinal cord or nerve roots causing damage that can be permanent.
Spinal cord tumours can occur inside the spinal cord (intramedullary), in the membranes covering the spinal cord (intradural-extramedullary), between the meninges and bones of the spine (extradural) or from other location (metastatic). Meningiomas and neurofibromas are benign tumors while metastatic spinal tumours are often malignant. Spinal cord tumours of any kind can lead to pain, neurological problems and paralysis. Noncancerous spinal tumours tend to develop slowly while cancerous spinal tumours grow more quickly. There are several different types of spinal cord cancer, but the most common are ependymomasand astrocytomas.Whether benign or malignant, spinal cord cancer can be life-threatening and can cause permanent disability.
Different signs and symptoms can develop as the tumours grow and affect the spinal cord and the surrounding nerves or blood vessels. Symptoms due to pressure on the spinal cord may include:
- Back pain often in the middle or lower back sometimes extending to the hips or legs that is unrelated to any activity. The pain progressively worsens and cannot be relieved by pain medicine. It gets worse over time when lying down or straining during a cough or sneeze.
- Cold sensation on the fingers, hands, legs or other areas
- Decreased sensation or numbness especially in the arms or legs. Loss of sensation in the knee, legs or ankle with or without shooting pain down the leg
- Decreased sensitivity to pain, cold or heat
- Difficulty walking which may lead to falls
- Muscle weakness or decrease muscle strength in different parts of the body
- Fasciculation (muscle contractions, twitches or spasms)
- Loss of bowel control or faecal incontinence
- Urinary incontinence or loss of bladder control
- Erectile dysfunction
- Scoliosis or spinal deformity resulting from large benign tumour
- Paralysis in different parts of the body caused by nerve compression
Back pain is the common early symptom of spinal cord tumours. Patients with severe back pain typically consult chiropractors to help alleviate the pain. Chiropractors are often the first to identify this life-threatening disease at its early stage. Patients are referred to medical specialist after diagnosis by a chiropractor of potential spinal tumours which means a physical examination, patient’s history, appropriate laboratory testing and diagnostic procedure are made. Early diagnosis and treatment are important for spinal tumours, consult your doctor if you have a history of cancer and develop persistent back pain that is sudden or gets worse.
Spinal cord tumour must be diagnosed and treated immediately to prevent paralysis and permanent damage. Doctors need to find out the position, type and size of tumour so they can plan the appropriate treatment. A thorough medical examination is the first step to diagnose spinal cord cancer. One or more of the following test can help locate the tumour and confirm the diagnosis:
Neurological exam includes a series of question and test to determine motor skills, hearing, vision, memory, cognition and other neurological functions. This exam may help pinpoint the location of the tumour.
X-ray is the application of radiation to produce a picture of a part of the body to see the structure of the vertebrae and the outline of the joints. This is also done to search for other potential causes of pain.
Computed tomography scan (CT Scan) uses a narrow beam of radiation to produce detailed images of the spine. It shows three-dimensional diagnostic images after a computer reads x-rays. It can show the shape and size of the spinal canal, bones and the structures around it. The scan is painless and takes about 10-30 minutes.
Magnetic resonance imaging (MRI) this diagnostic test produces three-dimensional images of the body using powerful magnets, radio waves and computer technology. It can accurately show the spinal cord, nerve roots and surrounding areas to see enlargement, degeneration and tumours. MRI yields better pictures of spinal tumours than computed tomography scan.
Biopsy is the examination of a small tissue sample to determine the precise cancer type and the available treatment options. Tissue samples can be obtained through a fine needle or during surgery.
Monitoring can help discover tumours before they cause symptoms. Doctors will recommend periodic CT or MRI scans to monitor the spinal cord tumour. Spinal cord tumour treatment aims to eliminate the tumour completely. Early treatment may delay major disability and death. The doctors will tell you what it involves before you have any treatment. You will be asked to sign a form saying you give consent for the treatment. No medical treatment should be given without your consent.
Surgery aims to remove the tumour without weakening the spine. Spinal cord tumours on the outer part of the spine can be removed completely. If it’s not possible a part of it is removed to help slow down the progress of the tumour. Surgery is only considered an option if the tumour is resistant to radiation or chemotherapy, and if the patient has metastases and is expected to live 12 weeks or longer.
Radiation therapy uses high-energy rays to destroy spinal cord cancer cells, while doing little harm to the normal cells. This is used to treat tumours that have not been completely removed from surgery. This is also used when surgery isn’t possible to relieve pain and symptoms.
Chemotherapy uses anti-cancer drugs (cytotoxic) to destroy tumours or stop them from growing. This is the standard treatment for many type of cancer. Your doctor can determine if chemo will be beneficial for you, either alone or in combination with radiation therapy.
Steroids can reduce the swelling around the spinal tumours. It can be given as tablets or injection. They may be used before or after surgery or during or after radiotherapy. This cannot treat the tumour by itself but it is useful in improving symptoms and making the patient feel better.
Physical therapy can help improve muscle strength and the patients’ ability to function independently.
Alternative medicine and complementary treatments like acupuncture, osteopathy and herbal remedies may help relieve pain and symptoms. Be sure to learn the risk and benefits of these treatments so it won’t interfere with your medications.
Recovery from spinal tumour depends on how quickly treatments begin and how much damage was done. If the tumour has not spread to any part of the body removing it can resolve the symptoms. The outcome greatly depends on the overall health and the age of the patient and whether the spinal cord tumour is benign or malignant. Early diagnosis and treatment usually leads to a better outcome. Engage in healthy cancer preventing lifestyle, good nutrition and utilise nutritional supplements to avoid cancer.