Spinal and spinal cord tumors can be examined in two groups as primary and secondary. Primary tumors are tumors arising from the cells of the structures that make up the spine. Secondary tumors consist of tumors called metastatic tumors that spread to the spine from organs such as lung, breast, prostate, kidney, lymphoma, gastrointestinal system, uterus. Another classification is those that are outside the spinal cord (extradural), spinal cord. between the spinal cord and the spinal cord (intradural extramedullary) and tumors in the spinal cord (intramedullary).
Approximately 10% to 25% of all central nervous system tumors are located in the spine and spinal cord. The incidence of spinal and spinal cord tumors in the community varies between 2 and 10 per hundred thousand people. Tumors outside the spinal cord membrane are more common than tumors inside. Of all spinal and spinal cord tumors, 60% are those outside the spinal cord, 35% are those inside the membrane, and 5% are inside the spinal cord.
90% of tumors outside the spinal cord membrane are metastatic tumors. Metastatic tumors are most common between the ages of 45 and 65 and are more common in men. Many types of cancer spread to the spine, and symptomatic spinal metastases are found in 5-10% of cancer patients, and loss of strength in the legs has been reported in approximately half of these patients. The vast majority of tumors in the spinal cord are benign tumors called meningiomas and neuromas. 90% of the tumors in the spinal cord are called ependymoma and astrocytoma.
On the other hand, 55% of the tumors in the spinal cord in children constitute tumors in the spinal cord, while intramembrane extra-spinal tumors constitute 45%.
What are the symptoms?
Spine and spinal cord tumors show findings according to their location in the neck, back and waist. The most common finding is pain and it can generally start as back pain. These pains do not go away with rest, especially at rest, and are more frequent at night. The pain is usually common and rarely localized. In some patients, it may start as abdominal pain. Depending on the location with the pain; If there is pressure in the neck region due to the tumor, loss of strength and numbness can be seen in both arms and legs. If there is a tumor in the back and waist region, only weakness in the legs, numbness, inability to walk can be seen. Again, bladder and bowel system control may be impaired in spinal cord and spine tumors. Urinary incontinence, inability to control the stool, loss of sexual function may occur. Impaired reflexes, almost complete numbness, and bed dependency may occur. In some tumors, depending on the degree of pressure, weakness can progress very quickly within a day or two. In some tumors, weakness progresses slowly and progresses very insidiously. Loss of strength in the form of clumsiness, weakness, falling attacks are common in children. Another complaint in children is the curvature of the spine, which we call scoliosis.
What are the risk factors?
The exact cause of spinal and spinal cord tumors, like most other tumors, is not known. Genetic factors, some chemical agents, radiation rays, viruses are risk factors in the formation of these tumors. Especially cancers that spread from other secondary organs love the spine.
How is the diagnosis made?
Since the most common symptom of spinal cord and spine tumors is pain, the patient may first apply to the physician with this complaint. The history of the disease and a good neurological examination are guides to suspect this diagnosis. Again, radiological imaging methods are essential in the diagnosis. According to the results of the examination, radiological examinations are performed for whichever level of the spinal cord and spine is suspected. Direct radiographs, computed tomography, magnetic resonance imaging, angiography, bone scintigraphy are the methods used in diagnosis.
In particular, patients with known cancer should be examined for spinal tumors in case of pain on the spine and weakness in the arms and legs.
How is it treated?
Treatment of spinal cord and spine tumors are tumors that branches such as neurosurgery, neurology, radiation oncology, medical oncology, and pathology decide together and treat. After the necessary diagnostic procedures are completed, the location and possible type of the tumor is determined and treatment options are offered. In treatment, methods such as surgery, radiotherapy, chemotherapy, immunotherapy can be used alone or in combination.
Surgery: Surgical treatment is essential in most spinal cord and spine tumors. In recent years, with the increase in technology, the diagnosis of these tumors has become easier, especially with the use of microscope in surgery, satisfactory results are obtained. Biopsy can be taken from most of these tumors and their pathology is determined under radiological intervention with special techniques. Benign tumors in the spinal cord membrane are easily removed by microsurgical techniques as a whole. Tumors in the spinal cord can be removed by microsurgical methods if they are not widespread. Tumors outside the spinal cord; most of these are metastatic tumors and they can cause fractures of the spine. They can reduce the load-bearing capacity of the spine. They can cause severe weakness and pain. In these metastatic tumors, it is necessary to make a joint decision especially by the branches of radiation oncology and medical oncology neurosurgery. The aim of surgical intervention, especially in cancer patients with spinal involvement, is to ensure that the patient continues a comfortable life rather than completely removing the tumor. In these patients, after removing the pressure on the spinal cord, various implants that support the spine are inserted and the patient is allowed to live comfortably.
Radiotherapy: Almost all spinal cord and spine tumors are sensitive to radiation. Radiotherapy is given to these tumors before and after the surgical intervention. Radiotherapy can be performed in the early postoperative period, especially in tumors that are diagnosed and pathologically typed. In radiotherapy, it is planned to kill tumor-oriented tumor cells in a way that does not harm normal tissues.
A great improvement has been observed in radiotherapy in recent years. The Cyberknife method can control pain and increase the quality of life. With Cyberknife, the duration of treatment has been shortened, rapid recovery has been achieved and positive responses have been obtained to the treatment. While this technique can be used primarily in spinal cord and spine tumors; It can also be used as supportive treatment in patients who cannot undergo surgery, in patients who have received radiotherapy before, and in patients who have undergone surgery.
While stereotactic radiosurgery and radiotherapy allow high doses in spinal cord and spine tumors; spinal cord dose should be limited to the tolerance level.
Chemotherapy: This method is based on the principle of shrinking the tumor by giving tumor-directed chemicals in spinal cord and spine tumors in support of other treatment methods. It is given in cooperation with a medical oncologist and a neurosurgeon.
