Spinal Metastasis

What is spinal metastasis?

Spinal metastasis (metastatic spinal cancer) happens when cancer in another part of your body spreads (metastasizes) to your spine (backbone). Healthcare providers may call this secondary cancer in your spine.

This condition is a type of bone metastasis. It most often develops in your thoracic spine (vertebrae in the middle section of your spine) or your lumbar spine (vertebrae in your lower spine). But you can also have spinal metastasis in your spinal cord.

A cancerous tumor in your spine may cause bone pain, compression fractures or affect how your spinal cord works. Treatment varies but typically emphasizes managing symptoms and slowing down tumor growth.

How common is spinal metastasis?

Spinal metastasis is a common complication of cancer. Experts estimate between 5% and 30% of people with cancer develop metastatic spinal tumors.

What are the symptoms of spinal metastasis?

Symptoms vary depending on whether the tumor is in your spine or spinal cord:

• Back or neck pain: Cancer in your spine may damage small bones (vertebrae) that make up your spine and house your spinal cord and nerves. Damage to your vertebrae causes pain. This pain may feel like a dull ache or a sudden sharp pain. It often gets worse at night.
• Deformed spine: A tumor in your spine can change the shape of your spine.
• Numbness, weakness or tingling sensations: A tumor pressing on your spinal cord may make your arms or legs feel numb or weak. You may have tingling (like pins-and-needles) feelings in your chest.
• Difficulty controlling how and when you pee or poop: Your spinal cord controls how your bladder and bowels work. You may have urinary incontinence or fecal incontinence if there’s a tumor pressing on your spinal cord.
• Paralysis: Spinal metastasis that damages your spinal nerves can lead to paralysis. That’s because your spinal nerves send electrical signals between your brain, spinal cord and the rest of your body. These electrical nerve signals help you feel sensations and move your body (motor nerves).

What causes spinal metastasis?

In spinal metastasis, cells from a cancerous tumor break off and enter your bloodstream. Your bloodstream carries the cells to your spine and sometimes, to your spinal cord, causing cancer in your spine.

Any kind of cancerous tumor can spread to your spine. But spinal metastasis often happens as a complication of the following cancers. They’re listed by frequency:

• Breast cancer.
• Lung cancer.
• Prostate cancer.
• Kidney cancer.
• Colorectal cancer and other gastrointestinal cancers.
• Thyroid cancer.

How is spinal metastasis diagnosed?

A healthcare provider will do a physical examination. They’ll look for balance issues and any weakness in your arms and legs.

If you have back or neck pain, they’ll ask you to describe what it feels like. For example, they’ll ask if the pain is an ache or a sharp pain. They’ll ask when it happens and if it comes and goes or is constant. Pain is a common spinal metastasis symptom.

Your provider will ask about your medical history. Specifically, they’ll ask if you have cancer or have had cancer. They may order the following tests:

• Blood tests: They may order a calcium blood test and an alkaline phosphatase test. When cancer makes bone tissue break down, your bones release these chemicals into your bloodstream.
• Imaging tests: Tests may include MRIs, CT scans and X-rays. MRIs let your provider view your spinal cord, nerves and spine. CT scans may detect issues within your vertebrae. X-rays may find growths on your spine and other issues.
• Bone scan: This test may detect abnormal areas in your spine that may be signs of spinal metastasis.
• Fine needle aspiration: Your provider may order a biopsy to get a sample of the tumor in your spine or a sample of bone. A pathologist studies the sample to find out what kind of cancer is in your spine. They also look for signs that cancer is spreading in your spine or spinal cord.

How is spinal metastasis treated?

In general, spinal metastasis treatment focuses on relieving pain and maintaining or improving how your spine works. There’s no cure for spinal metastasis. Your specific treatment will depend on factors like:

• Cancer type: For example, cancer that spreads from your lungs to your spine is still lung cancer, and your provider will use treatments that work best to treat that kind of cancer.
• Your overall health: Cancer that spreads to your spine may be in other areas of your body. For example, metastatic breast cancer can also affect your brain, lungs and liver.
• Cancer location: Cancer in your spinal cord may have different treatment from cancer in your spine.

Your treatment options might include:

• 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 tumors smaller (neoadjuvant therapy).
• Radiation therapy: Radiation therapy involves high doses of X-rays that destroy tumor cells or shrink tumors. Your provider may recommend this treatment if you have a single tumor on your spine. The treatment shrinks tumors, so you have less pain.
• 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: About 10% of people with spinal metastasis receive surgery. In general, healthcare providers use surgery in cases where chemotherapy and radiation therapy aren’t effective. Your provider may do vertebroplasty or kyphoplasty to treat compression fractures. These are minimally invasive procedures that may ease pain and help support your spine so it’s more stable.
• Palliative care: Palliative care is a specialized treatment that focuses on your quality of life. Often pain is the first and most significant symptom of spinal metastasis. In palliative care, you’ll receive pain management support. Your team will also help you manage treatment side effects. They can help you to understand how spinal metastasis may affect your quality of life and how they can help with that.

Treatment side effects

Spinal metastasis treatments cause different side effects:

• Common chemotherapy and radiation therapy side effects include fatigue, hair loss, nausea and vomiting.
• Stereotactic radiosurgery may cause fatigue.
• Kyphoplasty or vertebroplasty side effects are rare but may include infection or bleeding, increased pain, numbness or tingling and nerve damage.

What can I expect if I have spinal metastasis?

Spinal metastasis is advanced cancer, meaning there’s cancer in your spine and at least one other area of your body. Everyone’s situation is a bit different, but in general, people with spinal metastasis will need ongoing treatment that focuses on slowing down cancer and managing symptoms.

Spinal metastasis survival rates

Many things factor into spinal metastasis survival rates. For example:

• One factor is the survival rate estimates for the kind of cancer that spread to your spine. For example, if breast cancer spreads to your spine, you have breast cancer cells in your spine. That means any survival rate estimates reflect data for breast cancer, including the specific kind of breast cancer.
• Whether treatment slows down cancer in your spine.
• Your overall health.

Because so many elements may factor into your situation, your healthcare provider is your best source of information. They understand that survival rate data can be confusing and sometimes alarming and will be glad to explain what you can expect.

How do I take care of myself?

Spinal metastasis can affect your quality of life. You may have issues with ongoing pain, side effects from pain medication or anxiety from living with cancer that’s spreading. Here are some suggestions that may be helpful:

• Ask about cancer survivorship programs: These programs carry people through cancer, helping them live as long as they can and with the best possible quality of life. Ask your care team about programs focused on living with metastatic cancer.
• Eat well: Spinal metastasis symptoms and treatment side effects may affect your appetite. It’s important to get enough calories and nutrition to support your overall health. If you don’t have an appetite or don’t feel like eating, ask to speak with a nutritionist for ideas and support.
• Consider mental health support: Studies show people with spinal metastasis often develop depression or anxiety. Talking to a mental health professional may help.
• Manage your stress: Cancer is stressful at any time, particularly when cancer spreads. Stress management techniques like meditation and relaxation exercises may help.
• Explore clinical trials: Researchers are evaluating new ways to treat spinal metastasis. Ask your healthcare provider about clinical trials that may be appropriate for you to consider.

Should I consider hospice care?

Hospice care emphasizes your physical comfort, keeping you free of pain and managing other symptoms. Hospice care includes programs and services to support your physical, emotional, social and spiritual well-being. It may be an option for you if your healthcare provider believes you have fewer than six months to live and if you’re ready to stop cancer treatment.

When should I see my healthcare provider?

Contact your provider if you:

• Have pain that you can’t manage with the medications as prescribed by your provider.
• Have sudden sharp pain in your neck or back that may be symptoms of broken vertebrae.

When should I go to the emergency room?

Spinal metastasis can damage your spinal cord and cause paralysis. Call 911 or go to the emergency room right away if you have symptoms like:

• Your legs and belly feel numb.
• You have trouble moving your legs.
• You can’t control when you pee or poop.
• You can’t pee.

What questions should I ask my healthcare provider?

When cancer spreads to your spine, you may want to ask the following questions:

• What part of my spine is affected?
• What does this mean for my prognosis (chance of recovery)?
• Can you explain the options for managing my pain with medication?
• What are other ways I can manage pain?
• What changes will I need to make to my daily routine to reduce the risk of bone fractures and manage pain?