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Neuroscience Services - Spinal Cord Tumor
Tumors of the spinal cord can be classified by their location within the spinal canal or by their cell type. When classified by their location, the tumor may be described as extradural, intradural, medulla, extra-medullary and intramedullary. When tumors are classified by cell type they may be described as metastatic, meningioma, neurofibroma, lymphoma, ependymoma or astrocytoma.
Of the central nervous system tumors, spinal cord tumors are less common than brain tumors *-- approximately 10,000 Americans are diagnosed with either primary or metastatic spinal cord tumors each year. They affect people of all ages, but are most commonly found in young to middle-aged adults.
Symptoms
Some symptoms of spinal tumors are due to the compression of the spinal cord. They may come on gradually, and include:
 motor problems: including muscle weakness, spasticity, impaired bladder and/or bowel control; could develop into muscle wasting, paralysis and ataxia (abnormal walking rhythm).
pain: which may be severe and is often constant; may have a burning or aching quality.
sensory changes: numbness and decreased skin sensitivity to temperature changes.
Generally speaking, symptoms affect the body at or below the level of the tumor. For instance, a tumor midway along the spinal cord (thoracic spine) may cause pain throughout the chest area; a tumor located in the top fourth of the spinal column (cervical spine) may cause pain in the neck and arms; a tumor in the lower (lumbar spine) area can cause leg or back pain.
Testing
The most critical first step in diagnosing a spinal cord tumor is an accurate history and physical examination to help quickly pinpoint the affected area. This will include the testing of such functions as: motor, sensory reflexes, and reflexes of the arms and legs as well as balance and gait.
For a more detailed assessment, this preliminary exam may be followed by x-rays and:
CT (Computed Tomography) scan: This is a combination of an x-ray device and a computer. X-rays are taken of the brain, and this information is fed into a computer which transforms the data into a picture. In some cases, the patient is injected with a special dye to make abnormal tissue more evident. (MRI of the spine is much more commonly used than the CT scan.)
MRI (Magnetic Resonance Imaging): This procedure uses a tunnel-shaped piece of equipment that contains a magnetic field and radio energy; no x-rays are involved. Magnetic signals are fed into a computer which assembles a picture. Because the MRI ignores bone which can obstruct CT images, this device provides a clearer picture of tumors located near the bone, and can provide a wider variety of image angles. It can detect edema (swelling), but has difficulty distinguishing edema from tumor.MRI imaging takes longer than a CT scan, and is very noisy. Patients with cardiac monitors, pacemakers or surgical clips cannot take an MRI because of conflict with the magnetic fields.
Lumbar puncture: Also known as a 'spinal tap,' this procedure is used to obtain a sample of spinal fluid. The sample is examined to detect the presence of tumor cells, infection, protein or blood. This process is more commonly used with an intraspinal dye injection called a myelogram, to test for spinal tumors.
Treatment
Treatment of spinal tumors depends on whether the tumor is primary or metastatic, as well as its exact location and type.
Surgical
Surgery is the treatment of choice for intradural and extramedullary tumors. Malignant, partially resected or inoperable tumors may be treated with radiation therapy and/or chemotherapy.
Microsurgery is any surgery performed with the assistance of a microscope. It has improved several standard neurosurgical procedures, such as the removal of certain spinal tumors, and has allowed for the removal of some tumors that previously were inaccessible or dangerous to remove.
Stereotactic image-guided surgery, which allows the surgeon to pinpoint a specific target with greater accuracy than ever before, using three-dimensional coordinates and special instrumentation. It can be used for spinal fusions and to remove small tumors.
Lasers, which use focused light energy, can be used in place of a scalpel to remove a tumor or destroy remaining tumor tissue.
Non-surgical
Ultrasonic aspiration, to help break up and remove the tumor.
Ultrasound, to help localize the tumor at the time of exposure.
Steroids control the swelling due to accumulation of fluids associated with spinal tumors. They may be administered temporarily following surgery or during radiation to reduce edema, or they may be used long-term for relief of symptoms.
Chemotherapy uses special chemicals to poison tumor cells, which are more vulnerable to chemicals than healthy cells. It may be used before, during or after surgery and radiation therapy. Dozens of new chemotherapeutic drugs are being studied and tested to determine their effectiveness in improving survival and recovery. If you meet the criteria for a clinical trial, your physician can offer you the option of participating in the research.
Radiation
This treatment is often used as follow-up after surgery to eliminate remaining tumor cells, or may be used to treat tumors that cannot be operated upon. Because many tumors are radio-sensitive, their cells die when exposed to radiation. Conventional radiation uses external beams of either x- or gamma- rays aimed at the tumor, a process conducted over several weeks.
Research
There is a great deal of ongoing research in the U.S. involving better and more effective treatments for brain tumors. As their effectiveness is proven, they will be incorporated through the Sentara Neuroscience Network. Promising areas of research include:
gene therapy, a new area of active cancer research, may lead to new treatments for (or prevention of) spinal tumors. Proto-oncogenes are genes that direct normal growth and development. Alterations in these genes may activate them into oncogenes, which cause cancer. Gene therapy research concentrates on identifying oncogenes and determining what series of events activates them.
immunotherapy research, examining ways to stimulate and boost the body's immune system.
use of monoclonal antibodies (multiple copies of a single antibody) to pinpoint and destroy specific tumor cells. Currently, scientists are looking at this application for treating widespread cancer rather than solid tumors. They can also be used in combination with tracers to make tumor cells more visible and improve the ability to diagnose spinal tumors.
ways to make chemotherapy more effective for brain and spinal cord tumors by overcoming what scientists call 'the blood-brain barrier.' This network of blood vessels and cells filters the blood to the Central Nervous System to protect and insulate these (CNS) tissues from potentially dangerous changes in the environment and compounds in the bloodstream. But this protective barrier can also prevent anticancer drugs from reaching their target, so scientists are developing drugs to help open the barrier.
Prevention
Scientists do not know what causes most primary spinal cord tumors. Viruses, defective genes and certain chemicals are all being explored and researched as possible culprits, but until the causes have been identified there is no known way to prevent developing a spinal cord tumor.
Support Groups/Resources
Many patients and families find great comfort and support in talking with other patients, families and caregivers who have had (or are having) similar experiences. Support group meetings are free of charge, and are facilitated by a trained peer or qualified professional. For more information, or to find a support group nearest you, call:
The National Spinal Cord Injury Association:
1-800-962-9629
The National Spinal Cord Injury Hotline:
1-800-526-3456
The American Association of Spinal Cord Injury Nurses:
(718) 803-3782
The Spinal Cord Society:
(218) 739-5252
Spinal Network:
1-800-338-5412
The American Cancer Society:
1-800-ACS-2345
The National Institute of Neurological Disorders and Stroke:
1-800-352-9424
The National Cancer Institute:
1-800-422-6237
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