Spinal cord cancer

Spinal cord cancer is a malignant neoplasm in the spinal cord, which is located in the spinal canal and is an organ of the central nervous system that provides innervation to internal organs and the performance of reflex actions.

Spinal cord cancer accounts for no more than five cases out of a thousand oncological diagnoses. However, malignant tumors of this localization are characterized by the ability to progress rapidly.

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Causes of spinal cord cancer

In most clinical cases, the causes of spinal cord cancer are the spread of metastases from other affected organs: lungs, thyroid gland, mammary glands, prostate, stomach, intestines. Such spinal cord cancer is defined as secondary or metastatic. According to oncologists, this is the etiology that most often causes cancers of the spinal cord, and in two-thirds of cases, lymphomas and malignant tumors of the lungs and mammary glands metastasize to the spinal cord.

The causes of spinal cord cancer, which occurs due to the degeneration of its cells (i.e. primary cancer), despite the existence of many hypotheses, remain unclear to this day.

When malignant neoplasias form outside the dura mater, they are classified as extradural (extracerebral). Extracerebral cancers are mostly metastases of the primary cancer process elsewhere. When such a cancerous tumor forms from the connective tissue of the spine (bones, cartilage, ligaments, tendons), it is diagnosed as sarcoma.

When tumors affect part of the dura mater of the spinal cord, they are called intradural. These include tumors of the dura mater itself (meningiomas), as well as tumors growing from the nerve roots of the spinal cord (neurofibromas). In most cases, they are benign, but in the process of long-term growth they can degenerate into cancer.

If pathological proliferation and mutation of cells are observed inside the spinal cord tissues (located under the membrane of white and gray matter), this leads to intramedullary neoplasms - gliomas (astrocytomas and ependymomas). According to medical statistics, almost 85% of such neoplasms are not malignant. Astrocytomas are formed from astrocytes - neuroglial cells of the spinal cord. Oncologists consider glioblastoma to be the most malignant type of astrocytomas. Ependymomas occur when ependymocytes are damaged - cells that line the walls of the spinal canal. Ependioblastoma is considered the most dangerous tumor among ependymomas.

In addition, the formation of a tumor within the dura mater of the spinal cord, but growing beyond its boundaries, indicates an extramedullary localization of cancer.

Spinal cord cancer affects various cells, and based on this, oncology distinguishes the following types of this disease: chondrosarcoma, chordoma, neurogenic sarcoma (neurofibrosarcoma or malignant schwannoma), osteogenic sarcoma (osteosarcoma), Ewing's sarcoma, malignant meningioma, meningeal fibrosarcoma, myosarcoma.

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Symptoms of spinal cord cancer

Specific symptoms of spinal cord cancer are related to the type of tumor, its location and size. However, there are symptoms that are observed in the clinical picture of almost all types of this pathology, as they are explained by compression of the spinal cord. These include: pain; a feeling of cold and loss of sensitivity in the limbs; spasticity and weakness in the muscles, weakening of tendon reflexes; impaired coordination of movements and difficulty walking; segmental disorders (paresis of the limbs and paralysis of varying degrees); difficulty urinating or incontinence, inability to control the intestines (constipation).

Depending on the location of the tumor in one of the five sections of the spinal cord - cervical, thoracic, lumbar, sacral and coccygeal - certain of the most characteristic symptoms of spinal cord cancer appear.

Tumors that develop in the spinal cord closer to the skull can cause paroxysmal pain in the back of the head, numbness in the arms, and atrophy of their muscles. Involuntary eye movement (nystagmus) is also possible.

When spinal cord cancer is localized in the cervical region, spastic paresis of all limbs is often observed, accompanied by loss of sensitivity, as well as hiccups, shortness of breath, and difficulty coughing or sneezing.

Almost half of spinal cord cancer cases are associated with the development of tumors in the thoracic region. Very often, such tumors lead to pain similar to pain in the gallbladder and pancreas during cholecystitis and pancreatitis. At the same time, the upper limbs function normally.

In the presence of a cancerous tumor or metastases in the lumbosacral region of the spinal cord, patients are plagued by pain in the hip joints, weakness of the thigh muscles, loss of the ability to bend and straighten the legs at the knees, as well as involuntary urination and defecation.

If spinal cord cancer affects the coccygeal region, then pain is felt throughout the entire back of the body and radiates to the buttocks and legs, which is often mistaken for radiculitis. In addition, with this localization of neoplasia, such symptoms as leg paresis and urinary retention appear.

Diagnosis of spinal cord cancer

Diagnosis of spinal cord cancer is made on the basis of anamnesis, during neurological examination of patients (assessment of the degree of functional impairment) and, of course, with the help of hardware studies. For example, radiography with a contrast agent (myelography) is performed.

Today, spinal radiography has been almost completely replaced by computed tomography (CT) and magnetic resonance imaging (MRI), which allow us to detect a tumor and accurately determine its location.

These modern diagnostic methods make it possible to differentiate spinal cord cancer from diseases such as myeloma, ruptured intervertebral discs, multiple sclerosis, etc.

In order to establish an accurate diagnosis, a biopsy with histological examination of the samples of affected tissues is mandatory. A study of the cerebrospinal fluid is also carried out - liquorodynamic tests using a lumbar (spinal) puncture.

An additional diagnostic indicator of the malignancy of a spinal cord tumor is an analysis of the cerebrospinal fluid, which may reveal an increased protein content (hyperalbuminosis) or atypical cells that are not typical for the composition of the cerebrospinal fluid.

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Treatment of spinal cord cancer

Treatment for spinal cord cancer includes chemotherapy, surgical removal of the tumor (laminectomy), and radiation therapy.

In this case, before the start of treatment - provided that the tumor causes compression of the spinal cord - the administration of steroid drugs (corticosteroids) is prescribed. This does not affect the tumor itself, but, as a rule, reduces the inflammatory reaction around it, reduces the degree of pressure on the brain and helps to partially preserve the neurological functions of the spinal cord.

Chemotherapy for spinal cord cancer is used to slow or stop the division of cancer cells. Chemotherapy is used as a primary treatment to kill cancer cells; to shrink the tumor before subsequent treatment; after another treatment to kill any remaining cancer cells; to relieve symptoms of advanced spinal cord cancer.

Many spinal cord tumors can be removed surgically, while others require radiation therapy. These treatments can be combined. Thus, a combination of minimally invasive surgery, radiosurgery, and chemotherapy can be tailored to a specific case of spinal cord cancer – primary or metastatic.

In modern oncology, it is believed that patients with spinal cord compression due to secondary cancer are best treated with direct surgical removal of compression (decompression) of the spinal cord in combination with subsequent radiation therapy.

However, many tumors cannot be removed without causing significant damage to the spinal cord. In these cases, radiation therapy is the only option.

Thanks to modern radiosurgery systems (stereotactic radiation therapy, SRT) - CyberKnife, Gamma Knife, TrueBeam STX, Novalis/X-knife - non-surgical removal of tumor cells is now possible. This high-tech equipment ensures the absolute painlessness of the procedure (and no need for anesthesia), speed of treatment, high accuracy of tumor damage, safety for healthy tissues, and a minimal rehabilitation period.

The only caveat regarding stereotactic radiotherapy for spinal cord cancer is that SRT is typically used to treat small, well-localized tumors or in cases of recurrence of malignant growth after chemotherapy.

Prevention of spinal cord cancer

To date, there are no methods to prevent the occurrence of this pathology, nor any system of measures that would allow for the prevention of spinal cord cancer. Because the pathogenesis of malignant neoplasms has not been reliably identified.

Prognosis for spinal cord cancer

The prognosis for spinal cord cancer depends on many factors, primarily on the nature of the tumor and its size. And also on the success of the treatment. Oncologists do not hide the fact that no one undertakes to predict the long-term results of any treatment for spinal cord cancer…

How long do people live with spinal cord cancer? No doctor will probably answer this question for you or guarantee a 100% recovery. Although the use of radiotherapy (CyberKnife) is very effective in the treatment of spinal cord cancer.