Initial symptoms can vary. They can include pain and sensory changes (eg numbness) and motor problems (eg muscle weakness and spasticity). The parts of the body which may be affected by these symptoms may vary according to the location of the tumour along the spinal canal.
Several neurological tests will be performed. If necessary you will also have an MRI (magnetic resonance imaging) scan. This will show the spinal cord in detail.
If a spinal cord tumour is diagnosed the most common form of treatment is for it to be removed by surgery. This will be carried out by a neurosurgeon. In some cases it isn’t possible to remove the whole tumour and the growth of the residual tumour is usually monitored by regular MRI scans. Sometimes surgery isn’t recommended because the damage it might do to the nervous system is considered too risky, and your consultant will discuss your options with you following your diagnosis.
Long term effects of benign spinal cord tumours
This can be very difficult to predict. Sometimes the nerves can recover to some extent but in other cases there may be some permanent nerve damage.
We would like to thank Professor Richard Hayward who has very kindly written the information below for us. He tells us about the different categories of spinal tumours and describes the types of tumours which can grow in each category. He also explains the difference between benign and malignant tumours.
By Richard Hayward
Professor, Paediatric Neurosurgery
Emeritus Consultant Neurosurgeon,
Spinal tumours are traditionally divided into three categories according to their relationship to the spinal cord, its surrounding membrane (the dura) and the bones (vertebrae) of the spine.
These categories are:
And a word about benign and malignant,
Benign tumours tend to be slowly growing, are often well-demarcated from the surrounding normal tissues (making them easier to remove completely) and do not spread (metastasize) around either spine (or brain) or the rest of the body.
Malignant (which usually means cancerous) tumours are usually rapidly growing and tend to have extensions into the adjacent normal tissues making them difficult to remove completely unless some of that normal surrounding tissue can be sacrificed without causing harm (not the case when it comes to the spinal cord or brain). They can also spread (often through the bloodstream) to other parts of the body.
Any tumour that has been completely removed surgically cannot (by definition) recur. But if fragments (even those too small for the surgeon to see) remain after the operation (which is more likely with malignant tumours but can happen also with a benign tumour) then further growth is likely.
These arise within the spinal cord itself and are rare. The two types most commonly seen are the astrocytoma and the ependymoma.
An important variant is the myxo-papillary ependymoma. This is more rapidly growing than the “classic” ependymoma desribed above. It usually arises from and spreads over the lowest part of the spinal cord (the conus medullaris). It is a soft, easily fragmented tumour that is difficult to remove completely. Fortunately it is extremely sensitive to radiotherapy which is usually curative.
Other even more rare intramedullary tumours include the Neurocytoma and the Ganglioglioma. Both are very benign and may show little growth over many years.
These arise within the space between the spinal cord and the dura. The two types most commonly seen in this location are the meningioma and the neurofibroma.
Neurofibromas can sometimes be part of a more generalized tendency for the body to produce this type of tumour – a condition called neurofibromatosis that sometimes runs in families.
Extra-dural tumours are the most common spinal tumours and usually arise in the bone (vertebrae) themselves. Although some are primary (have started life there), the great majority are metastases (tumour spread) from a malignant tumour whose primary site is elsewhere.
Although this website deals predominantly with benign spinal tumours, some mention of the malignant types is made here.
Treatment has two aims – control of the underlying primary malignant disease and control of the local (spinal) disease. The latter may require an urgent surgical decompression with or without an orthopaedic input (to strengthen the weakened spine) followed by local (often palliative) radiotherapy. The outlook for regain of useful leg function depends on the diagnosis being made before all use of the legs and bladder has been lost. The overall outlook (ie for life) depends on what if anything can be done to control the underlying primary malignant disease.
Primary bone tumours that can affect the spine include the highly malignant tumours osteogenic sarcoma and Ewing’s tumour. Their treatment usually involves a combination of surgery, radiotherapy and chemotherapy.