TMEDULLARY AND SPINE TUMOURS

MEDULLARY AND SPINE TUMOURS

Tumours that affect the spine may have different origins and treatments depending on their location (vertebra, meninx, nerve or spinal cord). Treatments could be curative, conservative or palliative depending on the situation and extent of the injury. Previously, the appearance of tumour-like lesions that affect any of these structures should be assessed by an advising specialist.

Benign tumour lesions that most frequently affect the spine, such as meningiomas or neurinomas, are slow growing and usually do not affect the bone and spinal cord. Symptoms usually appear (la clínica se instaura) progressively and are habitually painless, but may affect the balance, strength or sensitivity in the case of spinal cord compression. In these cases surgery can be curative and it is highly recommended that it is evaluated by a specialised neurosurgeon.

Tumours affecting the vertebrae bones are very frequent in patients who suffer from other types of tumours that metastasize. In these cases, treatment of metastases is performed after an evaluation by a multidisciplinary committee that includes oncologists, and may require surgery with curative or palliative intent. At the moment techniques to free the spinal cord, perform a biopsy with vertebral cementation, and in some cases remove the affected vertebra and fix the spine to prevent it from becoming unstable, are available.

Síntomas del tumor medular

Los síntomas dependen de la localización, el tipo de tumor y de su salud general. Los tumores que se han diseminado desde la columna a otro sitio (tumores metastásicos) a menudo progresan rápidamente. Los tumores primarios con frecuencia progresan lentamente durante semanas o años.

Los tumores en la médula espinal generalmente causan síntomas, algunas veces, en grandes porciones del cuerpo. Los tumores por fuera de la médula espinal pueden crecer durante mucho tiempo antes de causar daño a los nervios.

Symptoms of the medullary tumour:

Symptoms depend on the tumour’s location and type, as well as on your general health. Tumours that have spread from the spine to another location (metastatic tumours) often progress rapidly. Primary tumors often progress slowly over weeks or years.

Tumours in the spinal cord usually cause symptoms, sometimes in large portions of the body. Tumours outside the spinal cord may develop for a long time before causing damage to the nerves

Tumours in the spinal cord usually cause symptoms, sometimes in large portions of the body. Tumours outside the spinal cord may develop for a long time before causing damage to the nerves.

Symptoms may include:

• Alteration of sensitivity (tactile alteration in legs or arms, feeling cold in the legs or hands) that can get worse progressively

• Back pain, sometimes restrictive. It is usually severe and does not improve with painkillers. It increases with time. It worsens when lying, turning, while performing efforts, coughing or sneezing. It can radiate to the hip, leg, feet, arms, all the limbs or stay in the spine

• Alterations in urination or defecation

• Muscle spasms or contractions (fasciculations)

• Loss of muscle function

• Muscle weakness (decrease in muscle strength that is not due to exercise)

• Inexplicable falls

• Disruption of the ability to walk

• Progressive worsening

Causes of medullary tumours

Tumours that start at the medullary tissue are called primary spinal tumours. Tumours that spread from some other locations (metastases) to the spine are called secondary spinal tumours. Tumours can spread from the breast, prostate, lung and other areas to the spine.

The cause of primary marrow tumors is unknown, and some occur due to genetic defects.

Spinal cell tumours can appear:

  • Inside the marrow (intramedullary)
  • In the membranes (meninges) that cover the spinal cord (extramedullary - intradural)
  • Between the meninges and the spine bones (extradural)
  • Otherwise, tumours can spread from other places. Most of these tumours are extradural.

    As it grows, the tumour can affect blood vessels, spine bones, meninges, nerves and the spinal cord.

    The tumour can put pressure on the spinal cord or nerve roots, causing damage. Over time this damage may become permanent. For this reason it is of vital importance that it is assessed by a specialist in vertebral or spinal tumours.

    Exams and tests of the medullary tumour

    A neurological exam can help indicate the location of the tumour. It is accompanied by the completion of several complementary tests.

  • Spine / lumbosacral spine MRIs
  • Spine CT scan
  • Spine X-ray
  • Cerebrospinal fluid (CSF) test
  • Spinal Tumour Treatment

    The goal of the treatment is to reduce or prevent damage to the nerves by pressure or compression of the spinal cord and, if possible, to remove it completely in order to alleviate or cure the disease. Treatment must be started quickly. The sooner the symptoms appear, the faster the treatment is needed to prevent a permanent injury. Any new or inexplicable back pain in a patient with cancer should be taken seriously. Treatments include:

    Los tratamientos abarcan:

  • Corticosteroids (dexamethasone) to reduce inflammation around the spinal cord and nerves
  • Surgery may be necessary in order to relieve compression on the spinal cord. Some tumours can be removed completely; in other cases, part of the tumour may be removed to relieve pressure on the spinal cord.
  • Radiation therapy may be used with or instead of surgery
  • Chemotherapy may be recommended in some cases
  • Physical therapy may be necessary improve muscle strength and independent motor ability
  • What is the prognosis?

    The clinical outcome varies depending on the tumour. Early diagnosis and treatment usually lead to a positive prognosis.

    Nerve damage often continues even after surgery. Although some permanent disability is likely, the treatment may delay the development of a major disability and death. Do not hesitate to ask a specialist for the best advice and treatment.