SPINAL TUMORS IN INDIA

A spinal tumor is a cancerous (malignant) or noncancerous (benign) growth that develops within or near your spinal cord or within the bones of your spine. Although back pain is the most common indication of a spinal tumor, most back pain is associated with stress, strain and aging not with a tumor.

In most areas of your body, noncancerous tumors aren’t particularly worrisome. That’s not necessarily the case with your spinal cord, where a spinal tumor or a growth of any kind can impinge on your nerves, leading to pain, neurological problems and sometimes paralysis.

A spinal tumor, whether cancerous or not, can threaten life and cause permanent disability. Yet advances in spinal tumor treatment offer more options than ever before.

Types of spinal tumors

Spinal tumors are classified according to their location in the spine.

• Extradural (vertebral) tumors : – Most tumors that affect the vertebrae have spread (metastasized) to the spine from another site in the body often the prostate, breast, lung or kidney. Although the original (primary) cancer is usually diagnosed before back problems develop, back pain may be the first symptom of disease in people with metastatic spinal tumors.Cancerous tumors that begin in the bones of the spine are far less common. Among these are osteosarcomas (osteogenic sarcomas), the most common type of bone cancer in children, and Ewing’s sarcoma, a particularly aggressive tumor that affects young adults. Multiple myeloma is a cancerous disease of the bone marrow the spongy inner part of the bone that makes blood cells most commonly seen in older adults.Noncancerous tumors, such as osteoid osteomas, osteoblastomas and hemangiomas, also can develop in the bones of the spine where they may cause long-standing pain, spinal curvature (scoliosis) and neurological problems.

• Intradural-extramedullary tumors : – These tumors develop in the spinal cord’s arachnoid membrane (meningiomas), in the nerve roots that extend out from the spinal cord (schwannomas and neurofibromas) or at the spinal cord base (filum terminale ependymomas). Meningiomas occur most often in middle-aged women. Although almost always noncancerous, meningiomas can be difficult to remove and may sometimes recur. Nerve root tumors also are generally noncancerous, although neurofibromas can become cancerous over time. Ependymomas at the end of the spinal cord are often large, and their treatment may be complicated by the extensive system of nerves in that area.

• Intramedullary tumors : – These tumors begin in the supporting cells within the spinal cord. Most are either astrocytomas, which mainly affect children and adolescents, or ependymomas the most common type of spinal cord tumor in adults. Intramedullary tumors can be either noncancerous or cancerous and, depending on their location, may cause numbness, loss of feeling, or changes in bowel and bladder function. In rare cases, tumors from other parts of the body can metastasize to the spinal cord itself.

Exams and Tests in India

A nervous system (neurologic) examination may find the location of the tumor.

The Health Care Provider May Also Find The Following During An Exam : –

• Abnormal reflexes
• Increased muscle tone
• Loss of pain and temperature sensation
• Tenderness in the spine

These Tests May Confirm Spinal Tumor : –

• Antidiuretic hormone (ADH) test
• Cerebrospinal fluid (CSF) examination
• Cytology (cell studies) of CSF
• Myelogram
• Spinal CT
• Spine MRI or lumbosacral spine MRI
• Spine x-ray

Causes

Any type of tumor may occur in the spine, including : –

• Leukemia
• Lymphoma
• Myeloma

A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas.

Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metatastasis) are called secondary spinal tumors.

The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects. A spinal tumor is much less common than a primary brain tumor.

Spinal tumors can occur : –

• Inside the cord (intramedullary)
• In the membranes (meninges) covering the spinal cord (extramedullary – intradural)
• Between the meninges and bones of the spine (extradural)

Signs and symptoms may include : –

• Back pain, often radiating to other parts of your body and worse at night
• Loss of sensation or muscle weakness, especially in your legs
• Difficulty walking, sometimes leading to falls
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis that may occur in varying degrees and in different parts of your body, depending on which nerves are compressed
• Scoliosis or other spinal deformity resulting from a large, but noncancerous tumor

Back pain, especially in the middle or lower back, is the most frequent symptom of both noncancerous and cancerous spinal tumors. The pain may be worse at night or on awakening. It also may spread beyond your spine to your hips, legs, feet or arms and may become more severe over time in spite of treatment.

Spinal tumors progress at different rates. In general, cancerous tumors grow more quickly, whereas noncancerous tumors may develop very slowly, sometimes existing for years or even decades before causing problems.

Complications in India

Both noncancerous and cancerous spinal tumors can compress spinal nerves, leading to a loss of movement or sensation below the level of the tumor and sometimes to changes in bowel and bladder function. Nerve damage is often permanent, and disabilities are likely to continue even after the tumor is removed. Depending on its location, a tumor that impinges on the spinal cord itself may be life-threatening.

Is there any treatment?

The three most commonly used treatments are surgery, radiation, and chemotherapy. Doctors also may prescribe steroids to reduce the swelling inside the CNS.

What is the prognosis?

Symptoms of brain and spinal cord tumors generally develop slowly and worsen over time unless they are treated. The tumor may be classified as benign or malignant and given a numbered score that reflects how malignant it is. This score can help doctors determine how to treat the tumor and predict the likely outcome, or prognosis, for the patient.

Treatment Options For Most Spinal Tumors Include : –

• Monitoring : – Sometimes spinal tumors are discovered before they cause symptoms often when you’re being evaluated for another condition. If small tumors are noncancerous and aren’t growing or pressing on surrounding tissues, watching them carefully may be the only treatment that you need. This is especially true in older adults for whom surgery or radiation therapy may pose special risks. If you decide not to treat a spinal tumor, your doctor will recommend periodic scans to monitor the tumor’s growth.

• Surgery : – This is often the first step in treating tumors that can be removed with an acceptable risk of nerve damage.Newer techniques and instruments allow neurosurgeons to reach tumors that were once inaccessible. The high-powered microscopes used in microsurgery make it easier to distinguish tumors from healthy tissue. Doctors also can test different nerves during surgery with electrodes, thus minimizing nerve damage. In some instances, they may use sound waves to break up tumors and remove the remaining fragments.Even with advances in treatment, not all tumors can be removed completely. Surgical removal is the best option for many intramedullary and intradural-extramedullary tumors, yet large ependymomas at the end of the spine may be impossible to extricate from the many nerves in this area. Although noncancerous tumors in the vertebrae can usually be completely removed, metastatic tumors are less likely to be operable.

  When a tumor has spread to the spine, radiation alone is usually the treatment of choice. However, research has found that surgery combined with radiation may be more effective at preventing loss of nerve function in people who are healthy enough to tolerate an operation and who have tumors that have spread from an unknown location, have some evidence of nerve injury, have tumors resistant to radiation or have recurrent tumors that were previously irradiated.

  Recovery from spinal surgery may take weeks or months, depending on the procedure, and you may experience a temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.

• Standard radiation therapy : – This may be used following an operation to eliminate the remnants of tumors that can’t be completely removed or to treat inoperable tumors. It’s also often the first line therapy for metastatic tumors. Radiation may also be used to relieve pain or when surgery poses too great a risk.Medications can help some of the side effects of radiation, such as nausea and vomiting. And depending on the type of tumor, your doctor may be able to modify your therapy to help prevent damage to surrounding tissue and improve the treatment’s effectiveness. Modifications may range from simply changing the dosage of radiation you receive to using sophisticated techniques that offer better protection to healthy tissue, such as 3-D conformal radiation therapy.

• Stereotactic radiosurgery (SRS) : – This newer method, capable of delivering a high dose of precisely targeted radiation, is being studied for the treatment of spinal tumors. In SRS, doctors use computers to focus radiation beams on tumors with pinpoint accuracy, and from multiple angles. This approach has been proved effective in the treatment of brain tumors. Research is under way to determine the best technique, radiation dose and schedule for SRS in the treatment of spinal tumors.

• Chemotherapy : – A standard treatment for many types of cancer, chemotherapy hasn’t proved beneficial for most spinal tumors. However, there may be exceptions. Your doctor can determine whether chemotherapy might be beneficial for you, either alone or in combination with radiation therapy.

• Other drugs : – Because surgery and radiation therapy as well as tumors themselves can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce the swelling, either following surgery or during radiation treatments. Although corticosteroids reduce inflammation, they are usually used for short periods only to avoid such serious side effects as osteoporosis, high blood pressure, diabetes and an increased susceptibility to infection.