Spinal Tumors: Causes, Symptoms, and Treatment

Overview of Spinal Tumors

What is a spinal tumor?

A spinal tumor is an abnormal growth of cells inside or around the spinal canal. Spinal tumors can be classified based on their location as follows:

• Intramedullary tumors – within the spinal cord
• Intradural-extramedullary tumors – within the spinal meninges but outside the spinal cord
• Extradural tumors – outside the meninges
• Vertebral tumors – within the vertebrae

Spinal tumors may be benign (non-cancerous) or malignant (cancerous). If a tumor continues to grow, it can damage various spinal tissues and structures.

Tumors that originate from the vertebrae or spinal cord are known as primary spinal tumors. Tumors that spread to the spine from other parts of the body are called secondary (metastatic) spinal tumors. Secondary spinal tumors are much more common than primary spinal tumors.

Metastatic spinal tumors account for about 97% of all spinal tumors. Each year, approximately 10,000 people in the United States are diagnosed with spinal metastases. Research shows that 30% to 70% of cancer patients will experience metastatic spread of cancer cells to the spinal region.

Primary spinal tumors, which begin in the spine itself, are rare. Benign primary spinal tumors make up only about 0.5% of all newly diagnosed tumors, and malignant primary spinal tumors are even less common.

Classification of Spinal Tumors

Some types of spinal tumors include:

• Astrocytoma
• Chordoma
• Ependymoma
• Glioma
• Hemangioblastoma
• Meningioma
• Neurofibroma
• Osteosarcoma
• Benign peripheral nerve sheath tumor
• Spinal hemangioma

Symptoms of Spinal Tumors

Signs and Symptoms

Spinal tumors may cause a variety of signs and symptoms, especially as the tumor grows and exerts pressure. Tumors can affect the spinal cord, nerve roots, blood vessels, or vertebrae. Common signs and symptoms may include:

• Localized pain at the tumor site caused by tumor growth
• Back pain, often radiating to other parts of the body
• Reduced or lost ability to feel pain, heat, or cold
• Bowel or bladder dysfunction
• Difficulty walking and increased risk of falls
• Spinal deformity or scoliosis
• Worsening back pain at night, persistent and progressive pain even at rest
• Muscle weakness or paralysis, particularly in the arms or legs
• Pain that disrupts sleep
• Symptoms not relieved by common pain medications

Complications of Spinal Tumors

Spinal tumors may lead to serious complications, such as:

• Nerve root compression causing motor or sensory dysfunction in the arms, legs, or body
• Bowel and bladder dysfunction
• Spinal fractures
• Death in severe cases

When to See a Doctor

Back pain can have many causes and is not always due to a tumor. However, early diagnosis and treatment are crucial for spinal tumors. You should see a doctor if you experience:

• Progressive and persistent pain
• Pain unrelated to movement or posture
• Pain that worsens at night
• A history of cancer accompanied by new back pain
• Progressive muscle weakness or sensory disturbances in the arms or legs
• Bowel or bladder dysfunction

Causes of Spinal Tumors

Causes of Primary Spinal Tumors

The exact causes of primary spinal tumors remain unclear. Some are believed to be related to exposure to certain chemicals or carcinogens. Spinal lymphoma (a cancer that affects a type of immune cell) is more common in people with weakened immune systems. Spinal tumors may also have a hereditary component, such as in neurofibromatosis type 2 (NF2) or Von Hippel–Lindau disease.

Causes of Secondary (Metastatic) Spinal Tumors

Certain cancers commonly spread (metastasize) to the spine, including:

• Lung cancer – the most common cancer to metastasize to the spine, especially in men
• Breast cancer – the most common cancer to metastasize to the spine in women
• Prostate cancer
• Leukemia (blood cancer)
• Lymphoma (cancer of the lymphatic system)
• Multiple myeloma (a type of blood cancer)
• Melanoma (skin cancer)
• Sarcoma (cancer of connective tissues)
• Kidney cancer
• Thyroid cancer
• Gastrointestinal cancers

Risk Factors for Spinal Tumors

Who Is at Risk?

Certain individuals are at higher risk of developing spinal tumors, including those with:

• Neurofibromatosis type 2 (NF2): An inherited disorder where benign tumors develop near the auditory nerves, leading to progressive hearing loss in one or both ears. Some people with NF2 may also develop spinal tumors.
• Von Hippel–Lindau disease: A rare multisystem disorder associated with hemangioblastomas (blood vessel tumors) in the brain, retina, and spinal cord, as well as other tumors in the kidneys or adrenal glands.
• Weakened immune system
• History of cancer in other organs

Additional Risk Factors

Other factors that may increase the likelihood of developing spinal tumors include:

• Weakened immune function
• Exposure to toxic chemicals
• Exposure to carcinogenic substances

Diagnosis and Treatment of Spinal Tumors

Diagnostic Methods and Tests

Because primary spinal tumors often cause no symptoms, they are frequently discovered incidentally when patients undergo imaging tests for other medical conditions.

Your doctor will ask about your symptoms and medical history, followed by a neurological and musculoskeletal examination, which may include:

• Palpation for spinal tenderness or localized pain
• Sensory testing
• Motor function testing
• Reflex and sphincter tone evaluation

To confirm a diagnosis, the doctor may recommend the following tests:

Imaging tests: X-rays of the spine are commonly used when patients are admitted with back pain.

MRI and/or CT scans: These assess the spinal cord, nerves, vertebrae, and surrounding soft tissues for abnormalities. They can also help determine the origin of the tumor if it is metastatic.

Biopsy: A tissue sample is taken from the tumor to determine whether it is benign or malignant.

Bone scan: In this procedure, a small amount of radioactive material is injected into a vein, and imaging is used to detect abnormalities in the bones.

Blood tests: These can detect abnormalities in substances such as calcium and alkaline phosphatase, which may be released into the blood when bone tissue is destroyed by cancer.

Treatment of Spinal Tumors

Treatment of spinal tumors is highly individualized and depends on the tumor’s location, size, and type. The primary goals of treatment for metastatic spinal tumors are:

• Pain relief
• Preserving or improving spinal cord and nerve function
• Improving quality of life and survival

Treatment for Secondary (Metastatic) Spinal Tumors

Doctors may use a combination of therapies to manage metastatic spinal tumors, including:

Chemotherapy: Delivered intravenously or orally; sometimes used before surgery to shrink the tumor.

Radiation therapy: High-dose X-rays destroy tumor cells or shrink tumors.

Stereotactic radiosurgery (SRS): A non-invasive procedure that delivers highly precise radiation beams to the tumor while minimizing exposure to surrounding tissues.

Surgery: Considered for patients with an expected survival of at least 3–4 months, especially if the tumor does not respond to radiation or chemotherapy.

Monitoring (watchful waiting): Regular imaging studies may be used to track tumor growth or spread.

Treatment for Primary Spinal Tumors

Benign tumors: If the tumor is asymptomatic or only mildly symptomatic, stable in size, and not progressing, doctors may recommend observation with regular MRI scans instead of active intervention.

Surgical removal: Some primary spinal tumors can be surgically resected.

Malignant tumors: Patients may require cancer therapies similar to those used for metastatic tumors, including surgery, chemotherapy, and radiation therapy.

Lifestyle and Prevention of Spinal Tumors

Healthy Habits to Help Manage Spinal Tumors

Lifestyle recommendations:

Patients should follow certain self-care practices during treatment to support recovery and improve outcomes:

• Adhere to the treatment plan prescribed by the doctor for the best possible results
• Maintain a positive outlook and remain persistent throughout the treatment process
• Attend regular follow-up visits for medical monitoring of disease progression
• Get adequate rest and avoid activities that may strain or damage the spine

Dietary recommendations:

Nutrition plays an important role during treatment for spinal tumors. Patients should observe the following dietary principles:

• Balanced and varied diet: Cancer patients undergoing surgery, chemotherapy, or radiation therapy require a resilient body. Main meals should include all four essential food groups: carbohydrates, protein, fats, vitamins, and minerals. However, avoid over-supplementation and limit fried, grilled, or processed foods.
• Small, frequent meals: Loss of appetite and poor taste are common in cancer patients. Dividing meals into smaller portions makes food intake easier and ensures sufficient nutrient absorption.
• Avoid unnecessary food restrictions: There is no scientific evidence that specific foods worsen tumors. Red meat provides protein to aid wound healing and iron to improve anemia caused by chemotherapy.
• Alternative nutrition support: If patients cannot eat orally, nutrition may be provided via nasogastric tube, gastrostomy, or intravenous feeding.

Prevention of Spinal Tumors

Prevention of primary spinal tumors:

Unfortunately, primary spinal tumors cannot be prevented. In rare cases, if you have a first-degree relative (parent or sibling) with inherited disorders such as neurofibromatosis type 2 (NF2) or Von Hippel–Lindau disease, you may benefit from genetic counseling or testing. Early detection of primary spinal tumors generally leads to better treatment outcomes.

Prevention of secondary (metastatic) spinal tumors:

Not all cases of metastatic spinal tumors can be prevented, as they typically occur once cancer has already spread from another organ.

The best way to reduce the risk of spinal metastases is through active and timely treatment of the primary cancer. Effective management helps shrink the original tumor and prevent tumor cells from spreading to the spine.