Spinal tumor

Spinal tumors
Classification and external resources
Specialty oncology
ICD-10 C72.0
ICD-9-CM 192.2
DiseasesDB 31483
MedlinePlus 001403
eMedicine orthoped/49 med/2993, radio/169
MeSH C04.557.465.220

Spinal tumors are neoplasms located in the spinal cord. Extradural tumors are more common than intradural neoplasms.

Depending on their location, the spinal cord tumors can be:

Pathology

Extradural tumors are mostly metastases from primary cancers elsewhere (commonly breast, prostate and lung cancer).[1] Intradural tumours can be classified as intramedullary (within the spinal parenchyma) or extramedullary (within the dura, but outside the spinal parenchyma). Extramedullary tumours are more common than intramedullary tumours. Common extramedullary tumours include meningiomas, schwannomas, extramedullary ependymomas, haemangioblastomas, while intramedullary tumours include astrocytomas and intramedullary ependymomas.[2]

Symptoms

Pain is the most common symptom at presentation.[2] The symptoms seen are due to spinal nerve compression and weakening of the vertebral structure. Incontinence and decreased sensitivity in the saddle area (buttocks) are generally considered warning signs of spinal cord compression by the tumor. Other symptoms of spinal cord compression include lower extremity weakness, sensory loss,numbness in hands and legs and rapid onset paralysis. The diagnosis of primary spinal cord tumors is very difficult, mainly due to its symptoms, which tend to be wrongly attributed to more common and benign degenerative spinal diseases.[1][3]

Spinal cord compression is commonly found in patients with metastatic malignancy.[4] Back pain is a primary symptom of spinal cord compression in patients with known malignancy.[5] It may prompt a bone scan to confirm or exclude spinal metastasis. Rapid identification and intervention of malignant spinal tumors, often causing spinal cord compression, is key to maintaining quality of life in patients.[6]

Diagnosis

The diagnosis of primary spinal cord tumors is difficult, mainly due to their symptoms, which in early stages mimic more common and benign degenerative spinal diseases. MRI and bone scanning are used for diagnostic purposes. This assesses not only the location of the tumor(s) but also their relationship with the spinal cord and the risk of cord compression.[7]

Treatment

References

  1. 1 2 Hamamoto, Yasushi; Kataoka, M.; Senba, T.; Uwatsu, K.; Sugawara, Y.; Inoue, T.; Sakai, S.; Aono, S.; Takahashi, T.; Oda, S. (9 May 2009). "Vertebral Metastases with High Risk of Symptomatic Malignant Spinal Cord Compression". Japanese Journal of Clinical Oncology. 39 (7): 431–434. doi:10.1093/jjco/hyp039.
  2. 1 2 3 Nambiar, Mithun; Kavar, B (2012). "Clinical presentation and outcome of patients with intradural spinal cord tumours". Journal of Clinical Neuroscience. 19 (2): 262–6. doi:10.1016/j.jocn.2011.05.021.
  3. 1 2 3 4 Ribas, Eduardo S. C.; Schiff, David (1 May 2012). "Spinal Cord Compression". Current Treatment Options in Neurology. 14: 391–401. doi:10.1007/s11940-012-0176-7.
  4. 1 2 Holt, T.; Hoskin, P.; Maranzano, E.; Sahgal, A.; Schild, S.E.; Ryu, S.; Loblaw, A. (6 March 2012). "Malignant epidural spinal cord compression: the role of external beam radiotherapy". Current Opinion in Supportive and Palliative Care. 6 (1): 103–8. doi:10.1097/spc.0b013e32834de701.
  5. Reith, W.; Yilmaz, U. (December 2011). "[Extradural tumors].". Radiologe. 51 (12): 1018–1024. doi:10.1007/s00117-011-2152-8.
  6. Jennelle, Richard L. S.; Vijayakumar, Vani; Vijayakumar, Srinivasan (2 August 2011). "A Systemic and Evidence-Based Approach to the Management of Vertebral Metastasis". ISRN Surg. 2011: 1–6. doi:10.5402/2011/719715.
  7. Segal D, Constantini S. C.; Korn, Lidar (14 May 2012). "Delay In Disgnosis of Primary Intra Dural Spinal Cord Tumors". Surg Neurol Int 2012;3:52. 3: 52. doi:10.4103/2152-7806.96075.
  8. Patchell, Dr. Roy A.; Tibbs, Phillip A.; Regine, William F.; Payne, Richard; Saris, Stephen; Kryscio, Richard J.; Mohiuddin, Mohammed; Young, Byron (20 August 2005). "Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial". The Lancet. 366 (9486): 643–648. PMID 16112300. doi:10.1016/S0140-6736(05)66954-1.
  9. Furlan, J.C.; Chan, K.K.; Sandoval, G.A.; Lam, K.C.; Klinger, C.A.; Patchell, R.A.; Laporte, A.; Fehlings, M.G. (May 2012). "The combined use of surgery and radiotherapy to treat patients with epidural cord compression due to metastatic disease: a cost-utility analysis". Neuro-Oncology. 14 (5): 631–640. doi:10.1093/neuonc/nos062.
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