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Vertebral tumor is a type of spinal tumor that occurs at the bone or vertebrae of the spine. Neurological deficit is a symptom when the tumor compresses the spinal cord or nerve root. The growth of the tumor may also lead to fractures of the vertebrae, an unstable spine or pain. Vertebral tumor can be benign or malignant, but either form can result in permanent neurological deficits or life-threatening conditions.
The vertebral body is the common site which other cancers spread to. However, some cancers may primarily originate within the vertebrae of the spine such as chordoma, chondrosarcoma, osteosarcoma, plasmacytoma and Ewing’s sarcoma.
The treatment of vertebral tumor includes surgery, radiation therapy, chemotherapy, and medications.
Types of vertebral tumors
The vertebrae are small bones that are stacked to cover and protect the spinal cord. Vertebral tumors are classified depending on their location in the vertebral column or spine. An extradural tumor is found outside the spinal cord.
Most vertebral tumors result from cancer that spread from the other part of the body (metastasis) such as breast, prostate, lung, or kidney cancer. Multiple myeloma is commonly found to metastasize to the spine.
Plasmacytoma is a type of primary vertebral tumor which is rarely found. Osteoid osteomas, osteoblastomas and hemangiomas are also the types of tumors developing in the vertebraes of the spine.
The primary cancer is most commonly diagnosed prior to any symptoms occurring at the back. Metastatic vertebral cancer usually presents with back pain symptoms.
Symptoms
The following signs and symptoms may occur as a result of the tumor growth compressing the spinal nerves, blood vessels, or bones of the spine:
- Back pain that extends to other areas of the body and worsens at night
- Pain on tumor site
- Loss of sensation and muscle weakness
- Less sensitive to pain, heat and cold
- Walking difficulty
- Bladder or bowel functions deterioration
- Mild or severe paralysis
Back pain is caused by many factors which may not be related to a tumor. Consult your doctor if the back pain is persistent, progressive, not related to activities, gets worse at night, or you have a history of cancer and has just recently developed back pain.
On the other hand, if experiencing progressive muscle weakness or numbness in your legs or arms, bladder or bowel function changes, seek medical treatment immediately.
Causes
The cause of vertebral tumor is unclear, genetic factors may have some influence to its occurrence or some environmental factors such as certain chemical exposure. Most vertebral tumors result from cancer spread from the other part of the body (metastasis). The most common cancer metastasis to the spine are breast, lung, and prostate, thyroid , kidney
Diagnosis
The signs and symptoms of vertebral tumor may resemble other conditions which are more common. Hence, it is vital to inform the doctor thorough medical history together with physical and neurological assessment.
The following tests are done if the doctor investigates for vertebral tumor.
- Spinal Magnetic Resonance Imaging (MRI). Uses a strong magnetic field and radio waves to present clear images of the spine, spinal cord and nerves. It may also be done without or with a contrast agent injection for a more specific view of the tissues and structures.
- Computerized Tomography (CT) scan. A narrow radiation beam is use to produce a more detailed images of the spine. A contrast agent may also be used during this procedure or it may be combined with MRI.
- Biopsy. A small suspected tissue sample is extracted and examined under a microscope to make a diagnosis and plan for future management. In most cases, radiologist will perform fine-needle biopsy under a guidance of X-ray or CT scan. An imaged-guide needle biopsy helps to locate tumor more precisely.
Treatment
Doctors need to take into consideration of the patient’s age, general health, tumor type and if the tumor is primary or has metastasized to the spine from other parts of the body. The treatment goal is to remove the vertebral tumor but there are risk of complications that need to be considered such as permanent damage to the spinal cord or nerves.
These are the treatment options available:
- Monitoring. Vertebral tumors may be found asymptomatic. The tumors then need to be closely observed and imaging such as CT scan or MRI must be done. If they are still small, and non-cancerous, no intervention is needed especially if the surgery is high risk for the patient
- Surgery. The most common treatment for vertebral tumors is surgical removal with bearable spinal cord or nerve injury risk. Microscopic surgery is used to carefully taken out a tumor from normal tissues. Surgical injury may be minimized by checking the spinal cord and nerve functions. Ultrasound may also be used to destroy tumors and remove fragments during the surgery. Not all of the tumor may be removed by surgery even with all the technological innovations. Radiation or chemotherapy or both may sometimes be used after the surgery to eliminate the remaining tumor.
- Radiation therapy. After surgery there may be residual tumor left, radiation therapy uses to destroy the remaining tumors that cannot be surgically removed. If surgical treatment of tumors are too dangerous or cannot be perform, radiotherapy can be an option.
It may also be the first choice of treatment for some late stages of vertebral tumors to help relieve pain or decrease size of tumor where surgery can be done after that.
The radiation treatment may be altered by adjusting the radiation dosage or by utilizing a 3-D conformal radiation therapy based on your condition to ensure its effectiveness and avoid destroying nearby structures. Certain types of vertebral tumors such as chordomas, chondrosarcomas and some cancers that occur during childhood can be treated by a proton beam therapy which particularly delivers radioactive protons to the tumor. This technique avoid damaging the healthy structures around the tumor unlike the regular radiation treatment. - Chemotherapy. Utilizes medications to kill cancer cells or stop their growth. It is the standard treatment for many cancer types. Chemotherapy can be given alone or combination with other therapy.
- Other drugs. The spinal cord may be inflamed from surgery, radiation therapy or even just the existing tumors, therefore, corticosteroids may be prescribed by the doctor to decrease swelling after surgery or while undergoing radiation therapy. Corticosteroids can make serious side effect such as osteoporosis, diabetic and muscle weakness.
