Metastatic Spinal Tumors

What are metastatic spinal tumors?

Metastatic spinal tumors are masses of abnormal tissue that develop in the spine or in or near the spinal cord. These tumors are also called secondary spinal tumors or spinal metastases. Tumors that begin in the spine are called primary spinal tumors.

Spinal metastases form when cancer spreads to the spine from another area in the body (metastasizes). Cancer cells can reach the spine by extending from a nearby area or traveling through the bloodstream.

Tumors in the spine can cause pain. They can impair your nervous system function if they grow large enough to press on surrounding nerves and tissue.

How common are metastatic spinal tumors?

Some 30% to 70% of people with cancer develop a metastatic spinal tumor during their lifetime.

What are the types of metastatic spinal tumors?

Doctors classify spinal metastases based on the section of the spine where they develop and where they form within the spine. The different regions of the spine are:

• Cervical: Neck area.
• Thoracic: Chest area.
• Lumbar: Lower back.
• Sacrum: Bottom of the spine.

The types of metastatic spinal tumors include:

• Extradural: A tumor that forms outside of the dura (thin membrane covering the spinal cord), often in the bones of the spine.
• Intradural-extramedullary: A tumor located within the dura, but not in the spinal cord itself. Some 40% of metastatic tumors are of this type.
• Intramedullary: A tumor that develops inside the spinal cord.

What are the symptoms of metastatic spinal tumors?

Some people with cancer that has spread to the spine have no symptoms. You may notice symptoms as a tumor grows and presses on nerves around your spinal cord, presses on the spinal cord itself or causes pain when cancer breaks down bone in your spinal column resulting in a fracture (bone break) and/or instability in your spine.

Signs and symptoms of a metastatic spinal tumor vary depending on the tumor’s location. They can include:

• Back or neck pain, often worse at night.
• Decreased ability to feel cold, heat and pain.
• Deformed spine.
• Difficulty with balance or walking.
• Bladder or bowel control problems.
• Numbness, tingling, or weakness in the arms, legs or chest.
• Paralysis.

What causes metastatic spinal tumors?

Spinal metastases are cancer cells that travel to the spine from another area of the body. When these cells grow uncontrollably, a tumor develops.

Cancers that can lead to spinal tumors include:

• Breast.
• Colon.
• Lung.
• Melanoma (skin).
• Prostate.
• Renal (kidney).
• Thyroid.
• Lymphomas.

How are metastatic spinal tumors diagnosed?

First, your healthcare provider will take your medical history including asking if you’ve had a prior diagnosis of cancer or a history of smoking. They will also ask you to describe your pain and its length. Specific questions about your pain might include:

• Is your back pain worse at night?
• Has your pain continued despite at least six weeks of standard treatments for back pain, such as pain-relieving medications, anti-inflammatories, steroids, rest, stretching exercises/ physical therapy, ice/heat.
• Do you have both ongoing back pain and a history of cancer?

During a physical exam, your healthcare provider will look for problems with how you walk, check your balance, and look for any weakness in your limbs.

Several other tests might be used to confirm the presence of a metastatic spinal tumor. These tests include:

• Blood test: A blood sample may be taken to look for certain chemicals (calcium and alkaline phosphatase). These chemicals are released into blood when bone tissue breaks down from cancer.
• Biopsy: A needle is used to take a sample of tissue from the tumor or changed area of bone to help determine the cause. A pathologist studies the sample to determine if it is growing or spreading and if so, how quickly.
• Bone scan: A doctor 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.
• Imaging tests: Tests may include MRIs, CT scans and X-rays. MRIs help view your spinal cord and nerves and the surrounding spine (bony and soft tissue). CT scans also help view problems within bones. X-rays are useful for showing stability and alignment issues of the spine and growths on the spine. Your doctor may use imaging tests to look at other parts of your body to determine where the tumor started.

What are the treatments for metastatic spinal tumors?

Treatment of metastatic cancer of the spine depends on the location, size, and type of the tumor. Treatment aims to relieve your pain, maintain or improve the function in your spine and improve the quality and length of your life. Your healthcare provider may use a combination of therapies to treat your spinal metastases.

Your treatment options might include:

• Chemotherapy: Anti-cancer drugs destroy cancer cells in the spine and throughout the 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: High doses of X-rays 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 non-surgical, non-invasive procedure that delivers precise narrow beams of radiation to a tumor while keeping exposure to nearby tissue to a minimum.
• Surgery: Surgeons remove the tumor to relieve pain and other symptoms. Surgery is also considered to preserve your neurologic function (bladder and bowel function, ability to walk, reduce numbness/tingling) 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 the spine, improve mobility and relieve pain.
• Active surveillance: Your healthcare provider closely monitors your cancer for signs of growth and spread with regular imaging tests but does not take other action.

What are the complications associated with metastatic spinal tumors?

Some metastatic spinal tumors grow large enough to cause spinal cord compression (the tumor presses on the spinal cord). Spinal cord compression can cause numbness and weakness in your arms and legs. It can also impair body functions including bladder and bowel control. In severe cases, spinal cord compression can cause paralysis.

In some cases, a spinal tumor weakens the bone so much that it fractures (breaks). Other complications of metastatic spinal tumors may include difficulty with balance or walking, and a decreased ability to feel cold, heat and pain.

How can you prevent metastatic spinal tumors?

You cannot prevent a metastatic spinal tumor. You can reduce your risk of metastases by keeping all of your follow-up appointments and getting prompt treatment for any suspected cancer.

Who is at risk of developing metastatic spinal tumors?

Anyone with cancer is at risk of metastatic spinal tumors. People with a family history of cancer have an even higher risk.

What should I expect if I have a diagnosis of spinal metastases?

If you have cancer that has metastasized to your spine, your outcome depends on many factors including the size, type, and location of your tumor, and your health and age.

Doctors and surgeons often treat metastatic spinal tumors successfully to relieve pain and improve quality and length of life. Some people live active and fulfilling lives with spinal tumors that don't grow or cause symptoms.

In some cases, people with metastatic spinal tumors need to continue treatments, including chemotherapy or radiation, to keep the cancer from spreading to other parts of the body. These treatments may continue indefinitely to manage the disease.

After metastatic spinal tumor treatment, you should follow up with your healthcare regularly. Your doctor can monitor you for signs of new tumor growth and treat you right away.

When should I see a healthcare provider about possible metastatic spinal tumors?

If you have cancer or a history of cancer, contact your healthcare provider if you have unexplained back pain or worsening back pain or other symptoms of metastatic spinal tumors.

What questions should I ask my doctor?

If you have a metastatic spinal tumor, you may want to ask your doctor:

• Will I have different treatment for the metastatic spinal tumor than for the original tumor?
• Will cancer spread to other areas of my body?
• What symptoms of other metastases should I watch out for?
• How can I stay as healthy as possible with a metastatic spinal tumor?
• How will treatment affect my work and daily life?

A note from Cleveland Clinic:

Learning that cancer has spread to your spine is scary. But there are treatments to relieve pain and improve your quality of life. Regular follow-up after cancer treatment can help catch metastases early. Contact your healthcare provider if you develop symptoms of a metastatic spinal tumor.