Section 6. Brain, Spinal Cord, and Nerve Disorders

Chapter 88. Tumors of the Nervous System

Topics: Introduction | Brain Tumors | Spinal Cord Tumors | Neurofibromatosis | Radiation Damage to the Nervous System

Spinal Cord Tumors

A spinal cord tumor is a noncancerous (benign) or cancerous (malignant) growth in or around the spinal cord.

Spinal cord tumors are much less common than brain tumors. Spinal cord tumors may be primary or secondary. Primary spinal cord tumors originate in the cells within or next to the spinal cord. Only about 10% of primary spinal cord tumors originate in the cells within the spinal cord. The rest originate in cells next to the spinal cord. For example, some tumors develop on spinal nerve roots--the parts of spinal nerves that emerge from the spinal cord (see Section 6, Chapter 76). Primary spinal cord tumors may be cancerous or noncancerous.

Secondary spinal cord tumors, which are more common, are metastases of cancer originating in another part of the body and thus are always cancerous. Metastases most commonly spread to the vertebrae from cancers that originate in the lung, breast, prostate gland, kidney, or thyroid gland. Then they compress the spinal cord from the outside. Lymphomas also may spread to the spine and compress the spinal cord.

See the table Tumors That Originate In or Near the Spinal Cord.

Symptoms

Symptoms of spine tumors are caused by pressure on the spinal cord and nerve roots. Pressure on the spinal cord may cause back pain, progressing paralysis, decreased sensation below the area compressed, impotence, and loss of bladder and bowel control. Pressure on the spinal cord may also block the blood supply to the cord, resulting in death of tissue, fluid accumulation, and swelling. Fluid accumulation may block more of the blood supply, leading to a vicious circle of damage. Pressure on spinal nerve roots can cause pain, numbness, tingling, and weakness of the muscles supplied by the compressed nerve root. Tumors originating in the spinal cord cause numbness, tingling, and weakness but may not cause pain.

Diagnosis

Compression of the spinal cord by a tumor must be diagnosed and treated immediately to prevent permanent damage to the spinal cord.

Doctors consider the possibility of a spinal cord tumor in people who have certain cancers in other parts of the body, who develop pain in a specific area of the spine, and who have weakness, tingling, or incoordination. Because the spinal cord is organized in a specific way, doctors can locate the tumor by determining which parts of the body are not functioning normally (see Section 6, Chapter 93).

Doctors must rule out other disorders that can affect the function of the spinal cord, such as sore back muscles, bone bruises, an inadequate blood supply to the spinal cord, fractured vertebrae, and a herniated disk, as well as syphilis, viral infections, multiple sclerosis, and disorders of the peripheral nerves such as amyotrophic lateral sclerosis.

Several procedures can help doctors diagnose a spinal cord tumor. Magnetic resonance imaging (MRI) is considered the best procedure for examining all the structures of the spinal cord and spine. When MRI is unavailable, myelography with computed tomography (CT) may be performed instead. X-rays of the spine can show only changes in the bones, and many tumors do not affect the bone when they are in an early stage.

A biopsy is usually needed to diagnose the precise type of tumor, especially primary spinal cord tumors. However, a biopsy is not needed for spinal cord tumors that result from metastases if cancer has been diagnosed elsewhere in the body. Often, a biopsy requires surgery, but sometimes it can be performed using a needle and computed tomography (CT) or MRI for guidance.

Prognosis and Treatment

Many tumors of the spinal cord and spine can be removed surgically. Others can be treated with radiation therapy or with surgery followed by radiation therapy. When a tumor is compressing the spinal cord, corticosteroids are given in high doses to reduce the swelling, and the tumor is surgically removed or treated with radiation therapy as soon as possible. Recovery generally depends on how long diagnosis and treatment were delayed and how much damage was done. Removal of meningiomas, neurofibromas, and some other primary spinal cord tumors may be curative.