Spinal Tumors

What is a spinal tumor?

A spinal tumor is an abnormal growth (mass) of cells within or surrounding your spinal cord and/or spinal column.

Your spine (backbone) is the long, flexible column of bones that protects your spinal cord. It begins at the base of your skull and ends in your tailbone, which is part of your pelvis.

Your spinal cord is a cylindrical structure that runs through the center of your spine, from your brainstem (the bottom of your brain) to your low back. It contains nerve bundles and cells that carry messages from your brain to the rest of your body, and from your body to your brain.

Spinal tumors can be located:

• Inside of your spinal cord (intramedullary).
• In the tissues (meninges) covering your spinal cord (intradural-extramedullary).
• Between the meninges and bones of your spine (extradural).
• In the bony vertebrae of your spine.

Spinal tumors can be benign (noncancerous) or malignant (cancerous). If the tumor continues to grow, it can cause damage to different tissues in your spinal column.

Tumors that first develop on your spine or spinal cord are called primary spinal tumors. Metastatic, or secondary spinal tumors, result from cancer spreading from another area in your body to your spine. Metastatic spinal tumors are much more common than primary spinal tumors.

What are the types of spinal tumors?

Healthcare providers categorize spinal tumors in many ways, including:

• Where the tumor’s located along your spine (cervical, thoracic, lumbar or sacrum).
• Where the tumor’s located within your spinal column (intradural-extramedullary, intramedullary or extradural).
• If the tumor began in your spine (primary spinal tumor) or is the result of metastasis from cancer in another area of your body (secondary spinal tumor).
• If the tumor is benign (noncancerous) or malignant (cancerous).

Regions of your spine

The different regions of your spine include:

• Cervical: Neck area.
• Thoracic: Upper- to mid-back.
• Lumbar: Lower back.
• Sacrum: Bottom of your spine.

While you can have a spinal tumor in any of these regions, the thoracic and lumbar regions are the most common locations.

Areas within your spinal column

Healthcare providers also describe spinal tumors based on where they form within your spinal column.

• Intradural-extramedullary tumor: This type of tumor is located inside the thin covering of your spinal cord (dura) but outside of your actual spinal cord. Approximately 40% of all spinal tumors are in this area.
• Intramedullary tumor: This type of tumor grows inside of your spinal cord. Approximately 5% of all spinal tumors are in this area.
• Extradural tumor: This type of tumor is located outside your dura (the thin covering surrounding your spinal cord), which includes your vertebrae (the bones that form your spine). Approximately 55% of spinal tumors are in this area.

Specific types of spinal tumors

Since your spinal column is a complex structure that consists of several different types of cells and tissues, there are several types of spinal tumors, some of which include:

• Astrocytoma: This is a tumor of the supporting cells inside of your spinal cord. There are several types of astrocytoma tumors — some are benign and some are malignant.
• Chordoma: These are rare malignant tumors that form in your spine and skull. They commonly form in the base of your spine (sacrum) and your tailbone (coccyx).
• Ependymoma: This is a tumor that develops in the lining of your spinal fluid passageways in your brain and spinal cord.
• Glioblastoma: This is an aggressive malignant tumor that forms from cells called astrocytes that support nerve cells in your spinal cord and brain.
• Hemangioblastoma: This is a tumor that forms from blood vessels connected to your central nervous system, including your brain and spinal cord.
• Meningioma: This is a tumor of the tissue (meninges) that covers your spinal cord and brain. A meningioma is usually benign, but it can grow large enough to be life-threatening.
• Neurofibroma: This is a benign tumor that grows on nerves in your body, which can include nerves in your spinal column. Most neurofibromas occur in association with a genetic disorder.
• Osteosarcoma: This is a type of bone cancer that can originate in your spine but is more common in your thigh and shin bones.
• Schwannoma: This is a tumor of the cells surrounding the nerve fibers of your spinal cord, peripheral nervous system and cranial nerves. Schwannomas are often benign and rarely become cancer.
• Spinal hemangioma: This is a tumor that forms from the tissues of blood vessels inside of your spinal column. Spinal hemangiomas are the most common primary spinal tumor and are usually benign.

What types of cancer spread (metastasize) to the spine?

Common cancers that begin elsewhere in your body and can spread (metastasize) to your spine include:

• Lung cancer. This is the most common cancer to spread to the spine in males.
• Breast cancer. This is the most common cancer to spread to the spine in females.
• Prostate cancer.
• Leukemia (blood cancer).
• Lymphoma (lymphatic system cancer).
• Multiple myeloma (a type of white blood cell cancer).
• Melanoma (skin cancer).
• Sarcoma (connective tissue cancer).
• Kidney cancer.
• Thyroid cancer.
• Cancers of your gastrointestinal tract.

These cancers most commonly metastasize (spread) to the bony part of your spinal column.

Who gets spinal tumors?

Anyone can get a spinal tumor, but they’re more likely to develop in people who have cancer, especially lung, breast and prostate cancers. These are considered metastatic, or secondary, spinal tumors.

Primary spinal tumors are rare but are more likely to occur in adults between the ages of 65 and 74 and in children between the ages of 10 and 16.

How common are spinal tumors?

Secondary (metastatic) spinal tumors are common — they represent 97% of all spinal tumors. Every year, approximately 10,000 people in the United States develop metastatic spinal cord tumors. Studies show that 30% to 70% of people with cancer will experience cancer metastasis to their spine.

Primary spinal tumors, which begin in your spine, are uncommon. Benign (noncancerous) primary spinal tumors account for 0.5% of all newly diagnosed tumors. Malignant (cancerous) primary spinal tumors are even less common.

What are the symptoms of spinal tumors?

The symptoms of spinal tumors depend on several factors, including:

• Where the tumor is in and along your spinal column.
• How big the tumor is.
• What type of tumor it is.

Some spinal tumors cause no symptoms because they’re small enough to not press on and irritate nearby tissues. However, as a tumor grows, it can cause certain symptoms, especially pain.

Spinal tumor pain

Back pain is the most common symptom of both benign (noncancerous) and malignant (cancerous) spinal tumors. Pain from spinal tumors in your middle or lower back is more common, as tumors are more likely to develop in those regions of your spine.

Pain from a spinal tumor usually:

• Isn’t specifically associated with an injury, stress or physical activity but can get worse with strain, such as from exercise, sneezing or coughing.
• Is aching and deep.
• Starts slowly and gradually increases.
• Is persistent at night, sometimes to the point of disrupting sleep.
• Over time, becomes intense and disruptive even at rest.
• Doesn’t respond to conservative pain relief therapies and medications.

Spinal tumors can also cause radicular pain, which is pain that radiates (spreads) from your spine to your hips, legs, feet or arms. Radicular pain often feels sharp and shooting.

Other symptoms of spinal tumors

Depending on the location and type of the spinal tumor, other signs and symptoms in addition to pain can develop. This usually happens when the tumor grows and presses on your spinal cord or your nerve roots, blood vessels or bones of your spine.

Other symptoms of spinal tumors include:

• Numbness, tingling or loss of sensation in your legs, arms or chest.
• Muscle weakness in your legs, arms or chest.
• Muscle twitches or spasms.
• Stiff back or neck.
• Loss of bowel and/or bladder control (bowel incontinence and urinary incontinence).
• Difficulty walking, which may cause falls.
• Scoliosis or other spinal deformity resulting from a large and/or destructive tumor.
• Paralysis that may occur in varying degrees and in different parts of your body, depending on which nerves the tumor is compressing.

What causes spinal tumors?

The cause of a spinal tumor depends on what type it is — primary or secondary (metastatic).

Primary spinal tumor causes

Scientists aren’t sure of the cause of most primary spinal tumors. Some of them may be caused by exposure to cancer-causing chemicals or substances. Spinal cord lymphomas (cancers that affect a type of immune cell) are more common in people with weakened immune systems. Spinal tumors can sometimes run in families, so scientists think there’s likely a genetic component.

Secondary spinal tumor causes

By definition, secondary (metastatic) spinal tumors are caused by cancer that formed elsewhere in your body and spread (metastasized) to your spine.

Metastases most commonly develop when cancer cells break away from the main tumor and enter your bloodstream or lymphatic system. These systems carry fluids around your body, so they can carry cancer cells from one area of your body to another.

Metastases can also develop when cancer cells from the main tumor, typically in your abdominal cavity, break off and grow in nearby areas, such as in your liver, lungs or bones.

Since your spine has a significant blood supply and is near lymphatic and venous drainage systems, it’s generally vulnerable to metastasis.

How are spinal tumors diagnosed?

As primary spinal tumors often have no symptoms (asymptomatic), healthcare providers often find them incidentally (accidentally) when a person is getting an imaging test for another reason.

People with symptomatic spinal tumors often believe that their back pain is related to a real or suspected injury in the recent past. If you’re experiencing back pain, it’s important to see your healthcare provider, especially if you have cancer.

Your healthcare provider will ask about your symptoms and medical history. They’ll also perform a neurological examination to check for the following symptoms:

• Tenderness in your spine.
• Loss of pain and/or temperature sensation.
• Abnormal reflexes.
• Muscle weakness.

Your healthcare provider will also order certain tests to help confirm or rule out a tumor diagnosis.

What tests will be done to diagnose a spinal tumor?

In addition to a physical and neurological exam, your healthcare provider may order several tests to confirm the presence of a spinal tumor, including:

• Imaging tests: Spine X-rays are the go-to imaging test for people with cancer who have sudden back pain. This is because metastatic spinal tumors commonly form in the bony part of your spinal column. Your healthcare provider may also order an MRI and/or CT scan to view your spinal cord, nerves and your surrounding spine (bony and soft tissue). Your healthcare provider may also use imaging tests to look at other parts of your body to determine where the tumor started if it’s a metastatic spinal tumor.
• Biopsy: Your healthcare provider may order a biopsy, which involves taking a sample of tissue from the tumor to help determine if the tumor is benign or malignant. A pathologist studies the sample to learn if it’s growing or spreading and if so, how quickly. If the tumor is malignant, a biopsy also helps figure out the cancer’s type, which determines treatment options.
• Bone scan: During a bone scan, your healthcare provider injects a very small amount of a radioactive substance into your vein and then uses imaging to look at your bones. Tracking the movement of the radioactive material helps detect abnormal areas in your spine.
• Blood tests: Your healthcare provider may order certain blood tests to look for abnormal levels of substances in your blood, such as calcium and alkaline phosphatase. Your body releases these substances into your bloodstream when bone tissue breaks down, which could happen from cancer.

How is a spinal tumor treated?

Treatment of spinal tumors is very individualized and depends on the location, size and type of tumor. The goals of metastatic spinal tumor treatment include:

• Relieving your pain.
• Maintaining or improving the function of your spine and spinal nerves.
• Improving the quality and length of your life.

The goal of primary spinal tumor treatment is to remove the tumor completely if it’s causing symptoms, when possible.

Several different healthcare specialists are usually involved in the treatment plan for spinal tumors. These specialists may include:

• Neurologists.
• Spinal surgeons.
• Medical oncologists.
• Radiation oncologists.
• Orthopaedists.
• Urologists.
• Vascular surgeons.

What medications and treatments are used for spinal tumors?

Treatment options for spinal tumors vary depending on what type of tumor it is.

Treatment for metastatic (secondary) spinal tumors

Your healthcare team may use a combination of therapies to treat a metastatic spinal tumor, including:

• Chemotherapy: Chemotherapy drugs can destroy cancer cells in your spine and throughout your body. You may receive chemotherapy through an injection into a vein or by taking a pill. Sometimes, healthcare providers use chemotherapy before surgery to make the tumor smaller.
• Radiation therapy: Radiation therapy involves high doses of X-rays that destroy tumor cells or shrink the tumor. Shrinking the tumor can make it small enough to reduce or eliminate pain or other symptoms.
• Stereotactic radiosurgery: This is a nonsurgical, noninvasive procedure that delivers precise narrow beams of radiation to a tumor while keeping radiation exposure to nearby tissue to a minimum.
• Surgery: In general, healthcare providers only consider surgery as an option for people with metastatic spinal tumors when they’re expected to live three to four months or longer and the tumor is resistant to radiation or chemotherapy. Surgery can help relieve pain and other symptoms, preserve your neurologic function and stabilize your spine. Your surgeon may suggest traditional open surgery, or you might have a minimally-invasive procedure. Your surgeon may perform vertebroplasty or kyphoplasty — a procedure in which bone cement is injected into your spine after removing the tumor. These procedures provide support and stability to your spine, improve mobility and relieve pain. Up to 10% of people who have symptomatic spine metastases can be treated by surgery.
• Monitoring: Your healthcare team may closely monitor your cancer for signs of growth and spread with regular imaging tests.

Treatment for primary spinal tumors

If you have a benign primary tumor that’s asymptomatic or mildly symptomatic and doesn’t appear to be changing or progressing, your healthcare provider may recommend monitoring it with regular MRIs.

Some primary spinal tumors can be surgically removed through complete en bloc resection (complete removal of the tumor) for a possible cure. But for other tumor types, particularly those that form inside the spinal cord-intramedullary, complete surgical removal isn’t possible without significant neural damage.

If your spinal tumor is malignant, you’ll need cancer treatments like the options listed above.

How can I prevent spinal tumors?

Prevention methods for spinal tumors depend on the type — primary or secondary (metastatic).

Preventing primary spinal tumors

Unfortunately, primary spinal tumors aren’t preventable.

In a small number of cases, primary spinal tumors may result from having certain genetic conditions, including:

• Neurofibromatosis Type 2 (NF2): People with this hereditary (genetic) condition may develop benign tumors in the arachnoid layer of their spinal cord or the supporting glial cells.
• Von Hippel-Lindau disease (VHL): This rare genetic condition is associated with benign blood vessel tumors (hemangioblastomas) in your brain, retina and spinal cord, and with other types of tumors in your kidneys or adrenal glands.

If you have a first-degree family member (sibling or parent) with one of these conditions, it’s important to get genetic counseling or testing to see if you may also have the condition. Catching spinal tumors in their early stages generally has the best outcome.

Preventing secondary (metastatic) spinal tumors

Unfortunately, not all cases of secondary (metastatic) spinal tumors are preventable. Many people are diagnosed with metastatic cancer as their initial diagnosis.

The best way to try to prevent secondary spinal tumors is with adjuvant or neoadjuvant therapy if you’ve received a localized cancer diagnosis. The goal of adjuvant therapy is to shrink the primary tumor and prevent tumor cells that have broken away from the original tumor from forming metastatic tumors later on.

Healthcare providers use several different types of adjuvant therapy and are currently researching new types of treatment.

What is the prognosis (outlook) for spinal tumors?

The prognosis (outlook) of spinal tumors depends greatly on your age and overall health and on whether the tumor is benign or malignant and primary or metastatic. Your healthcare team can give you a better idea of what to expect if you have a spinal tumor. Don’t be afraid to ask them questions.

In general, early diagnosis and treatment of a spinal tumor usually lead to a better outcome. If you’re experiencing symptoms of spinal tumors, such as back pain that gets worse at night, it’s important to see your healthcare provider.

How do I take care of myself if I have a spinal tumor?

If you have a spinal tumor, it’s important to follow your treatment plan so it works as well as possible. You’ll also need support for the physical, emotional and social effects of living with back pain and/or cancer if these situations apply to you.

When should I see my healthcare provider about a spinal tumor?

If you develop severe back that is sudden or gets worse, it’s important to see your healthcare provider, especially if you have a history of cancer.

Go to the nearest emergency room or call 911 if you develop new or worsening symptoms during treatment of a spinal tumor.