Spinal tumours: types, symptoms and treatment

A tumour is a lump formed when cells keep dividing out of control. The Christie explains that a benign tumour can keep growing but cannot spread elsewhere, while a malignant tumour can grow into and destroy nearby tissue. In the spine, even a benign tumour can cause problems because the space is narrow and the nerves are delicate.

Macmillan describes primary spinal cord tumours as those that start in the spinal cord, the nerves branching from it, or the layers of tissue that protect the brain and spinal cord, called the meninges. Tumours that have spread from elsewhere in the body are called secondary or metastatic and are treated differently.

Where a tumour sits tells doctors a great deal about its likely type. The Christie groups spinal tumours into three positions, and adds secondary cancers in the spinal bones as a separate category.

Macmillan says symptoms depend on the position of the tumour and often come from pressure on the spinal cord or nerves. It lists weakness and numbness in the arms and legs, clumsiness or difficulty walking, back or neck pain, aching in the spinal area, arms or legs, tingling or pins and needles in the hands or feet, loss of bladder and bowel control, and sexual problems such as erectile dysfunction.

The Christie notes that tumours in the lower part of the spinal cord may cause loss of bladder and bowel control. Most back pain has nothing to do with a tumour, but pain that is getting worse, wakes you at night, or comes with new weakness or numbness should be assessed promptly.

• Back or neck pain that keeps getting worse or does not go away.

• New weakness, numbness or tingling in the arms or legs.

• Difficulty walking or new clumsiness.

• Difficulty passing urine or opening the bowels, or loss of control.

Cancer Research UK describes metastatic spinal cord compression as pressure on the spinal cord from cancer that has spread to the spine. It says this is an emergency that needs treating quickly. Pain is often the first symptom, affecting more than 90 in 100 people with it.

The pain may be anywhere in the back, spine or neck, may feel like a tight band around the body, can worsen with coughing, sneezing or going to the toilet, can wake you at night and may be worse lying flat. Other symptoms include leg or arm weakness, difficulty walking, numbness, and bladder or bowel problems.

Anyone with cancer who develops these symptoms should contact their hospital team straight away using the emergency number they were given, or their GP or nearest A&E if they cannot get through. Cancer Research UK says an urgent MRI is usually done within 24 hours and treatment starts as soon as possible, usually within 24 hours of diagnosis.

Macmillan says the causes of spinal cord tumours are unknown, though research continues. In a small number of cases they are linked with inherited conditions, namely neurofibromatosis syndrome and von Hippel-Lindau syndrome, which raise the risk of some types.

Secondary tumours in the vertebrae come from cancers elsewhere. The Christie names lymphoma and lung, breast and prostate cancer as the commonest primaries to spread to the spinal bones.

Macmillan says doctors need to know the type, position and size of the tumour to plan treatment. You will have an MRI or CT scan, an examination of the nervous system including reflexes and the power and feeling in the arms and legs, and blood tests to check general health.

Doctors may also describe the grade of a tumour, which reflects how abnormal the cells look. Macmillan says most spinal cord tumours are low grade, grow slowly and do not usually spread to other parts of the brain or spine. High-grade tumours grow faster and can grow into nearby tissue.

UCLH describes how its spinal MDT, a meeting of spinal neurosurgeons, neuroradiologists, oncologists, expert nurses and therapists, reviews scans and plans the best treatment for each person.

Macmillan lists the main treatments as surgery, radiotherapy and steroids, with the choice depending on general health, the size, position and type of the tumour and the symptoms. A team of specialists plans treatment.

Surgery is the main treatment for many types. If the tumour cannot be removed completely, debulking surgery may remove part of it to relieve pressure, and a biopsy identifies the type. Radiotherapy may be the main treatment when surgery is not possible, or follow surgery if the tumour cannot be fully removed. Steroids, most often dexamethasone, can reduce swelling around the tumour and ease symptoms, and should not be stopped suddenly.

For a slow-growing, low-grade tumour that is not causing problems, active monitoring with regular MRI scans may be suggested. Macmillan says chemotherapy is rarely used for spinal tumours.

Recovery depends on the tumour, the treatment and how much nerve function was affected. UCLH says spinal tumours can affect the messages from the brain to the rest of the body, which may affect movement and independence, and describes specialist therapy services for those who need them.

Macmillan says anyone with a driving licence must tell the DVLA or, in Northern Ireland, the DVA that they have been diagnosed with a spinal tumour. Support is available from Macmillan and charities including The Brain Tumour Charity, Brainstrust and the Spinal Injuries Association.

On the NHS, people are usually referred to a neurosurgical or oncology team that works with a spinal MDT. Urgent spinal cord compression is managed through emergency pathways and is not delayed by referral routes.

A private spinal surgeon or neurosurgeon may be consulted for imaging and an opinion, but complex tumours are generally discussed in a multidisciplinary team. Ask who will be in the team, how the tumour type was confirmed, and what follow-up scans will be needed.