Spinal axis tumors
Spinal axis tumors are rare cancers that occur in the spinal cord and represent a small percentage of primary neoplasms in the central nervous system (CNS), making up about 4 to 15 percent of such cases. While many spinal tumors are benign, the most common types include schwannomas and meningiomas, with the majority being metastatic tumors arising from primary cancers in other body parts, such as the breast, prostate, and lung. These tumors can be classified based on their location within the spinal column: extradural (outside the dura mater), intradural (within the dural matrix), and intramedullary (inside the spinal cord).
Risk factors for developing spinal axis tumors include exposure to certain industrial chemicals, genetic conditions, and childhood exposure to electromagnetic radiation. Symptoms of spinal tumors often relate to spinal cord compression, leading to back pain, incontinence, and sensory changes. Diagnosis typically involves imaging techniques like MRI, CT scans, and sometimes biopsies. Treatment usually involves surgical intervention, with additional therapies such as radiation or chemotherapy if complete tumor removal is not feasible. The prognosis for spinal axis tumors varies significantly based on tumor type and characteristics, with benign tumors generally having a better outlook compared to more aggressive forms.
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Spinal axis tumors
ALSO KNOWN AS: Spinal tumors, osteoid osteomas, osteoblastomas, osteochondromas, giant cell tumors, chondroblastomas, vertebral hemangiomas, aneurysmal bone cysts, multiple myeloma, solitary plasmacytomas, osteosarcomas, Ewing sarcoma, soft-tissue sarcomas, chordomas, chondrosarcomas, central nervous system tumors
Related condition: Central nervous system metastasis
DEFINITION: Spinal axis tumors are rare cancers of the spinal cord, an integral component of the central nervous system (CNS). Spinal tumors constitute between 4 and 15 percent of all primary neoplasms (tumors) in the central nervous system. The most common primary spinal axis tumors, which are usually benign, are schwannomas and meningiomas. The majority of spinal tumors are metastases from primary neoplasms elsewhere in the body, most commonly, the breast, prostate, and lung. Spinal cord tumors can be classified according to their location in the spinal column. Extradural tumors are those that occur outside the dura mater lining. Intradural tumors occur within the dural matrix, and intramedullary tumors occur inside the spinal cord.
Risk factors:Vinyl chloride (also known as vinyl chloride monomer, or VCM, and chloroethene in the International Union of Pure and Applied Chemistry literature) has been implicated in the development of gliomas. VCM is an industrial chemical chiefly used to produce its polymer, polyvinyl chloride (PVC). VCM is a toxic, colorless gas at room temperature with a sickly-sweet odor. Once polymerized, it is stable and nonhazardous. Billions of pounds of PVC are produced annually and used in products, such as PVC pipes (used in construction) and bottles. VCM was used as an anesthetic until its toxic effects were uncovered. Genetic conditions, compromised immune systems, and childhood exposure to electromagnetic radiation are other risk factors.
Etiology and the disease process: Considerable advances have been made about the genetic and environmental factors involved in tumors. However, information about spinal tumors still needs to be made available. Spinal tumors have been found to contain abnormal genes, but the causes of the genetic alterations remain unclear. Some of the better-established hereditary (familial) models include neurofibromatosis 2 and von Hippel-Lindau (VHL) disease.
Incidence: The Central Brain Tumor Registry of the United States reported in 2023 the incidence rate of all primary brain and CNS tumors is 24.83 cases per 100,000 people. The American Association of Neurological Surgeons reported that primary spinal tumors are generally rare compared to those that originate in the brain. It estimates that about 10,000 Americans develop primary or metastatic spinal cord tumors annually. However, incidence depends on age, with bimodal distribution. The first peak occurs among children aged four and younger, and the second peak rises gradually from about age twenty-four and plateaus between the ages of sixty-five and seventy-nine. The incidence for each type of spinal tumor is also age-dependent. Low-grade astrocytomas (primary intracranial tumors derived from astrocyte cells of the brain) are common among children. Gliomas (tumors that arise from glial brain cells) tend to afflict adults, particularly those between the ages of forty and sixty. Certain spinal tumors are more common in one gender than the other.
Symptoms: Clinical signs and symptoms reflect sequelae of spinal cord compression. Back pain in the middle and lower back, incontinence, and decreased sensitivity in the buttocks are warning signs of spinal nerve compression. The pain may spread beyond the aforementioned regions to the hips, legs, feet, or arms and may continue to worsen even with treatment. Depending on the location and type of tumor, other symptoms include pain and temperature sensation, muscle weakness, difficulty with locomotion, and scoliosis (spinal deformity) may develop.
Screening and diagnosis: Spinal tumors are often overlooked because of their rarity and because their associated symptoms resemble more common conditions. Spinal magnetic resonance imaging (MRI) is commonly used for diagnostic purposes. Less commonly, computed tomography (CT) scans are used alone or in combination with contrast dyes and myelograms. A positron emission tomography (PET) scan may also be used. Biopsies (small tissue sampling technique) are conducted to determine the malignancy and grade (aggressiveness) of the tumor. In patients with known metastasis, particularly those with back pain, bone scans are used to confirm or exclude spinal metastasis.
Treatment and therapy: Surgery is usually the recommended treatment, and surgical innovations continue to be made in the treatment of spinal axis tumors. Radiotherapy or chemotherapy is used in cases in which the tumor is incompletely resected or when lesions are discovered. Although corticosteroids do not affect the tumors, they are commonly administered to reduce inflammation following surgery or radiation treatments. They are usually used for short durations to minimize the risk of osteoporosis, high blood pressure, diabetes, and infection. Advances in understanding the genetic and molecular components of spinal axis tumors have led to an increased in individualized and targeted therapies.
Prognosis, prevention, and outcomes: Prognosis varies depending on the type of tumor, the extent of invasion, and how much of the tumor can be resected. For example, the prognoses for meningiomas and schwannomas are good, moderate for gangliomas, and poor for glioblastoma multiforme. A spinal tumor can impinge on nerves and cause pain, edema, ischemia, infarction, motor and sensory deficits, including paralysis (below the level of the tumor), and death.
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