Medical Management of Spinal Cord Tumors

Spinal cord tumors can have a significant effect on the central nervous system and its functions. They can affect the spinal cord, nerves, and vertebrae, leading to pain, impaired motor function, sensory abnormalities, and even disruptions in bowel and bladder control. Fortunately, there are several treatment methods available to reduce or eliminate the tumor in your spine.

Surgery and radiation therapy are commonly used treatment modalities. However, in some cases, these options might not effectively control tumor growth. When surgical and radiation options are not viable, doctors could turn to chemotherapy and medical management strategies to control the condition and alleviate associated symptoms. This article provides detailed information about the medical management of spinal cord tumors.

A spinal cord tumor can cause various neurologic deficits that disrupt your daily life and hinder your ability to carry out normal routines. These symptoms can be exhausting, making it essential to rely on your support system for assistance. When you hear that the diagnosis is a spinal cord tumor, the information provided can be both shocking and overwhelming.

The spinal cord is a long structure that is approximately 1 cm wide in its largest diameter and carries millions of neurons that communicate information between the brain and the rest of the body. It is covered by a protective membrane (meninges) and sits within the spinal canal, a hollow space protected by bony vertebrae. Tumors can grow within the spinal cord or in any of its nearby structures. Doctors classify spinal cord tumors primarily as extradural or intradural depending on their location relative to the outermost part of its meningeal covering (dura).

• Extradural tumors (60%): develop outside of the protective meninges and typically occur within the vertebral column or in nearby tissues; most of them result from cancer cells that have spread (metastasized) from cancer in a different part of the body, such as the lungs, prostate, or breasts
• Intradural tumors: further divided into 2 subcategories
  • Intradural-extramedullary tumors (30%): grow within the protective meninges but outside of the spinal cord
  • Intramedullary tumors (5%–10%): the rarest type of spinal cord tumor, these tumors arise directly from within the spinal cord and are significantly problematic because of their proximity to the spinal cord; although treatment options for them are similar to those for of other spinal cord tumors, they can be more challenging to address

Spinal cord tumors can be classified as primary or secondary, depending on their origin. Primary spinal cord tumors originate from within the spinal cord or its surrounding structures. Secondary spinal cord tumors, also known as spinal cord metastases, occur when cancer cells spread to the spinal cord from a primary tumor located in a different part of the body. Spinal cord metastases commonly arise from lung, breast, prostate, kidney, colon, and skin cancers.

Spinal cord tumors can be treated through various approaches; surgery and radiation therapy are the primary options. Surgery involves removal of the tumor, which provides immediate decompression of the spinal cord. In contrast, radiation therapy uses radiation beams targeted on the tumor to inhibit its growth.

If the tumor is causing significant symptoms, surgery is often recommended. In some cases, radiation therapy can be used after surgery to eliminate any remaining tumor fragments.

However, there are situations in which surgery or radiation therapy is not feasible or effective in controlling tumor growth. In such cases, chemotherapy might be considered as an alternative treatment option.

It is important to note that research on the effectiveness of chemotherapy specifically for spinal cord tumors is limited, but it can be pursued when other standard treatment options have been exhausted.

For patients with an asymptomatic noncancerous (benign) spinal cord tumor or metastatic disease, a conservative approach can be taken. This approach involves regular monitoring of the tumor without immediate intervention.

For situations in which maximizing quality of life is more important than extending life, medication(s) to control symptoms, such as a pain reliever, might be chosen over more invasive treatment.

Ultimately, the choice of treatment approach and the best treatment plan depends on the specific characteristics of the tumor, the patient's overall health, and the goals for treatment. A comprehensive evaluation by medical professionals is crucial for determining the most appropriate course of action for each individual person.

Chemotherapy is an important treatment option for certain types of tumor that occur in the brain, but the role of chemotherapy in the treatment of spinal cord tumors is unclear. Studies investigating the outcomes of chemotherapy treatment for spinal cord tumors are limited by having only a small number of patients and testing only a few chemotherapeutic agents. Although a minority of patients can experience some benefit from chemotherapy, the extent of this benefit is generally modest.

It is important to note that the efficacy of chemotherapy for spinal cord tumors remains uncertain. However, the potential adverse effects of chemotherapy are well established.

Common adverse effects include fatigue, nausea, vomiting, hair loss, decreased appetite, and increased susceptibility to infections. These adverse effects can vary in severity depending on the specific chemotherapy drug(s) used and the individual patient’s response.

Given the limited evidence of chemotherapy's effectiveness and the potential adverse effects associated with its use, the decision to pursue chemotherapy for a spinal cord tumor should be considered carefully and discussed with a health care professional.

Participating in a clinical trial might also offer access to new and experimental treatments. However, such treatments could be associated with unknown complications and additional adverse effects.

Being told that you have a spinal cord tumor can be a devastating and challenging experience. Exploring treatment options and making decisions should not be rushed. Take each day as it comes.

Seek support from your family, friends, and medical team; they can provide valuable guidance and encouragement throughout this journey. Remember that you are not alone and that together with your support circle, you can face the challenges of this diagnosis and work toward the best possible outcome.

• Chemotherapy is a potential treatment option once other standard treatment options are exhausted
• The evidence for chemotherapy in the treatment of spinal cord tumors is limited
• Adverse effects of chemotherapy include fatigue, nausea, vomiting, hair loss, decreased appetite, and increased susceptibility to infections

• American Association of Neurological Surgeons (AANS): Spinal tumors
• National Cancer Institute: Related organizations
• Cancer Support Community: Brain and spinal cord tumors
• Glioma Foundation Center
• Collaborative Ependymoma Research Network (CERN) Foundation