Spinal Tumors | Treatment and Management

Spinal tumors can be scary, but having an understanding of the various treatment options available can help patients feel more in control. 

“What is the Treatment and Management for Spinal Tumors?”, is an important question for those diagnosed with these abnormal growths in or near their spine. Treatment is highly individualized and depends on many factors. The good news is that management strategies and care teams exist to help relieve pain, maintain stability, and improve quality of life.

Types of Spinal Tumors

Spinal tumors can occur in several locations along the vertebrae and spinal column. They also vary in origin – some start in the spine while others result from cancer spreading from elsewhere in the body.

Locations

Understanding tumor location is key for treatment. Areas affected include:

Cervical

The cervical section of the spine starts in the neck. Tumors here can impinge shoulders, arms and vital structures. Fortunately, surgery is often possible given anatomy.

Thoracic

The mid back or thoracic spine houses important nerves, so tumors can cause notable symptoms. Still, radiation and cement injections help stabilization.

Lumbar

Spinal tumors affecting the lower lumbar spine near the pelvis are complicated by effects on mobility and stability. Goals involve pain relief and strength preservation.

Sacral

The base of the spine in the sacral region has a complex anatomy, making tumor elimination difficult. Treatments aim to preserve bowel/bladder function.

Origins

Additionally, specialists categorize spinal tumors based on where they originated.

Primary

Rare primary spinal tumors comprise abnormal masses growing initially from cells inside the spinal column itself. Types range from largely harmless growths to cancers requiring coordinated intervention. Benign nerve sheath tumors may only need monitoring if asymptomatic. All cases warrant customized care based on factors like tumor type, location, and staging.

Malignant primary cancers like chordomas, chondrosarcomas or osteosarcomas necessitate aggressive, integrated treatment plans to extend life while maintaining function. These complex spinal cord cancers require care coordination to manage disease through methods like surgery, radiation, chemotherapy or precision medicine approaches.

Secondary/Metastatic

Metastatic spinal tumors are unfortunately more common than primary tumors of the spine. These occur when cancer that started elsewhere, often in the breast, prostate, or lungs, travels through the bloodstream and gets deposited in the spine. 

Symptoms and Diagnosis

Early spinal tumor detection improves treatment success. These tumors often cause only mild symptoms initially. Subtle changes should prompt imaging tests before extensive damage emerges. Catching small spinal tumors early optimizes outcomes.

Symptoms

Back pain – unusual, unexplained back pain worsening at night warrants attention, especially with cancer history. While pain has many causes, persistent or worsening symptoms justify spinal tumor testing.

Radicular pain – Sharp, shooting nerve pain radiating to the hips, legs or arms can signal spinal lesions impinging nerves as they exit the spinal column. Quick evaluation is prudent.

Numbness/tingling – Tumor masses pressing on nerves and tissue also cause decreased or absent sensation in limbs along with tingling. Take new numbness seriously by scheduling scans.

Muscle weakness – Nerve damage from spinal tumors interrupts vital communication between brain and muscles. Sudden difficulty moving or controlling legs or arms warrants prompt medical review.

Bladder/bowel issues – Tumors in the lumbar or sacral spine can especially impede nerves controlling critical pelvic functions. New incontinence or retention needs rapid response.

Diagnostic Tests

Since spinal tumor symptoms can mimic other conditions, doctors use imaging tests and laboratory tools to confirm the presence, type, and extent of abnormal growths.

Imaging: Basic X-rays assess spinal alignment and bone integrity but provide limited information about tumors. CT scans and MRIs better characterize tumor location, size, and effects on surrounding soft tissue and nerves. Serial imaging is used to monitor treatment effectiveness over time.

Biopsy: Examining tumor tissue sampled via needle biopsy or surgical excision allows microscopic characterization of cancer type and aggressiveness. Further genetic and hormonal testing guides treatment selection.

Blood tests: Laboratory work can analyze spinal tumor effects through markers such as proteins released during bone breakdown. Testing also screens for contributing conditions like anemia, clotting disorders, or infection.

Treatment and Management

Once key details are known about a spinal tumor, including its location, type, and stage, custom treatment plans are created to suit each patient while balancing their goals and quality of life impacts.

Goals of Treatment

When facing spinal cancer, doctors want to help patients achieve several core goals:

• Relieving pain
• Preserving or improving spinal stability and neural function
• Increasing patient safety, comfort and independence
• Maximizing longevity and quality of life

Types of Treatments

Prescribed interventions depend on tumor specifics like location, metastases risk and nerves affected.

Surgery

Tumor removal – Surgical removal of bone tumors aims to extract the entire tumor mass along with surrounding healthy tissue to ensure clean margins, which lessens the risk of recurrence. If the tumor cannot be fully removed, more invasive techniques may be used to disrupt the tumor’s blood supply and restrict further growth. Reconstruction to provide structural stability typically follows tumor removal procedures.

Spinal reconstruction – When vertebrae are damaged by tumors or surgery, rebuilding spine stability helps protect nerve function. Techniques include using bone grafts, spinal cages with bone graft material, or cement to enable fusion. Rods, screws and plates also help realign and stabilize the spine while fusion occurs. New expandable titanium rod systems allow noninvasive adjustments during recovery to optimize alignment as the patient heals.

Radiation Therapy

External beam: Advanced external beam radiation techniques such as conformal radiation therapy and stereotactic radiosurgery allow high doses of radiation to be precisely delivered to the tumor while minimizing exposure of surrounding healthy tissues including the spinal cord.

Stereotactic radiosurgery: The CyberKnife system uses a robotic arm to deliver highly focused beams of radiation to treat small or hard-to-reach spinal tumors noninvasively, without surgery. Tumor motion tracking allows the radiation beams to be continuously adjusted during treatment to target the tumor from the optimal angles while the patient breathes normally.

Proton therapy: Rather than using standard radiation, proton beam therapy takes advantage of the unique dose distribution of proton beams, which can peak at the site of spinal tumors before stopping. This reduces radiation exposure beyond the tumor site, potentially lowering side effects compared to standard radiation.

Chemotherapy and Other Drug Therapies

Chemotherapy: Systemic chemotherapy medicines are used to treat certain spinal tumors, frequently shrinking tumors before surgery or reducing the likelihood of metastasis after other treatments.

Targeted therapies: Newer targeted cancer drugs are designed to selectively identify and attack tumors based on specific genetic traits. While precision medicine approaches for spinal tumors remain limited at this time, targeted therapies represent an area of active research for pharmaceutical developers.

Tumor embolization: Occluding the blood supply to vascular spinal lesions via injected agents can reduce surgical blood loss risks.

Radiofrequency ablation: Radiofrequency thermal ablation uses electrode needles to heat and destroy large, inoperable spinal tumors. Strict temperature and device controls help prevent damage to delicate nerves.

Vertebroplasty/kyphoplasty: After tumor removal, injectable bone cement can be used to fortify vertebral bodies through vertebroplasty or kyphoplasty, providing rapid pain relief and renewed mechanical strength.

Outlook and Prognosis

Although spinal tumors are complex conditions, outcomes and quality of life for those diagnosed have improved in recent decades thanks to multidisciplinary care teams. Cautious optimism is warranted, as steady research advances have led to new and enhanced therapies for spinal tumors, providing more options for patients through clinical trials. However, open communication with your medical team is key to ensuring you fully understand your diagnosis, latest treatment options, and optimal courses of action for your individual case. While spinal tumors remain challenging to treat, the ongoing progress in research and cross-disciplinary collaboration has resulted in important advances, enabling better management and improved results compared to the past.