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Cancer of the spinal cord
Last reviewed: 23.04.2024
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Spinal cord cancer is a malignant neoplasm in the spinal cord that is in the spinal canal and is the organ of the central nervous system that provides innervation of internal organs and the performance of reflex actions.
The share of cancer of the spinal cord falls not more than five cases of thousands of oncological diagnoses. However, malignant tumors of this localization are characterized by the ability to rapidly progress.
Causes of Spinal Cord Cancer
In most clinical cases, the causes of spinal cord cancer are the spread of metastases from other affected organs: lung, thyroid, mammary glands, prostate, stomach, intestines. Such a cancer of the spinal cord is defined as secondary or metastatic. According to oncologists, most often this etiology is caused by cancer of the spinal cord, and in two thirds of cases metastasize to the spinal cord lymphomas and malignant tumors of the lungs and mammary glands.
The causes of cancer of the spinal cord, which arises from the degeneration of its cells (that is, the primary cancer), despite the existence of a variety of hypotheses, to date, remain unclear.
When malignant neoplasms are formed outside the dura mater, they are classified as extradural (extra-cerebral). Extracerebral cancers are mainly metastases of the primary oncological process in other places. When a cancerous tumor is formed from the connective tissue of the spine (bones, cartilage, ligaments, tendons), the sarcoma is diagnosed.
When tumors affect part of the dura mater of the spinal cord, they are called intradural. These include tumors of the actual cerebral membrane (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 prolonged growth can degenerate into cancerous.
If pathological proliferation and mutation of cells are observed inside the tissues of the spinal cord (under the envelope of white and gray matter), this leads to intramedullary neoplasms - gliomas (astrocytomas and ependymomas). According to medical statistics, almost 85% of similar neoplasias are not malignant. Astrocytomas are formed from astrocytes - spinal cord neuroglial cells. Oncology is considered to be the most malignant variety of astrocyte glioblastoma. Ependymomas occur when ependymocytes are affected - cells that line the walls of the spinal canal. The most dangerous tumor among ependymomas is ependoblastoma.
In addition, the formation of a tumor inside the hard shell of the spinal cord, but expanding beyond it, indicates extramedullary localization of the cancer.
Cancer of the spinal cord affects different cells, and on this basis oncology distinguishes the following types of the 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 associated with specific features of the tumor, its location and size. However, there are symptoms that are observed in the clinical picture of almost all types of this pathology, because they are explained by squeezing the spinal cord. These include: pain; sensation of cold and loss of sensation in the limbs; spasticity and weakness in muscles, weakening of tendon reflexes; impaired coordination of movement and difficulty walking; segmental disorders (paresis of limbs and paralysis of varying degrees); difficulties with urination or incontinence, inability to control the intestines (constipation).
Depending on the location of the tumor in one of the five parts of the spinal cord - the cervical, thoracic, lumbar, sacral and coccygeal - some of the most characteristic symptoms of spinal cord cancer appear.
Tumors arising in the spinal cord closer to the skull, can give paroxysmal pains in the occipital part of the head, numbness of the hands and atrophy of their muscles. It is also possible for involuntary eye movement (nystagmus).
When the cancer of the spinal cord is localized in the cervical region, spastic paresis of all limbs, accompanied by a loss of their sensitivity, hiccups, dyspnoea and difficulty in coughing or sneezing are often observed.
Almost half of the cases of spinal cord cancer are associated with the appearance of tumors in its thoracic region. Very often, such tumors lead to the appearance of pain, similar to pain in the gallbladder and pancreas with cholecystitis and pancreatitis. In this case, the upper limbs function normally.
In the presence of a cancerous tumor or metastases in the lumbosacral spinal cord, patients suffer from pain in the hip, weakness of the hip muscles, loss of the ability to flex-unbend legs in the knees, as well as involuntary urination and defecation.
If the cancer of the spinal cord affects the coccygeal region, the pain is felt in the entire posterior part of the trunk and is given to the buttocks and legs, which is often taken for radiculitis. In addition, with this localization of neoplasia, signs such as leg paresis and urinary retention are manifested.
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Diagnosis of spinal cord cancer
Diagnosis of spinal cord cancer is based on anamnesis, during a neurological examination of patients (assessment of the degree of functional disorders) and, of course, with the help of hardware studies. For example, X-rays with a contrast medium (myelography) are performed.
Today, the radiography of the spine has almost completely replaced computer tomography (CT) and magnetic resonance imaging (MRI), which can detect the tumor and accurately determine its location.
These modern diagnostic methods make it possible to differentiate cancer of the spinal cord and diseases such as myeloma, rupture of intervertebral discs, multiple sclerosis, etc.
In order to establish an accurate diagnosis, a biopsy with a histological examination of the samples of the affected tissues is required. Also, a study of cerebrospinal fluid - liquorodynamic tests with the help of a lumbar (spinal) puncture.
An additional diagnostic indicator of the malignancy of the spinal cord tumor is the analysis of cerebrospinal fluid in which an increased protein content (hyperalbuminosis) or non-typical for the composition of cerebrospinal atypical cells can be found.
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Treatment of spinal cord cancer
Treatment for cancer of the spinal cord includes chemotherapy, surgical removal of the tumor (laminectomy) and radiation therapy.
At the same time before the start of treatment - provided that the tumor causes compression of the spinal cord - the administration of steroid medications (corticosteroids) is prescribed. It does not affect the tumor itself, but, as a rule, it 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.
Chemotherapeutic effects in cancer of the spinal cord are aimed at slowing or stopping the division of cancer cells. Chemotherapy is used as a primary treatment for the destruction of cancer cells; to reduce neoplasm before subsequent treatment; after another treatment - to destroy the remaining cancer cells; to alleviate the symptoms of progressive cancer of the spinal cord.
Many tumors of the spinal cord can be removed surgically, while others need to be treated with radiation therapy. These methods of treatment can be combined. So, a combination of minimally invasive surgery, radiosurgery and chemotherapy can be adapted to a specific case of spinal cord cancer - primary or metastatic.
In modern oncology it is believed that patients with spinal cord compression in secondary cancer are best able to use direct surgical removal of compression (decompression) of the spinal cord in combination with subsequent radiation therapy.
However, many tumors can not be removed without significant damage to the spinal cord. Then only radiotherapy is used.
Thanks to the modern systems of radiosurgery (SRT), CyberKnife, Gamma Knife, TrueBeam STX, Novalis / X-knife, non-surgical removal of tumor cells is possible today. This high-tech equipment ensures absolute painlessness of the procedure (and no need for anesthesia), rapid treatment, high accuracy of tumor damage, safety for healthy tissues, and minimal rehabilitation period.
The only comment about the stereotaxic radiation treatment of spinal cord cancer: usually SRT is used to treat small and clearly localized tumors, or in case of a relapse of malignant growth after chemotherapy.
Prophylaxis of spinal cord cancer
To date, neither ways to prevent the emergence of this pathology, nor any system of measures that would allow for the prevention of cancer of the spinal cord, does not exist. For the pathogenesis of malignant neoplasms has not been identified for certain.
Prognosis for spinal cord cancer
The prognosis of cancer of the spinal cord depends on many factors and, first of all, on the nature of the tumor and its scale. And also on the success of treatment. Oncologists do not hide the fact that no one is going to assume the long-term results of any treatment for the cancer of the spinal cord ...
How many live with cancer of the spinal cord? On this question, no doctor, perhaps, will not answer you and does not guarantee a 100% recovery. Although the use of radiotherapy (CyberKnife) is very effective in treating cancer of the spinal cord.