A metastatic spinal tumour is when cancer in another location of the body spreads to the spine.
This is a common variety of spinal tumour and it usually affects the thoracic spine the most often. More than 30% of patients with cancers in other locations will metastasise to the spine.
There are more common subtypes of cancers that spread to the spine.
This includes cancers from:
Other less common types include:
The presentation of symptoms depends on few factors which include:
Commonly the symptoms include:
The typical pain symptoms are constant and unrelated to activity. Although movement may aggravate pain symptoms further.
The first step is to complete a comprehensive neurological and physical examination. This includes a detailed review of the patient’s medical and family history.
The confirmatory diagnosis comes from performing an MRI scan. It may be necessary to perform a CT scan to understand the extent of bony involvement or destruction if any. A biopsy may also be advised to confirm the specific cancer type. The following are the two categories of biopsies:
• Surgical Biopsy
• Needle Biopsy
The treatment of metastatic spinal tumours is usually multidisciplinary. The team at Neuroaxis works closely with oncologists to assist the decision-making process around treatment. Together they will offer the best possible surgical therapy option to achieve the goals of surgical treatment with reduced morbidity. Using keyhole surgery techniques hastens recovery and reduces postoperative complications. The goals of surgery in the setting of a metastatic spinal tumour range from:
The following are the risk factors associated with metastatic spinal tumours:
Types of tumours that are expected to spread to the spine include those of the lung, breast, multiple myeloma, and prostate.
People who have weak immune systems tend to develop spinal cord lymphomas.
The following congenital disorders are sometimes associated with spinal cord tumours:
Exposure to industrial chemicals or radiation may increase the chance of developing a spinal tumour.
Complications related to spinal tumours can be divided into the following two categories:
Complications related to the tumour, its metastases, or its recurrence
Neurologic problems including focal weakness or radicular pain from impingement on a nerve root and incomplete or complete paraplegia from spinal cord compression
Complications associated with chemotherapy, radiation, or surgical management of the spinal tumours
Complications that result from the treatment options performed on the patient may be linked to the body structures sacrificed during the surgical resection process to attain clear margins, structures in the path of radiation therapy, or the systemic effects of chemotherapy .
Some of the other complications, that can arise out of the disease include:
Apart from radiation exposure, there are no environmental or lifestyle-related causes yet known of spinal metastatic tumours. There are currently no known ways for prevention against most of such tumours.
Imaging tests like CT scans or X-rays generate much lower levels of radiation than the ones generated for cancer treatment. Early detection through these tests with fewer radiation is better than more radiation used later during the treatment.
A pilot study is currently underway to understand the clinical significance and initial dosimetric evaluation of stereotactic boost for malignant epidural spinal cord compression. The main objective of the clinical study is to determine if stereotactic body radiation therapy (SBRT) is a viable choice. This is in addition to standard 3D conformal radiotherapy (3DCRT) for metastatic epidural spinal cord compression (MESCC) patients. The study aims to consider future randomised trials if the outcome is positive.
Another clinical study is being conducted to assess clinical outcomes of surgical management for symptomatic metastatic spinal cord compression from prostate cancer. Reconstruction and decompression surgery for symptomatic metastatic spinal cord compression (MSCC) from prostate cancer (PC) might contribute to a favourable functional outcome among men with mHNPC and mCRPC. However, its role in enhancing the oncological outcome is still unclear. The treatment strategy should be shared among patients, radiation oncologists, urologists, and orthopedic surgeons.
The major differential diagnoses for spinal metastatic tumour include the following:
Sometimes, patients may be cured using surgery alone, if the whole tumour can be removed. This is not possible in all scenarios. Getting completely cured also sometimes depends on the type of tumour.
The MRI scan is the best way to diagnose any tumour growth. It generally shows the exact location of the tumour, how much it has grown or spread into or near the spinal column. It also outlines if the pain is due to some other condition such as arthritis.