Spinal tumours

What is a spinal tumour?

A spinal tumour is an abnormal growth of cells in or around your spinal cord or the bones of your spine. Most are secondary tumours, meaning they have spread there from cancer elsewhere in the body, rather than starting in the spine itself.

What are the symptoms of a spinal tumour?

No single symptom on its own points to a spinal tumour, but a combination of the following is worth discussing with your doctor:

• pain in or near the spine that isn't relieved by rest, or that's worse at night
• pain that spreads from your back into your arms, legs or chest
• numbness, tingling or weakness in one or both arms or legs
• increasing difficulty walking, or clumsiness
• loss of bladder or bowel control
• problems with sexual function

Where the tumour sits affects which symptoms you get. A tumour near the top of your spine is more likely to cause problems in your arms, while one lower down is more likely to affect your legs, bladder, bowel or sexual function.

What causes a spinal tumour and who is at risk?

Doctors don't fully understand what causes tumours to develop in the spine itself (called primary tumours), though research continues. Most spinal tumours are secondary, meaning cancer cells have spread there from elsewhere in the body, most often from lung, breast or prostate cancer.

Primary spinal tumours are rare, but you may be at slightly higher risk if you have:

• a genetic condition called neurofibromatosis, which is linked to some tumours of the nerves and their covering
• a rare inherited condition called von Hippel-Lindau disease, which is linked to tumours that form from blood vessels
• a weakened immune system, which raises the risk of a rare cancer called spinal cord lymphoma

Primary spinal tumours are most often diagnosed in adults aged 65 to 74, and in children aged 10 to 16.

Are there different types of spinal tumour?

Yes. Doctors classify spinal tumours in several ways:

• primary tumours, which start in the spine itself, or secondary (metastatic) tumours, which spread there from cancer elsewhere in the body; secondary tumours are far more common
• benign (non-cancerous) or malignant (cancerous)
• by where they sit: inside the spinal cord itself, in the covering (membrane) around it, between that covering and the bones of the spine, or in the bones (vertebrae) of the spine itself

Doctors may also describe a tumour as low-grade, meaning it grows slowly and is less likely to spread, or high-grade, meaning it grows more quickly and is more likely to spread to nearby tissue.

How is a spinal tumour diagnosed?

A firm diagnosis usually needs an MRI scan, which uses a magnetic field rather than X-rays to produce detailed pictures of your spine. Scanning your whole spine typically takes around 30 minutes, and you may be given a dye injection to help show up any abnormal areas more clearly.

Your doctor may also arrange:

• a CT scan, to look for tumours elsewhere in the body if a secondary tumour is suspected
• a neurological examination, checking your reflexes, strength and feeling in your arms and legs
• blood tests, to check your general health
• a biopsy, taking a small sample of the tumour to confirm what type it is

How is a spinal tumour treated?

Treatment depends on the type, size and position of the tumour, and on your general health. There are 4 main goals: reaching a diagnosis, relieving pressure on the spinal cord and nerves, keeping the spine stable, and controlling pain.

Non-surgical treatment

• radiotherapy, which uses high-energy X-rays to destroy tumour cells or shrink the tumour; this may be the main treatment for malignant tumours, or used after surgery to treat cells left behind
• chemotherapy, which is less commonly used for spinal tumours, mainly for cancers that started elsewhere and are known to respond well to it
• steroids, usually given during radiotherapy or around the time of surgery, to reduce swelling around the tumour and relieve pressure on the spinal cord and nerves
• painkillers, to manage back pain, which can sometimes be severe
• active monitoring with regular MRI scans, which may be suggested instead of immediate treatment for a small, slow-growing tumour that isn't causing problems

Surgical treatment

A specialist surgeon (neurosurgeon) removes as much of the tumour as possible, usually through an operation from the back of the spine called a laminectomy.

• benign tumours, and some malignant primary tumours, can often be removed completely, giving a good chance of a cure
• tumours inside the spinal cord itself, or those affecting the bones of the spine, are harder to remove completely
• if it isn't safe to remove the whole tumour, taking away even part of it can relieve pressure and improve your symptoms
• if the spine has been weakened, it may need extra support with an implant

When should I see a doctor?

See your doctor if you have back pain that isn't relieved by rest, that's worse at night, or that comes with any of the following:

• numbness, tingling or weakness spreading down an arm or leg
• increasing weakness or numbness in both legs
• new problems controlling your bladder or bowel
• a history of cancer, along with new or worsening back pain

These symptoms are more often caused by other, more common conditions, such as a slipped disc. But it's important to get them checked, especially if you've previously been diagnosed with cancer, so any serious cause can be found and treated early.