Q. What is the central nervous system?
A. The brain and the spinal cord form the central nervous system. It controls walking, talking, breathing and digesting food. It is also involved with our senses – seeing, hearing, touching, tasting and smelling – as well as our emotions, thoughts and memory.
Q. What are spine tumors?
A. Spine tumors are abnormal growths of tissue found in and around the spine. Tumors in the spine may be primary (begin in the spine) or secondary (metastatic – move to the spine from other locations). The most common cancers that move to the spine are breast, lung, renal and prostate.
Q. What are metastatic spine tumors?
Metastatic is a term that describes cancer that has spread from its primary site to other places in the body. Metastatic spine tumors are abnormal growths of tissue that are found in and around the spine, but that began in another location in the body. The skeletal system is the third most common site of metastases.
Most often cancer that moves to the spine is not fatal, although it can cause pain and compress nerves. Nerves that are compressed can cause weakness or paralysis of the arms or legs. Treatment of spine tumors is focused on maintaining quality of life.
Q. Where are spine tumors located?
A. The majority of spine tumors are located in the center of the back. But they also occur in the lower back or neck region. The location of the tumor determines the symptoms experienced.
Q. What are the symptoms of spine tumors?
A. Some patients have no symptoms. The most common symptom, however, is pain. Patients may experience persistent back or neck pain. Other complaints may include numbness, tingling or weakness in the arms or legs, problems walking and maintaining balance or problems with bowel and bladder function.
Q. How is a spine tumor diagnosed?
A. The most common test is a magnetic resonance imaging (MRI) of the spine, which will show the soft tissues and nerves of the spinal column. Plain X-rays will show vertebral fractures, common when the tumor invades the spinal bones. A computerized tomography (CT) scan shows the bones more clearly and can help to determine the extent of the bony disease. Other tests include CT scans of the chest, abdomen and pelvis or a positron emission tomography (PET) scan to determine where else the cancer may be.
Q. What are the treatments for spine tumors?
A. The type of treatment that is best for you depends on the type of your tumor, the location of the tumor and how much tumor is in the spine. Your options may include:
- No medical treatment
- Managing your pain
- Radiation and/or chemotherapy
- Vertebroplasty (injecting bone cement into spine bones to make them strong)
Q. When is surgery necessary?
A. The role of surgery for metastatic spine tumors is to improve or maintain quality of life. There are a number of reasons why surgery would be a good treatment option for spine tumors:
- Surgical cure, if tumor can be removed
- Control of tumor growth by surgical removal, sometimes accompanied by radiation and/or chemotherapy
- Alleviation of symptoms by reducing pressure on nerves and stabilizing spine to prevent deformities, collapse or paralysis
The goal is usually to reduce the severity of symptoms, including:
- Reduction of pain
- Restoration of spine stability to improve mobility
- Preservation of neurological function
- Alteration or change in prognosis
Q. How do I know if I am a candidate for surgery?
A. The following are factors that determine if you are a candidate for surgery:
- Medically stable
- Expected survival of three months or more
- Extent of systemic disease
Q. What are the surgical options?
A. The type of surgery your doctor recommends will depend on the type of tumor, its location and the symptoms you are experiencing. If you have weakness, numbness or paralysis of arms and legs or a change in bladder or bowel function, an open surgical procedure may be necessary.
- Closed procedure (vertebroplasty) – Using a needle, the surgeon injects special cement into the vertebral body damaged by the tumor.
- Open procedures – These procedures may be done with a surgical incision on the front or back
o Decompression: to remove bone that has the tumor and to increase the space around the spinal cord and nerves
o Stabilization: application of screws, rods or cement to stabilize the spinal column
o Combination: both of the above procedures; may be staged one or more days apart
Q. How long is the recovery period after surgery?
A. Your length of stay in the hospital will vary by the extent and type of surgery. A typical hospital stay after spinal tumor surgery is 5 to 10 days, although each person will respond differently and recover differently.
Following surgery, you may need help with activities of daily living. This is referred to as rehabilitation. Rehabilitation may be done in an inpatient setting, which means you are admitted to a rehab unit or hospital. It can also be done as an outpatient, which means you could receive therapy in your home or be transported to a rehab facility during the week.
Q. What are the other treatment options?
A. The non-surgical treatment options for spinal tumors are observation, radiation therapy and chemotherapy.
- Observation – Tumors that cause mild or no symptoms and do not appear to be progressing may be observed and monitored with regular MRIs.
- Radiation therapy – If you are a candidate to receive radiation therapy to the spine, you will be evaluated by a radiation oncologist who specializes in radiation treatments. Radiation therapy, if indicated, may be delayed to allow time for healing after surgery. This will be determined by your doctors.
- Chemotherapy – Usually, chemotherapy for spinal tumors is not indicated. If you require chemotherapy for systemic cancer, you will be referred back to your original oncologist to make determinations regarding chemotherapy.
Q. What questions should I ask the doctor?
A. Here are some suggestions:
- What treatment do you recommend?
- Are there other methods of treatment?
- What are the benefits of the various treatment options?
- What are the risks?
- What are you prescribing, and what is it supposed to do?
- How should I expect to feel during treatment?
- What side effects, if any, can I expect from treatment?
- Should I bring someone with me for my treatments?
- Will the treatment or disease affect my ability to work, drive or care for my family?
- How often are the treatments and checkups?