Spinal Metastatic Disease

Most tumors that affect the vertebrae have spread, or metastasized, to the spine from another area of the body. According to the journal "Oncologist", between 5 and 10 percent of all cancer patients develop spinal metastases during the course of their disease. The American Cancer Society (ACS) says the spine is the most prevalent site of bone metastasis. The Mayo Clinic says even noncancerous (benign) growths that develops within or near the spinal cord or in the bones of the spine can cause serious problems. The first sign of spinal metastatic disease is often back pain.

Significance

• The ACS says when a primary (from another part of the body) cancer travels to the bone, it can weaken the bones and may cause them to fracture or break. Spinal metastatic disease can hamper your ability to maintain your regular activities and lifestyle.

  If tumors growing in the bones of the spine (vertebrae) become large, they may press on or dislodge the adjacent spinal cord .

  Since calcium is released when cancer cells harm the bone, problems related to high blood calcium levels (hypercalcemia) can develop. Problems associated with hypercalcemia may include osteoporosis and abnormal heart rhythm (arrhythmia).

Symptoms

• The most common symptom of spinal metastatic disease is back pain. The pain may intensify at night or in the morning. Sometimes, the pain extends to the hips, legs, feet or arms. As a cancerous tumor expands, it becomes compressed on the spinal cord or on the nerve roots, blood vessels or spinal bones. A person with spinal metastatic disease may find he has trouble walking, which can lead to falls. He may lose control of his bladder or bowel and notice a diminished sensitivity to heat, cold and pain.

Diagnosis

• A doctor has a few options to identify spinal metastatic disease. A spinal magnetic resonance imaging (MRI) uses a powerful magnet and radio waves to produce a defined image of the spinal cord and nerves. A computerized tomography (CT) uses a narrow beam of radiation to generate specific cross-sectional images of the spine. The only way to be certain that a tumor is cancerous, however, is to study a small tissue sample under a microscope. This is called a biopsy. A doctor may use a thin needle to extract a trace of tissue, or tissue may be removed during a surgical procedure.

Treatment

• Radiotherapy is fundamental in the treatment of spinal metastatic disease. The ACS says external beam radiation (x-rays directed from an external machine) may help ease the pain associated with spinal metastases by destroying cancer cells.

  Surgery may be an option when spinal tumors are pressing on the spinal cord and can be removed without causing an unacceptable amount of nerve damage.The procedure involves removing the affected vertebra.

  Since both surgery and radiation can cause inflammation inside the spinal cord, your doctor may prescribe corticosteroids to minimize swelling.

  Chemotherapy has not demonstrated its effectiveness for the majority of spinal tumors.

Prognosis

• The National Cancer Institute (NCI) says the mean survival time following diagnosis of spinal metastasis is just over two years.

  The National Institutes of Health (NIH) says the prognosis of spinal metastatic disease will vary depending on the size of the tumor depending on the tumor. The outcome is usually better when diagnosed early.

  Although spinal metastatic disease commonly results in permanent disability (nerve damage even following surgery) radiation may delay major discomfort and prolong life.

  Physical therapy may help improve muscle strength and the ability to function.