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Prognosis of Lumbar Metastatic Disease

Five percent of cancer patients have tumorous growths in or near the spine, of which 60 percent occur in the thoracic region of the spine and 20 percent occur in the cervical lumbar region. While back pain is typically associated with age, stress, back injury or strain, it is also symptomatic of central nervous system metastasis. Left undiagnosed and untreated, tumor growth can be life threatening, can cause neurological complications and possible paralysis.

  1. Metastasis

    • When cancer initially develops in the body, the site is referred to as a primary tumor. Cancerous cells may break away from the primary tumor and travel through the body's bloodstream (arteries and veins), lymph system or spinal fluid, where eventually a secondary tumor develops. This secondary tumor is referred to as metastasis. Spinal tumors are typically metastatic and not primary tumors. Sometimes doctors are unable to determine the primary tumor for metastatic spinal tumor patients, lowering their prognosis (chance of surviving). But for most of these patients, primary tumors are in the breast, prostate or multiple myeloma.

    Metastasis of the Central Nervous System

    • Metastatic spinal tumors are one of three central nervous system (CNS) metastases. These tumors usually grow outside of the dura mater, which acts as the protective covering of the brain and spinal cord. As the tumor grows, pressure (compression) is placed on the spinal cord and nerves, which could eventually be life threatening or lead to permanent paralysis. Of all CNS patients, about one third of them are not clinically diagnosed with having cancer and are only tipped off to the fact that something is wrong when CNS produced symptoms become pronounced.

    Symptoms

    • Generally, symptoms of metastatic spinal tumors tend to be pain directly over the metastasis, or along the nerve. Oftentimes, the pain will come before any other symptoms. Standing, handling heavy objects, or moving can worsen the pain. Initially, bed rest may alleviate some of the pain. But as the cancer progresses, muscles will progressively weaken and loss of sensation, bladder or bowel control will occur.

    Diagnosis

    • Doctors look at a patient's medical history; perform a neurological exam, and do a battery of tests during the initial CNS metastasis diagnosis. These tests include: taking X-rays; possibly testing a patient's blood and taking stool and urine samples; spinal fluid tests and possibly contrast-enhanced CT and MRI scans. Because various conditions can imitate CNS symptoms, it is important that the diagnosis be done accurately, as that will determine the prognosis and treatment for the patient.

    Prognosis and Treatment

    • The stage of the cancer and whether or not it's curable will determine the type of treatment recommended. The number of tumors, their location and accessibility for surgery, the type of primary cancer and whether it is under control, the chances of new metastatic cancers forming, metastases responsiveness and a patient's overall general health also help determine the course of treatment. Usually, radiation therapy is done with metastatic spinal tumors, followed by systemic chemotherapy. Surgery may be advised for some patients. Depending on the primary cancer site, hormone therapy may also be performed.

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