Metastatic Spinal Epidural Disease

In patients with cancer, approximately 40 percent have metastatic spinal epidural disease. This is a condition in which the spinal cord is compressed and there is potential neurological involvement. Although this does not happen in all cases of cancer, there is significant risk when the cancer has metastasized to other parts of the body. It is estimated that about 50 to 75 percent of patients that have cancer have some form of metastasization at the time of their death.

About

• Metastatic spinal epidural disease is a condition in which the spinal cord is being compressed by cancerous growths. According to Paul Klimo, Jr., M.D., M.P.H., Meic H. Schmidt, M.D., and John R. W. Kestle, M.D., M.Sc., of the University of Utah, the most common site for metastatic growths is the thoracic region of the spine. Although growths may appear in other portions of the spine, this is the most common site. It is estimated that 50 percent of all growths result from breast, prostate and lung cancers.

Symptoms

• According to Klimo and his colleagues, the most common symptoms of metastatic spinal epidural disease are extreme pain at the site of the tumor and paralysis below the level of the tumor. Since the growths are usually pressing down upon the spine, treatments are specifically directed at either reducing the tumor growth or eliminating the tumor all together. Symptom management is often the determinant of what type of treatment to pursue, with the mildest symptoms being addressed with the least invasive and conservative treatments being utilized first.

Treatments

• One of the recommended treatments for this disease is the use of steroidal drugs. However, according to Klimo and his colleagues, the use of this kind of treatment should not occur until there is a firm diagnosis of the condition. The reason for this, he explains, is that in some cancers steroids can delay diagnosis.

  Once a diagnosis is made, steroids can be prescribed. Klimo and his colleagues describe the use of radiation therapy as an alternative to chemotherapy and surgery. Radiation is administered for 10 to 14 days, with the highest levels of radiation being given during the first few days and then tapering off as the treatment progresses.

  Another form of radiation therapy is called "non-conventional" radiation therapy. Non-conventional radiation is able to specifically target the tumorous growths of metastatic spinal epidural disease, avoiding potential damage to healthy tissues. This is considered a preferable method of delivering radiation treatment.

Surgery

• According to Klimo and his colleagues, for many years surgical laminectomy was the only treatment option available to individuals with metastatic spinal epidural disease. This is a surgical procedure that can be conducted easily by a neurosurgeon and is often the preferred treatment because it is an easy procedure. However, with other treatments available, laminectomy may be a less attractive option for individuals who are uncomfortable with the idea of spinal surgery.

Prognosis

• Klimo and his colleagues suggests that much of the treatment for this disease is palliative, since patients with this condition often are in the final stages of cancer. However, he also suggested that successful treatments have the potential to extend the life of a patient from 3 to 36 months. As a result, treatment for this disease can be extremely beneficial to patients who are candidates for treatment.