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What are Spine Tumors & Spinal Cord Tumors?

Tumors in and around the spine and spinal cord aren’t as common as brain tumors, but they do occur. The majority of spinal cord tumors are found in children and young adults, but anyone can be diagnosed with a tumor at any point in their life.Both primary and secondary spinal tumors are caused by abnormal cell growth. Approximately 3,000 children are diagnosed with spinal tumors annually. In some cases, the cause may be prolonged exposure to chemicals or radiation, but it’s also possible that environmental factors and genetics play a role in a tumor’s development. For example, spine tumors can form because of neurofibromatosis, a hereditary disease that involves tumors on or near the spinal nerves. About 90% of spinal cord tumors originate in the cells next to the spinal cord, such as the spine nerve roots. Only 10% of all primary spinal cord tumors begin in the cells within the spinal cord itself.

Causes of Spine and Spinal Cord Tumors

While researchers are beginning to more fully understand the genetic and environmental factors that can contribute to the development of many kinds of tumors, the origins of spinal tumors are still relatively unknown.

Like many other tumor types, spinal tumors contain a number of abnormal genes. But doctors and researchers are not yet sure what causes the genes to change. In some cases, spinal cord tumors are known to run in families. Others are associated with specific diseases, such as neurofibromatosis type 2 and Von Hippel-Lindau disease.

The origins of secondary spinal tumors are easier to identify. These tumors begin elsewhere in the body and spread to the spine and spinal cord through a process called metastasis.

No matter what the cause, the highly experienced team at the Florida Hospital Brain and Spinal Cancer Program can identify spine and spinal tumors even in their earliest stages and devise a course of treatment that addresses them with advanced procedures and techniques.

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Symptoms of Spine and Spinal Cord Tumors

A benign (noncancerous) or malignant (cancerous) tumor can cause symptoms that may be mistaken for other diseases. Since an undetected tumor can have serious health ramifications including paralysis or even death, it’s important that you see your doctor or one of the specialists at the Florida Hospital Brain and Spinal Cancer Program if you display any of the following symptoms for any length of time.

Pain
In most cases, one of the first signs of a possible spinal tumor is pain. As the tumor grows, it creates pressure on the nerves of the spine. These nerves then become irritated and inflamed, creating pain. Because they affect the nerve endings in the spine, you may also feel pain in other regions of your body.

Numbness
Numbness may or may not accompany pain. It depends on how the pressure is affecting the impulses that travel between the brain and the nerve endings. Wherever the restricted nerve goes is where the numbness can be felt. In most cases, it will start in the legs, but you may also feel numbness in the arms, hands and shoulders.

Motor Skills
An especially large spinal tumor growth can interfere with your motor skills. This includes a decrease in motor skills in the legs, causing weakness and making it difficult to walk or stand easily. A tumor can also affect the arms, making it harder to hold, clasp or carry things.

Bowel Issues
In more advanced cases, you may experience incontinence or have trouble urinating. This is because the spinal tumor is placing pressure on the nerves that affect the bowel or the bladder, causing paralysis in the region. 

Paralysis
If the tumor places enough pressure on the nerves, you may experience paralysis in certain parts of the body. A tumor can actually exert enough pressure that it severs a nerve, leading to a complete loss of control over the extremities. Symptoms this severe occur in more advanced stages, but if initial symptoms are ignored for a long period of time, paralysis can result.

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Diagnosing & Staging

Because early detection and treatment is key, it’s important that you see a doctor if you notice symptoms that could be caused by a tumor. While many of these symptoms could indicate another health issue, only an experienced doctor can make that determination through additional testing.

Tests utilized by the spine and spinal cord tumor specialists at the Florida Hospital Brain and Spinal Cancer Program include:

  • Physical exam and history: The first stage is a basic physical examination. The doctor will check your overall health and look for signs of a spine or spinal cord tumor. The doctor will also ask you detailed questions about your overall health, lifestyle habits, exposure to any risk factors and family history to see if there is a reason you are experiencing these symptoms.
  • Neurological Exam: Since spine or spinal cord tumors can affect a wide range of issues, from walking and standing to motor skills, your doctor may conduct a neurological exam. This includes a series of questions and tests to see how your brain, spinal cord and nerves are functioning. Tests include mental awareness, basic coordination, the ability to walk and stand, and assessments of your muscles, senses and reflexes. 
  • MRI (Magnetic Resonance Imaging): To get a detailed look at the spine and spinal cord, Magnetic Resonance Imaging (MRI) may be conducted. The MRI uses magnetism and radio waves to generate computer images of the spinal cord. To get added detail of any cancers present, the radiologist may have gadolinium injected into the vein. This substance makes cancer cells appear brighter in the imaging, making it easier to confirm the presence and location of spinal tumors.
  • CT Scan: To acquire additional imaging of the spine, technicians may perform a CT scan, or CAT scan as it is sometimes known. After a dye is swallowed or injected to help the region show up more clearly, three-dimensional images are created using computerized x-rays. 
  • Myelogram: If an MRI or conventional CT does not yield enough data, a myelogram may be ordered. A contrast dye is first injected directly into the spinal column. This dye moves through the spinal cord and spinal nerves, appearing as white on an x-ray or CT scan. It is often effective in identifying compressed nerves.
  • PET Scan (Positron Emission Tomography Scan): A PET scan is highly effective in locating malignant tumor cells in the region. To increase the accuracy of the scan, radioactive glucose is injected into a vein. Cancerous tumor cells consume more energy than noncancerous cells, so the areas show up as bright spots on the PET scanner’s imaging. 
  • SPECT Scan (Single Proton Emission Computed Tomography Scan): With its special camera connected to a computer, SPECT scans can make highly detailed images in three dimensions. To enhance the imaging, a radioactive substance is added to your bloodstream. Areas with increased blood flow and more chemical reactions show where cancer could be growing.
  • Angiogram: Used to find abnormalities of blood vessels supplying the spine, a spinal angiogram requires several rounds of imaging to complete, each needing multiple injections through a catheter that has been fed into the spinal arteries.

If initial tests detect an area of interest, a biopsy may be required. This is the only way to determine the type and growth rate of the spine or spinal cord tumor. Depending on the tumor’s location and the patient’s health, the biopsy will be conducted one of two ways. The preferred method is a needle biopsy that uses image guidance technology to direct the needle into the tumor area of the spine. Tumor specimens can also be obtained using open surgery, which is far more complex with associated increased risks. 

Once the tissue sample is retrieved, it will be analyzed under a microscope by a highly trained pathologist who will grade the tumor based on its type and extent, or aggressiveness.

Grading Spine and Spinal Cord Tumors

The World Health Organization approved today’s generally accepted spinal tumor grading system in 1993. Tumors may be classified as low-grade (slowly growing) or high-grade (rapidly growing), change grades as they progress, or become a different type of tumor altogether.  Spine and spinal cord tumors are not “staged” as most people think of today.

Grade I -  grows slowly and generally does not spread to other parts of the brain.  It is often possible to surgically remove an entire grade I benign tumor, but this type of tumor may be monitored periodically, without further treatment. 

Grade II - grows slowly, sometimes into surrounding tissue, and can become a higher-grade tumor.  Treatment varies according to tumor location and may require chemotherapy, radiation, or surgery followed by close observation. 

Grade III - considered malignant and can spread quickly into other tissue.  Tumor cells will look different than those in surrounding tissue.  Aggressive treatment, often using a combination of chemotherapy, radiation, and/or surgery, is required. 

Grade IV - invade nearby tissue very quickly and are difficult to treat.  The cancerous tissue will look very different from surrounding tissue.  Aggressive treatment is required.

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Types of Spine and Spinal Cord Tumors

Like brain tumors, spinal tumors are caused by abnormal cell growth, either in the spine or next to the spine. Researchers are unsure what causes the cells to grow abnormally, but the tumors can either become benign (noncancerous) or malignant (cancerous).

While rare, these types of tumors can be extremely serious. Depending on the form they take and their type, a tumor in this region can lead to spinal canal compression, which can cause paralysis or even death if left untreated.

If you are diagnosed with a type of spinal tumor, know the specialists at the Florida Hospital Brain and Spinal Cancer Program have the experience required to effectively treat the disease using the latest technologies and techniques available, including access to clinical trials and comprehensive rehabilitation and recovery services.

There are four main classifications of spine and spinal cord tumors. They are categorized according to whether they are cancerous or noncancerous, by location, and by their ability to spread (metastasize) from one part of the body to another:

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Primary Benign Spinal Tumors

Originating in the spinal cord itself, primary benign tumors aren't cancerous, but they can cause significant problems due to the pressure they place on the spine. It's crucial that the tumors are treated effectively by a skilled team that understands their unique characteristics.

To date, the causes of primary benign tumors aren't understood, but doctors and researchers at the Florida Hospital Brain and Spinal Cancer Program continue to look for new ways to treat the disease with the hope of not only finding a cause, but a cure.

Following are the most common primary benign spinal tumors:

Enostosis (En-os-toe-sis)

Also known as a bone island, enostosis occurs most frequently in the thoracic and lumbar part of the spine, usually between T1 and T7 and L1 and L2. Usually, these lesions are are discovered early as part of other routine examinations. Most remain stable, though some may grow slowly.

Osteoid Osteoma (Os-tea-oid Os-tee-oh-ma

Sixty percent of all incidences of osteoid osteomas can be found in the lumbar region, 27% in the cervical region, 12% in the thoracic region and 2% in the sacral region. These tumors are actively symptomatic, causing painful scoliosis, radicular pain, gait disturbances and muscular atrophy, particularly at night. On a plain x-ray, osteoid osteomas appear as round or oval with a surrounding rim of hardened bone.

Osteoblastoma (Os-tea-oh-blast-oh-ma)

Similar in appearance to osteoid osteoma, it is behaviorally different. Osteoblastomas occur in patients between the ages of 20 and 40, predominantly males. The tumor can be found equally in the cervical, thoracic and lumbar segments of the spine. Most people show symptoms such as back pain which is increased by motion, neurologic abnormalities, or weakness.  In particularly aggressive cases, osteoblastoma will cause bone destruction and invade surrounding tissue. The recurrence rate of conventional osteoblastomas is 10-20%.

Aneurysmal Bone Cysts (An-you-ris-mal)

Known as ABC for short, aneurysmal bone cysts affect young patients - 8 out of 10 ABC diagnosis are given to patients younger than 20. They are blood-filled, tumor-like cysts that expand the bone, giving it the appearance of being "blown out." Aneurysmal bone cysts can involve the entire vertebrae it started in and invade others as well. While benign, they can be fairly destructive in the area they inhabit and there is a high likelihood they will reoccur.

Osteochondroma (Os-tea-oh-chon-dro-ma)

This is a benign tumor that usually occurs near the end of a long bone, such as those in the spine. Containing bone and cartilage, this tumor is one of the most common forms of benign bone tumors. Osteochondromas don't spread beyond the affected bone and rarely change into a malignant condition down the road, but the osteochondromas in the spine have a higher risk of malignancy.

Giant Cell Tumor

These tumors are extremely rare. Only one person in every million is diagnosed with this type of cancer. It is characterized by its large, multi-nucleated cells, hence the name. Giant cell tumors are solitary, can be quite destructive locally and typically affect adults between 20 and 40 years of age. While considered benign, giant cell tumors in the spine can spread elsewhere. However, this type of tumor is rare, accounting for only 7% of all giant cell tumors in the body.

Even if these tumors are benign, they can still cause complications and should be treated by a specialist. You should consult with your doctor to confirm the presence of the tumor and obtain treatment for it so early symptoms worsen, preventing the best possible outcome. The doctors at the Florida Hospital Brain and Spinal Cancer Program will be happy to perform a complete examination and develop a treatment plan that is sensible and effective for any benign spine or spinal cord tumor diagnosis.

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Primary Malignant Spinal Tumors

Primary malignant tumors - tumors that originate in the spine - are far less prevalent than their benign counterparts. In fact, primary malignant spine tumors account for less than 5% of all primary bone tumors.

Because malignant tumors are cancerous, they add a special element to how doctors must approach your treatment. Any spinal tumor can seriously affect your mobility and, if left unchecked can cause permanent paralysis and even death.

Following are the major primary malignant spinal tumors:

Chondrosarcoma (Kan-dro-sar-coh-ma)

Accounting for 7 to 12% of all spine tumors, chondrosarcomas can occur at all levels of the spine but most often occur in the thoracic spine area. The average age of adults diagnosed with chondrosarcoma is 45 years old.Patients often have pain, notice a palpable mass or have neurologic issues.

Ewing sarcoma (Yoo-ing sar-coh-ma)

Ewing sarcoma is a very rare primary malignant spine tumor in children and adolescents, typically between 10 and 20 years old. Only about 250 cases are diagnosed each year. A combination of chemotherapy and radiation therapy is often used to combat the tumor spreading.

Osteosarcoma (Os-tea-oh-sar-coh-ma)

Osteosarcomas are relatively rare and typically occur in patients who are male and in their 40s. These lesions account for only 5% of all malignant tumors of the spine. Most often, patients diagnosed with this form of spinal tumor report pain, some sensory deficits and a mass that could be felt. This type of tumor can be aggressive and should be diagnosed and treated quickly.

Chordoma (Core-doh-ma)

This is a rare tumor that represents about 1% of all malignant bone tumors. It is fairly slow growing, but do not often spread to other parts of the body. Most chordomas form at the base of the spine, in the tailbone or at the base of the skull. While chordomas can form in younger patients, the average age for patients with this tumor is 55. Patients often do not readily recognize the symptoms which can include incontinence, changes in bowel habits, or headaches, depending on the tumor's location.

Multiple Myeloma (My-e-loh-ma)

Typically affecting middle and older aged people, patients diagnosed with multiple myeloma often visit their physician complaining of back pain. Upon further examination, it is discovered that the patient has a back fracture as a result of the tumor degrading the spine. Multiple myelomas are usually very responsive to radiation therapy and chemotherapy. Surgery may be required to stabilize the region if the vertebrae in the spine have been severely compromised by the tumor and can't provide adequate support.

Solitary Plasmacytoma (Plas-mah-sy-toe-ma)

Similar to multiple myeloma in characteristics, solitary plasmacytoma is a single lesion that affects the spine or other bones. Because they can eventually evolve into multiple myeloma, doctors often monitor their patients for many years after treatment. This type of tumor typically affects men over the age of 55, but women and other ages can also be diagnosed with solitary plasmacytoma.

Since the cause of primary malignant tumors is not completely understood, doctors at the Florida Hospital Brain and Spinal Cancer Program continue to research their causes and refine their treatments, including improving methods for the early detection and accurate diagnosis of malignant spinal tumors.

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Metastatic Tumors in the Spine

Some tumors begin elsewhere in the body and then move to the spine and spinal cord region. These tumors are known as metastatic tumors since they metastasize (move) to the spine from another point of origin.

The most common cancers that metastasize to the spine are:

  • Prostate
  • Breast adenocarcinoma (add-no-car-see-no-ma)
  • Lung adenocarcinoma
  • Renal cell carcinoma
  • Gastric carcinoma

The most likely cancer to metastasize to the spine is prostate cancer. Lung cancer is the most common primary lesion in patients whose spinal metastases were detected before the diagnosis of the primary lesions. Each form of cancer spreads at a different rate. For example, the shortest timeframe from diagnosis to spinal metastasis is lung cancer. The longest is breast cancer.

Doctors at the Florida Hospital Brain and Spinal Cancer Program are well versed in metastatic tumors and can monitor their evolution through state-of-the-art diagnostics and detection methods. Early detection followed by effective treatment offers you the best chance of minimizing the effects of metastasizing spinal tumors.

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Request an Appointment

Contact one of our Cancer Care Coordinators to schedule an appointment at FHCI. You can call a coordinator at (407) 303-1700 between 8 a.m. and 4 p.m. (Eastern Time) Monday through Friday. Or fill out our online assistance form and one of our coordinators will get back to you within one business day.

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