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Spinal Cord Tumors

by Roy A. Patchell, MD

A spinal cord tumor is a noncancerous (benign) or cancerous (malignant) growth in or around the spinal cord.

  • People may have weak muscles, lose sensation in particular areas of the body, or become unable to control bowel and bladder function.

  • Magnetic resonance imaging can usually detect spinal cord tumors.

  • Treatment may involve surgical removal, radiation therapy, or both.

Spinal cord tumors are much less common than brain tumors. Spinal cord tumors may be primary or secondary.

Primary spinal cord tumors may be cancerous or noncancerous. They may originate in the cells within or next to the spinal cord. Only about one third of primary spinal cord tumors originate in the cells within the spinal cord. These tumors can extend within the cord and cause a fluid-filled cavity (syrinx) to form.

Most primary spinal cord tumors originate in cells next to the spinal cord, such as those of the meninges—the layers of tissue that cover the spinal cord (see Figure: How the Spine Is Organized). Meningiomas and neurofibromas, which originate in cells next to the cord, are the most common primary spinal tumors. They are noncancerous.

Secondary spinal cord tumors , which are more common, are metastases of cancer originating in another part of the body and thus are always cancerous. Metastases most commonly spread to the vertebrae from cancers that originate in the lungs, breasts, prostate gland, kidneys, or thyroid gland. Metastases usually put pressure on (compress) the spinal cord or nerve roots from the outside. Lymphomas may also spread to the spine and compress the spinal cord.

Tumors That Originate in or Near the Spinal Cord*

Type of Tumor

Origin

Cancer Status

Astrocytoma

Cells of the tissue that supports nerve cells

Cancerous or noncancerous

Ependymoma

Cells lining the canal in the center of the spinal cord

Noncancerous

Meningioma

Cells of the layers of tissue covering the spinal cord (meninges)

Noncancerous but may recur or occasionally become cancerous

Neurofibroma

Cells that support peripheral nerves (the nerves outside the brain and spinal cord)

Usually noncancerous

Sarcoma

Cells of connective tissue in the spine

Cancerous

Schwannoma

Cells (called Schwann cells) that wrap around peripheral nerve fibers, forming the myelin sheath

Usually noncancerous

*These tumors can occur in children and adults.

Symptoms

Symptoms are caused by pressure on the spinal cord and nerve roots. Pressure on the spinal cord may cause the following:

  • Back pain that progressively worsens, is unrelated to activity, and is worse when people lie down

  • Decreased sensation, progressive weakness, or paralysis in areas controlled by the parts of the spinal cord below the part that is compressed

  • Erectile dysfunction

  • Loss of bladder and bowel control

Pressure on the spinal cord may also block the blood supply to the cord, resulting in death of tissue, fluid accumulation, and swelling. Fluid accumulation may block more of the blood supply, leading to a vicious circle of damage. Symptoms due to pressure on the spinal cord can worsen quickly.

Pressure on spinal nerve roots can cause pain, numbness, tingling, and weakness in areas supplied by the compressed nerve root. Pain may radiate along the nerve whose root is compressed. If compression continues, the affected muscles may waste away. Walking may become difficult.

Diagnosis

Compression of the spinal cord by a tumor must be diagnosed and treated immediately to prevent permanent damage.

Doctors consider the possibility of a spinal cord tumor in people who have certain cancers in other parts of the body, who develop pain in a specific area of the spine, and who have certain patterns of weakness or tingling. Because the spinal cord is organized in a specific way, doctors can locate the tumor by determining which parts of the body are not functioning normally (see Figure: Where Is the Spinal Cord Damaged?).

Doctors must rule out other disorders that can affect the function of the spinal cord, such as a herniated disk, injuries, inflammation of the spinal cord, an inadequate blood supply to the spinal cord, or compression by a pocket of pus (abscess) or a blood clot .

Several procedures can help doctors diagnose a spinal cord tumor. Magnetic resonance imaging (MRI) is considered the best procedure for examining all the structures of the spinal cord and spine. When MRI is unavailable, myelography with computed tomography (CT) may be done instead. X-rays of the spine can show only changes in the bones, and many tumors do not affect the bone when they are in an early stage.

A biopsy is sometimes needed to diagnose the precise type of tumor, especially primary spinal cord tumors. However, a biopsy is not needed for spinal cord tumors that result from metastases if cancer has been diagnosed elsewhere in the body. Often, a biopsy requires surgery, but sometimes it can be done using a needle with CT or MRI to guide doctors as they place the needle in the tumor.

Treatment

If symptoms suggest that the tumor is compressing the spinal cord, corticosteroids (such as dexamethasone) are immediately given in high doses to reduce the swelling. Such tumors are treated as soon as possible, often surgically.

Many tumors of the spinal cord and spine can be removed surgically. If tumors cannot be removed, radiation therapy is used, sometimes after surgery has been done to relieve the pressure on the spinal cord.

Recovery generally depends on how quickly treatment begins and how much damage was done. Removal of meningiomas, neurofibromas, and some other primary spinal cord tumors may result in a cure. If a tumor has distinct borders and has not spread from elsewhere in the body, removing it causes symptoms to resolve in about half of people.

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