Timothy Ryken, MD
Department of Neurosurgery
University of Iowa Hospitals and Clinics

Creation Date: November 2000
Last Revision Date: December 2000
Peer Review Status: Internally Peer Reviewed

Spinal tumors cover a broad spectrum of disease states. The general categories include metastatic spinal tumors and primary spinal tumors. These two main categories affect the bones of the vertebral column. This topic also encompasses tumors that involve the spinal cord and spinal nerves. Many of these tumors require treatment in addition to surgical resection, primarily variations of radiation therapy. However, many of these tumors can be taken care of primarily through a surgical approach. Spinal tumors and conditions in general have greatly benefited from improvements in neuroimaging, particularly magnetic resonance imaging. The entire field of oncology is benefiting from rapid advances in molecular biology and the treatment of spinal tumor is no exception. Therefore in addition to exciting improvements in surgical techniques, the advances in neuroimaging and molecular biology should predict an exciting time in the development of new treatments for spinal cord tumors.

Can you tell me what diseases anasarca may be a common symptom?

Anasarca refers to severe generalized edema. This means severe swelling and retention of fluid in the soft tissues of the body. My experience with this has been limited to patients who have had problems with the lymphatic drainage of an extremity such as patients with breast cancer following lymph node dissection. I am not aware of a specific relationship with any one form of spinal tumor.

When should one suspect a problem with the spine... specifically what kinds of symptoms?

In one sense, the spine and the nerve associated with the spine and spinal cord serve as a rough "road map" to the location of problems. For example, burning pain shooting down a nerve associated with a leg may indicate a problem with that nerve close to its origin in the spine. The symptoms related to a spinal tumor can vary from local pain to a shooting pain down an arm or leg, and may include weakness or loss of sensation in the extremities. One very concerning sign of pressure on the spinal cord or nerve is problems with problems with bowel or bladder control. Although these symptoms occur with spinal tumors, we must remember that these are relatively infrequent in occurrence. These types of symptoms are more often the result of degenerative changes in t he spine such as bone spurs, arthritis, or degenerative disc disease.

Do you see it much in neurological conditions or does it lean towards other things?

In my experience I have not seen patients with neurologic conditions have an increase in anasarca. Anasarca is more of a general description of a swelling in soft tissues.

Are there any particular environmental causes that contribute to a higher risk of spinal tumors?

To my knowledge there is no solid evidence that certain environments cause increases in spinal tumors. Because there are a variety of spinal tumor types the incidence of these is often related more to the primary tumor, such as in metastatic spread of cancer to the spinal bone.

Can you describe the basic treatment of a patient with a spinal tumor?

The first thing we have to accomplish is to obtain a diagnosis. Much of the information required can be obtained from radiographic studies. The standard work up could include plain x-rays, CT and MRI scans and occasionally bone scans. However, no matter how many x-rays we take there is no alternative to obtaining a tissue diagnosis. Many times this requires either a biopsy or an open surgical procedure to obtain tissue. Once a diagnosis can be made these tumors can be divided into several treatment categories. The first issue is whether the tumor involves the bones of the spinal canal or the tissue of the spinal cord. If the bone is involved one must be concerned about the structural integrity of the spinal column. Many of these patients would present primarily with localized pain. Patients who have a tumor affecting the spinal cord or nerve tend to present with neurologic symptoms such as weakness, numbness or shooting pain down an arm or leg.

How are metastatic tumors to the spine treated?

The options for treatment include surgery, radiation and chemotherapy--which are similar to oncology diseases. Primarily the goals are to maintain neurologic function and eliminate symptoms that many times are related to pain from compression on nerve. Radiation can help to limit pain but doesn't always restore the stability to the spine that surgery can. Most of the time the process is best treated by treating the primary tumor.

How many radiation treatments can one have to those sites?

The tolerance of the central nervous system tissue is variable and the total amount of radiation is the important issue. For most purposes, the total dosage to the spinal column should be maintained between four and six thousand RADs. This is carefully monitored by the radiation oncologist treating these patients.

Why does pain often increase with radiation for a while?

Usually the goal of radiation is to treat pain coming from metastatic tumors. I agree that patients often notice an increase in discomfort for a period of time. I believe this is related some increase in swelling as the radiation begins to affect the tumor cells. It usually improves as the treatments continue.

Would the use of a steroid decrease the pain, and if so why isn't used?

Typically I do use a steroid or at least a non-steroidal anti-inflammatory to help with pain during radiation. There may be concerns over the side effects of these medications, complicating treatment in some situations.

What new treatments for spinal tumor are on the verge of clinical use?

There are two main areas of exciting advances. One group involves improvement in surgical stabilization. This would include the use of biologic agents to reconstruct and improve the rate of healing for spinal instability resulting from spinal tumors. The other big are relates to the biologic treatments of the cancer cells themselves. For example, genetic therapies targeted specifically to the tumor tissues are becoming closer and closer to clinical trials. Major advances in spinal reconstruction have allowed many patients to remain ambulatory longer than previously possible.

Can you explain with the onset of severe pain happens suddenly? Almost like one day there is no pain or only minimal pain and the next day the pain is intolerable. I am referring to metastatic disease.

When my patients tell me they've had major change in their pain pattern I become concerned that they may have had a fracture or a bone involved with the tumor. Although patients often notice fluctuations in the level of pain from day to day, if it truly is a dramatic alteration, I think fracture of the bone must be considered.

Do the genetic therapies involve surface protein receptors or some other biological markers to signal immune responses to cancer cells versus normal brain cells?

Pretty much every biological aspect of tumor cells has been targeted in one fashion or another. In terms of brain tumor therapies, the surface proteins appear most promising. In terms of spinal column tumors, metastatic tumors in particular, the treatment is more focus toward the underlying tumor type such as lung or breast cancer.