Comprehensive Guide to Spinal Tumours

What Are Spinal Tumours?

The word tumour originates from the Latin 'tumor' meaning swelling. The tumour may be benign or malignant growth. Benign tumours do not cause spread to other organs whereas malignant does. Benign tumours are usually harmless, non- or slow growing masses and usually do not need therapy, unless they cause restriction of motion or function, and/or cause a lot of pain. Malignant tumours are usually aggressive, painful, rapidly growing masses and usually result in more tumour cells appearing in other organs such as the lungs, liver or bone. These secondary tumours are called 'metastases' and usually spread through blood circulation.

Types of Spinal Tumours and Their Origins

Haematogenous tumours can also involve the spine including myeloma or lymphoma. This is mainly a cancer of the bone marrow, and usually affects the vertebral column. Other primary tumours can be of the nerve structures in the spine.

Who Gets Spinal Tumours and What Causes Them?

Primary spinal tumours (those that start only in the spine) are in general extremely rare. According to the type of tumour, different age groups can be affected. Like other bone structures, the vertebral column is most commonly involved with secondary tumours, i.e. metastasis from other organs. This is normally in older patients, rarely under the age of 55-60 years. The common primary tumours include breast, prostate and kidney cancers.

Recognising the Symptoms of Spinal Tumours

The symptoms of a tumour of the spine mostly start with worsening persistent back pain, getting worse at night while resting. Depending on the position of the tumour, it can cause compression of a nerve or even the cord, which can cause arm or leg pain or even cause paralysis. If there is a known primary tumour, the doctor may suspect a secondary tumour in the spine and refer for urgent evaluation and management. Some tumours cause a fracture of the vertebra along with sudden, severe back pain.

Imaging and Diagnostic Tests for Spinal Tumours

The diagnosis will be mainly through a magnetic scan (called an MRI) of the spine. The MRI will show exactly how much the spinal canal is narrowed and how much it is affecting the spinal cord. A plain x-ray and/or a CT scan (computer tomography) will show the bone structure with fine details which can confirm the diagnosis and help the doctor with therapy planning. Sometimes biopsies are needed for diagnosis of spinal tumours.

Treatment Strategies for Spinal Tumours

Treatment of spinal tumours depends on the type and extent of the tumour, and of course of the patient's symptoms. It is of critical importance to deliver treatments as part of a multidisciplinary team involving medical, surgical, radiotherapy, nursing, physiotherapy and psychological support members. While benign, painless tumours can be ignored or only followed-up and have very good prognosis, secondary and malignant tumours usually need surgical intervention.

The Role of Surgery in Spinal Tumour Management

The surgery is done through either from the front or the back of the spine, or both. The main goal of surgery is to stabilise the spine to prevent any collapse. This can be done using metal screws and a rod system. Primary surgery requires removal of the tumour whereas this is less of a priority for metastatic tumours where other treatments (chemotherapy, radiotherapy, etc.) address the tumour burden. Afterwards, regular follow-up is essential.