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