Metastatic disease occurs when cancer from one site in the body spreads to another area. The spine is a common area for the spread of cancer and can cause a variety of neurological and bone related symptoms.
Who gets Metastases of the Spinal Cord?
The spine is a common site for metastasis in patients with cancer. One study found that 30-70% of cancer patients had spinal metastases at autopsy.
Predisposing Factors
Metastases of the spinal cord commonly originate from cancers occurring in the lung, breast, gastrointestinal tract, prostate and lymphomas (such as Hodgkin's lymphoma).
Progression
The spread of cancer from a primary (original) site such as from the breast or lung usually occurs through the blood supply, although the exact process is not well understood. As the cancer grows in size, it can compress the surrounding structures and cause damage to the spinal cord.
Probable Outcomes
The long term outlook for patients with spinal metastases is generally poor, as often the disease has progressed to an advanced stage by the time a diagnosis is made. Outlook in terms of survival and prospective quality of life varies according to the amount of function the patient has at the time of diagnosis. For instance, being able to walk is a good sign, whilst loss of bladder and bowel control is a poor sign.
How is Metastases of the Spinal Cord Diagnosed?
x-ray of the spine may be normal but sometimes show destruction of bone associated with cancer.
CT or MRI scanning is commonly performed to identify the site of spinal cord involvement and to see how far the cancer has spread.
The MRI scan to the left illustrates multiple vertabral metastases causing spinal cord compression.
Sometimes a procedure is performed to remove fluid from within the spine. This is examined under a microscope and often found to have abnormally high levels of protein in the setting of spinal metastases.
How is Metastases of the Spinal Cord treated?
The primary aims of therapy are to control pain and to preserve function as much as possible. Spinal cord compression must be diagnosed and treated immediately to prevent permanent damage. Standard treatment consists of high dose steroids, with 70-80% of patients experiencing improvement of symptoms within 48 hours. Radiation therapy is usually used for treatment of spinal metastases. Surgery is not usually performed unless it is to decompress (if the spinal cord is being compressed by the growing tumour) or stabilise the spine. Cyberknife Surgery Shows Promise in Spinal Metastases : -
Presented at ECCO
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