Spinal Tumors: Definitions, Causes, Symptoms, Diagnosis, Treatment, and Prognosis

Spinal tumors are abnormal growths of cells that occur within or near the spinal cord or the bones of the spine (vertebrae). These tumors can be either benign (non-cancerous) or malignant (cancerous). They can be caused by abnormal growth of tissue in the spine or spread from other parts of the body (metastases). Spinal tumors can affect people of any age, but they are more common in older people. They can cause a variety of symptoms, depending on their location and size, including pain, numbness, weakness, and difficulty with bowel or bladder control. Treatment options for spinal tumors may include surgery, radiation therapy, and chemotherapy.

What are Spinal Tumors?

Spinal tumors are abnormal growths of tissue that occur in or around the spinal cord or the bones of the spine. They can be benign (non-cancerous) or malignant (cancerous). They can be caused by abnormal growth of tissue in the spine or spread from other parts of the body (metastases).

Types of Tumors

There are several different types of spinal tumors that can occur in or around the spine.

Benign (non-cancerous)

Benign tumors of the spine are abnormal growths of tissue that are not cancerous and do not spread to other parts of the body. Some common types of benign tumors that can affect the spine include:

1. Meningiomas: These grow from the membranes that cover the brain and spinal cord. They are the most common type of spinal tumor.
2. Schwannomas: These grow from the cells (Schwann cells)  that make up the protective sheath around nerve fibers. They can occur anywhere along the spine, but are most common in the neck.
3. Ependymoma: These arise from the ependymal cells, which are cells that line the the central canal of the spinal cord. Ependymomas can occur anywhere along the spine, but they are more common in the lower part of the spine (the lumbar region).
4. Vertebral hemangiomas: These occur in the bones of the spine. They are made up of abnormal blood vessels and are often slow-growing.

Malignant (cancerous)

Malignant cancers of the spine are tumors that are cancerous and can spread to other parts of the body. Some common types of malignant cancers that can affect the spine include:

1. Osteosarcomas: These are cancerous tumors that occur in the bones of the spine. They are aggressive and can spread to other parts of the body.
2. Chordomas: These are rare, slow-growing tumors that occur in the bones of the spine. They can be benign or malignant, but when they are malignant, they are aggressive and can spread to other parts of the body.
3. Ewing’s sarcomas: These are a rare type of cancer that occurs in the bones and the soft tissue around the bones. It is most commonly found in the long bones of the arms and legs, but it can also occur in the bones of the spine.
4. Metastases: These are tumors that have spread from other parts of the body to the spine. Common types of cancer that can spread to the spine include breast, lung, prostate, and kidney cancer.

Primary vs Metastatic

Malignant tumors can be further classified as primary or metastatic. Primary cancers of the spine are tumors that originate in the spine itself, while metastatic cancers of the spine are tumors that have spread to the spine from other parts of the body. 

It is estimated that up to 70% of patients with cancer will have metastases to their spine

Common types of cancer that can spread to the spine include breast, lung, prostate, and kidney cancer.

Causes of Spinal Tumors

A tumor is an abnormal growth of cells. Tumors can develop when normal cells in the body undergo changes that cause them to grow and divide in an uncontrolled way. 

The exact cause of a tumor is not always known, and can vary depending on the type of tumor.

There are a variety of potential causes and risk factors for tumors, including:

1. Exposure to certain substances: This can include exposure to tobacco smoke, radiation, certain chemicals, and certain infections.
2. Family history of cancer: Some inherited genetic mutations can increase the risk of developing certain types of cancer.
3. Certain inherited genetic conditions: Some inherited genetic conditions, such as inherited cancer syndromes, can increase the risk of developing certain types of cancer.
4. Age: The risk of developing a tumor increases with age.
5. Gender: Certain types of cancer are more common in males or females.
6. Lifestyle factors: This can include diet, physical activity level, and other behaviors that may increase the risk of cancer.
7. Certain medical conditions: Some medical conditions, such as certain immune disorders, can increase the risk of developing cancer.

It is important to note that having one or more of these risk factors does not necessarily mean that a person will develop a tumor. Many people with risk factors never develop cancer, while others who do not have any known risk factors may develop cancer.

Incidence of Spinal Tumors

Spinal tumors are relatively rare, accounting for less than 1% of all cancers. According to the American Cancer Society, the annual incidence (new cases) of cancer in the spine is about 2.9 cases per 100,000 people in the United States.

Spinal tumors can be benign (non-cancerous) or malignant (cancerous), and the incidence of each type can vary. Benign tumors are more common, accounting for about 50-60% of all spinal tumors. The most common types of malignant spinal tumors are metastatic tumors, which occur when cancer cells from another part of the body spread (metastasize) to the spine.

Symptoms of Spinal Tumors

Symptoms of spinal tumors may depend on the location and type of the tumor, as well as the size of the tumor and whether it is pressing on nerves or other structures. Some common symptoms of spinal tumors may include:

• Neck or back pain
• Numbness or tingling in arms or legs
• Weakness in arms or legs
• Bowel or bladder problems
• Weight loss
• Fatigue

Diagnoses of Spinal Tumors

Spinal tumors can be diagnosed through a variety of tests, which may include:

1. Physical examination: The doctor will check for signs and symptoms of a spinal tumor, such as back pain, weakness or numbness in the legs, changes in sensory perception, and reflexes.
2. Imaging tests: These may include X-rays, CT scans, MRI scans, and PET scans. These tests create detailed pictures of the spine, which can help the doctor see the location and size of the tumor. MRI is often considered the imaging modality of choice. 
3. Biopsy: A biopsy is a procedure in which a small sample of tissue is removed from the tumor and examined under a microscope. This can help the doctor determine the type of tumor and whether it is benign or malignant.
4. Blood tests: The doctor may order blood tests to check for certain markers that may be present in people with certain types of cancer.

Treatment of Spinal Tumors

Treatment for spinal tumors depends on the type and location of the tumor, as well as the patient’s overall health and symptoms. Some common treatment options for spinal tumors include:

1. Surgery: Surgery is often the first line of treatment for spinal tumors. The goal of surgery is to remove as much of the tumor as possible while preserving as much normal function as possible. The specific type of surgery will depend on the location and size of the tumor.
2. Radiation therapy: Radiation therapy uses high-energy beams to kill cancer cells. It may be used alone or in combination with surgery or chemotherapy.
3. Chemotherapy: Chemotherapy uses drugs to kill cancer cells. It may be used alone or in combination with surgery or radiation therapy.
4. Supportive care: This may include medications to manage pain, physical therapy to help maintain or improve mobility and strength, and other supportive measures to help the patient manage their symptoms.

The specific treatment plan for a spinal tumor will depend on the type and location of the tumor, as well as the patient’s overall health and symptoms. It is important to work closely with a medical team to determine the best treatment plan for the individual patient.

Prognosis for Spinal Tumors

The prognosis for spinal tumors depends on a number of factors, including the location of the tumor, the size of the tumor, the type of tumor (whether it is benign or malignant), and the overall health of the patient.

 In general, the prognosis is better for patients with benign tumors and those who are in good health. However, even with benign tumors, the location of the tumor can affect the prognosis. For example, if a tumor is located in the spinal cord, it can cause significant neurological symptoms and may be more difficult to treat.

The prognosis for a malignant spinal tumor depends on the specific type of cancer and how advanced it is at the time of diagnosis. In general, the prognosis is better for malignant tumors that are caught early and can be completely removed through surgery. However, even with treatment, some malignant tumors may come back (recur) or spread (metastasize) to other parts of the body.

It is important to note that the prognosis for spinal tumors can vary widely from person to person and it is not possible to predict the outcome for an individual patient with certainty. It is important for patients to work closely with their healthcare team to determine the best course of treatment and to receive ongoing care and support throughout the treatment process.

Sources

Ciftdemir, Mert et al. “Tumors of the spine.” World journal of orthopedics vol. 7,2 109-16. 18 Feb. 2016, doi:10.5312/wjo.v7.i2.109

Sundaresan, Narayan et al. “Primary malignant tumors of the spine.” The Orthopedic clinics of North America vol. 40,1 (2009): 21-36, v. doi:10.1016/j.ocl.2008.10.004