Spinal Tumor - Symptoms, Types, Causes, Surgery & Treatment

A spinal tumour is an abnormal growth that develops within or surrounding your spinal cord or canal. Spinal tumours can be located inside your spinal cord, in the tissues covering your spinal cord, between the tissues and bones of your spine, or in the vertebrae. A tumour that affects the spine’s vertebrae is also called a vertebral tumour. Spinal tumours can be classified as benign (non-cancerous) and malignant (cancerous). 

The tumour that develops on your spine or spinal cord is called a primary spinal tumour. On the other hand, a tumour that results from cancer spreading from another body part to the spine is called a secondary or metastatic tumour. Secondary spinal tumours are more common than primary spinal tumours. Prostate, lung, and breast cancer are the most common cancers that spread to the spine. 

1. Grade I: The cells look like normal brain cells that are least malignant and slow-growing. 
2. Grade II: These tumour cells are considered malignant and appear less normal under a microscope. The tumour in this stage grows slowly but has a high chance of spreading to the nearby tissue. 
3. Grade III: The tumour is malignant, grows quickly, and spreads into the nearby tissue. 
4. Grade IV: This tumour is the most malignant, with extremely abnormal cells. The cells grow and spread quickly to other areas of the brain.

Spinal tumours can be categorised in several ways. Based on the location of the tumour within the spinal cord, spinal tumours can be classified into:

1. Intradural-extramedullary Tumour: These tumours are located inside the dura (the thin covering of your spinal cord) but outside the actual spinal cord. Neurofibromas are more common in males. Spinal Meningiomas are commonly seen in females.
2. Intramedullary Tumour: These tumours grow inside the spinal cord. The most common is Glioma. Others are Ependymomas and vascular malformations.
3. Extradural Tumour: Also known as Epidural tumours, these form inside the spinal column, involving the bony vertebrae. These do not affect the spinal cord. The commonest is secondaries. Rare extradural tumours are sarcomas, osteoclastoma and chondroma.

Spinal tumours are also classified as benign and malignant. Some malignant spinal tumours include:

1. Osteosarcoma is a type of bone cancer that may originate in the spine. However, it is more common in shin bones and the thigh. 
2. Multiple myeloma affects plasma cells in the blood. These cells collect in the bone marrow and the bone’s outer layer in the spine. 
3. Chondrosarcoma arises from cartilage cells around the bone. The tumour is uncommon in the spine, but sometimes it can develop as primary cancer in the bones that form the spinal column. 
4. Chordoma is a bone tumour that can develop anywhere inside the spinal column. These are most commonly seen in the base of your spine (sacrum) and the tailbone (coccyx). 
5. A lymphoma is a group of cancers that affect the immune system’s cells, known as lymphocytes. It can form as a primary tumour in the spine, but it more commonly arises elsewhere in the body and spreads to the spine. 
6. Ewing sarcoma affects both the bone and its surrounding soft tissue. 
7. Metastatic Tumours from Prostate, Breast, Lung and Kidney

Benign spinal tumours can be divided into Epidural and Intradural tumours. 

Benign epidural tumours

1. Osteoid osteoma is a small bone tumour in children and younger adults. 
2. Osteoblastoma is similar to osteoid osteoma but larger and more aggressive. 
3. Osteochondroma is the bone and cartilage overgrowth that forms at the end of the bone near the growth plate. 
4. Hemangioma is a benign tumour made up of blood vessels inside the spinal column. These are commonly seen on an infant’s skin surface but can also affect internal organs. 

Benign intradural tumours

1. Meningioma commonly forms in the brain, but it can also affect the dura mater (one of the meninges that protect the brain and spinal cord). The tumour can grow large enough to be life-threatening. 
2. Astrocytoma is the most common malignant spinal cord tumour.
3. Ependymoma, a malignant tumour that develops in the lining of the spinal fluid passageway in your brain and spinal cord. 
4. Neurofibroma can develop on the nerves in your spinal column. 
5. Schwannoma is a tumour of the cells surrounding the nerve fibres of the spinal cord, cranial nerves, and peripheral nervous system. 
6. Hemangioblastoma arises from the blood vessels connected to the central nervous system, including your brain and the spinal cord. 

The symptoms of a spinal tumour can vary depending on its type and location. They may include:

1. Back pain and neck pain
2. Pain at the site of the tumour
3. Loss of sensation in arms or legs
4. Muscle weakness in arms or legs, often with paraplegia
5. Less sensation to pain, cold, and heat
6. Numbness or tingling
7. Muscle twitches or spasms
8. Loss of bowel or bladder control
9. Difficulty walking
10. Scoliosis (sideways curvature of the spine)
11. Kyphosis (an increase in the front-to-back curve of the upper spine)
12. Paralysis

The cause of spinal tumours depends on whether the tumour is primary or secondary. 

1. Primary spinal tumours: The cause of primary spinal tumours is not clear. These tumours can be caused by exposure to certain cancer-causing chemicals or substances. Some experts suspect that genetics play a role in developing these tumours. 
2. Secondary (metastatic) spinal tumours: Secondary spinal tumours are caused when cancer that developed in other parts of the body spreads to the spine. It develops when cells break away from the main tumour and enter your lymphatic system or bloodstream. These systems carry fluid around your body, moving cancer cells from one body region to another. 

Spinal tumours are more common in people who have the following conditions:

1. Neurofibromatosis 2: A hereditary condition in which benign tumours occur on the nerves related to balance and hearing. Some people with this condition can also develop spinal tumours. 
2. Von Hippel-Lindau Disease: A hereditary condition associated with blood vessel tumours (hemangioblastomas) in multiple organs, such as the brain, retina, and spinal cord.

While diagnosing spinal tumours, your doctor will ask you about your symptoms and medical history. They’ll conduct a neurological exam to check for tenderness in your spine, loss of sensation, muscle weakness, and abnormal reflexes. They may order several other tests, which include:

1. Imaging tests: The doctor will perform a spine MRI if you have back pain because metastatic tumours usually develop in the bony part of the spinal column. 
2. Biopsy: The doctor examines a small tissue sample under a microscope to determine the exact type of spinal tumour. The biopsy results help your provider determine treatment options. 
3. Bone scan: The doctor inserts a small amount of radioactive substance into the vein and uses imaging tests to look at the bones. The test helps detect abnormal areas in your spine. 
4. Blood tests:  The test is used to check for abnormal levels of substances in the blood, including protein, alkaline phosphatase and calcium. When the bone tissue breaks down, your body releases these substances into the bloodstream. 
5. Protein levels in Lumbar CSF is usually raised in the presence of Lumbar Tumours, commonly ‘Schwannomas’.

How to Prepare for Doctor Consultation?

While preparing for your doctor consultation, make sure to:

1. Take a prior appointment.
2. Note down your medical information, including your medical conditions and your medicines.
3. List down the symptoms you are experiencing.
4. Make a list of the questions for your doctor. 
5. Take a friend or family member along. 

Here’s what you can expect from your doctor during the consultation:

1. What symptoms are you experiencing?
2. When did you first begin to notice these symptoms?
3. Where does the pain seem to start?
4. Does it spread to other parts of the body?
5. Do you feel any numbness or weakness in your legs?
6. Have you engaged in any activities that may have caused the pain?
7. Do you have difficulty in walking?
8. Do you have problems with bladder or bowel control?
9. Is there any family history of benign or malignant spinal tumours?
10. Do you have any other medical conditions?
11. Which prescribed and over-the-counter medications are you taking?

Here’s what you can ask your doctor about spinal tumours:

1. What is the cause of my symptoms? 
2. What tests do I need to undergo?
3. Do I have a spinal tumour?
4. Which type of spinal tumour do I have?
5. How can I prevent its progression?
6. Is surgery necessary? What are the risks?
7. Can it be managed without surgery?
8. What treatment approach do you recommend?
9. What is the recovery time?

The goal of the spinal tumour treatment is to remove the tumour completely, but the treatment can be complicated by permanent damage to the spinal cord and surrounding tissues. The treatment approach also varies according to the type of tumour and whether it is a primary or metastatic tumour. The treatment for most spinal tumours includes:

1. Monitoring: Some tumours are discovered before they cause any symptoms while being evaluated for another condition. The doctor will use imaging tests to closely monitor cancer for symptoms of growth and spread. 
2. Chemotherapy: Chemotherapy uses medication that destroys cancer cells in your spine or stops them from growing. You may receive it through an injection into the vein or a pill. 
3. Radiation therapy: The therapy is used to destroy tumour cells or shrink the tumours. The doctor recommends radiation therapy when the tumours are inoperable, or the surgery is risky. Shrinking the tumour can reduce the pain and other symptoms. 
4. Cyberknife Radiosurgery: It is a non-invasive, non-surgical procedure that delivers high-dose radiation beams to treat a tumour while minimising damage to nearby tissues. The procedure is used to treat cancerous and non-cancerous tumours.
5. Surgery: Doctors consider surgery for people with metastatic spinal tumours when the tumour is resistant to chemotherapy or radiation. Surgery can help improve pain and other symptoms, stabilise your spine and preserve your neurological functions. Surgery options for spinal tumours may include: 
   1. Decompression: In this surgery, the entire tumour or a part of it is removed. It helps relieve pressure on the spinal cord, reducing pain and other symptoms. 
   2. Kyphoplasty and vertebroplasty: These are minimally invasive procedures in which bone cement is injected into the spine after removing the tumour. They help provide immediate fracture stabilisation, support your spine, improve mobility, and relieve pain. 
   3. Spine stabilisation: The procedure corrects spinal instability and deformity, involving bone graft and implantation of plates and screws.  

Please note that the selection of the treatment approach is based on your medical condition and your doctor’s opinion. 

Spinal tumours can sometimes compress spinal nerves, leading to:

1. Loss of movement and sensation below the region of the tumour
2. Changes in bowel and bladder function
3. Permanent nerve damage
4. If left untreated, a tumour that presses against the spinal cord can be life-threatening hence this is a surgical emergency.