Spine Tumors
Updated: Nov 26, 2020
For people who have severe back pain, it is natural to wonder whether or not the pain might be a sign of spinal tumor. While most back pain is unrelated to cancer or tumors, it is possible and important to check out.
This article explains when back pain may be related to a spinal tumor, how to get an accurate diagnosis, and what to consider for treatment options.
Types of Spinal Tumors
A spinal tumor is an abnormal growth of cells within the spinal column. These tumors may be cancerous (malignant) or noncancerous (benign). A cancerous tumor is composed of abnormal cells that continue to divide uncontrollably and have the potential to spread via the blood or lymphatic system.
There are 2 general types of spinal tumors:
Primary tumors originate in the spinal column. While most primary tumors are noncancerous, some are cancerous.
Secondary tumors, also called metastatic tumors, have spread to the spine from another part of the body. Metastatic tumors are cancerous.
Spinal tumors can also be classified by whether they are outside the spinal cord (extradural), within the spinal cord’s protective covering (intradural-extramedullary), or within the spinal cord itself (intramedullary).
How Spinal Tumor Pain May Feel
When back pain is caused by a cancerous spinal tumor, it typically:
Starts gradually and worsens over time
Does not improve with rest and may intensify at night
Flares up as a sharp or shock-like pain in the upper or lower back, which may also go into the legs, chest, or elsewhere in the body
Other signs and symptoms that could potentially indicate the origin of back pain from cancer include unplanned weight loss, nausea, fever, chills, or other troubling symptoms.
How Spinal Tumor May Cause Back Pain
Tumors in the spinal column may cause back pain by:
Expanding and/or weakening the bone
Causing the vertebrae to easily fracture
Compressing the spinal cord and/or spinal nerves.
Additional factors, such as spinal instability, may also be involved in spinal tumors causing back pain.
The Course of a Cancerous Spinal Tumor
Cancer is more likely to occur with age. People who are older than age 50 or previously had cancer are at an increased risk of developing a cancerous spinal tumor.
A cancerous spinal tumor’s rate of growth can vary depending on the type. A tumor may be relatively small and contained within the spine, or it could have already spread through blood or lymph (fluid that travels throughout the body) from another area of the body. An untreated cancerous spinal tumor is likely to keep growing and may become life-threatening.
Treatment options for spinal tumor may include surgical removal of the tumor, radiation therapy, chemotherapy and/or immunotherapy. In cases when the patient is unlikely to tolerate surgery well or has advanced cancer, palliative care may be offered to reduce pain and stay as comfortable as possible.
When to See a Doctor
When unexplained back pain persists for a couple weeks despite rest and/or self-care, it is typically recommended to visit a doctor (Neurosurgeon or Ortho-Spine Surgeon) for a medical evaluation. Severe back pain that interferes with daily activities, or any back pain that is accompanied by red flag symptoms such as nausea or weight loss, requires an immediate medical evaluation. For people who currently have or previously had cancer, any new back pain needs to be evaluated by a doctor immediately.
It is also important to note that back pain rarely turns out to be cancer. Getting an accurate diagnosis for back pain from a medical professional is an important first step toward finding an effective treatment plan.
Symptoms of a Spinal Tumor
While some spinal tumors have no symptoms, most eventually lead to back pain and could also cause neurological deficits, such as numbness or weakness. Spinal tumor symptoms can vary greatly based on where the tumor is located and whether or not it is cancerous.
Pain from a Spinal Tumor
Tumors in the spinal column may cause back pain by damaging healthy tissues, such as the vertebrae (bones), and/or by compressing (pinching) the nerves.
Spinal tumor pain may feel like one or more of the following:
Upper or middle back pain. While most spinal pain is located in the lower back or neck, pain from a spinal tumor is more likely to be felt in the upper or middle back. About 70% of spinal tumors are located in the thoracic spine.
Deep ache. Spinal tumor pain may feel like an achiness or discomfort deep within the back, rather than feeling painful on the surface or skin.
Sharp or shock-like pain. Pain from a spinal tumor may be limited to a specific region in the back, or it could travel along a nerve root (radicular pain) or the spinal cord (myelopathic pain). Shock-like pain could radiate into the chest, abdomen, leg(s), or arm(s).
Feels worse at night than during the day. Spinal tumor pain typically does not diminish with rest or activity avoidance, and it may intensify at night, causing disturbed sleep.
Feels worse in the morning when waking up. For some people, spinal tumor-related back pain may be at its worst when waking up in the morning.
Worsens with touch or compression. Pain may flare up or intensify when the spinal tumor or nearby region is touched or undergoes compression, such as during strenuous activity.3
Lower back or neck pain. About 20% of spinal tumors are in the lumbar spine(lower back) and about 10% are in the cervical spine (neck).
Spinal tumor-related pain may also be located in multiple levels of the spine, such as in the thoracic spine and lumbar spine, when there are multiple tumors or a tumor has become bigger.
Red Flag Symptoms with Back Pain
When back pain is accompanied by one or more of the following symptoms, it requires immediate medical attention.
Loss of appetite
Unplanned weight loss
Nausea or vomiting
Fever, chills, or shakes
These symptoms could indicate cancer or another serious condition is present.
Neurological Deficits from a Spinal Tumor
When a spinal tumor grows big enough to compress the spinal cord or a nerve root, neurological deficits can occur. Examples include:
Radiculopathy. When one or more nerve roots become compressed or inflamed, pins-and-needles tingling, numbness, and/or weakness can radiate into the chest, abdomen, leg(s), or arm(s). These signs can vary based on the location of the tumor within the spine. A thoracic spinal tumor is more likely to radiate symptoms into the chest or abdomen, whereas a lumbar spinal tumor is more likely to radiate symptoms into the legs.
Myelopathy. When the spinal cord becomes compressed or inflamed, neurological deficits may be experienced anywhere in the body at or below the level of spinal cord compression. For example, numbness or weakness could travel into both legs and reduce coordination for walking.
Cauda equina syndrome. When the cauda equina (bundle of nerve roots that descend from the spinal cord) becomes compressed in the lumbar spine, it can cause numerous neurological deficits beneath the level of compression, such as numbness or tingling in the saddle region (inner thighs, genitals, and buttocks), walking dysfunction, and/or loss of bowel and/or bladder control.
Spinal tumors may cause neurological deficits with or without back pain and/or leg pain.
Types of Spinal Tumors
There are 2 general types of spinal tumors that can cause pain: primary tumors and secondary (metastatic) tumors.
Primary spinal tumors originate in the spinal column, such as by growing in the bones, discs, nerves, or other elements within the spine. Primary spinal tumors are usually noncancerous (benign) and occur in younger people. Hemangiomas are among the most common benign primary spinal tumors. Osteosarcomas and multiple myeloma are two of the more common primary spinal tumors that are cancerous (malignant).
Secondary spinal tumors (metastatic tumors) are tumors that have spread to the spine from a cancer that has started elsewhere in the body. These tumors are the most common type in the spine and are cancerous (have the potential to spread further and are typically fast-growing). Cancerous cells from the lung, breast, and prostate are most likely to spread and become lodged in the spine.
Spinal Tumors by Location
Spinal tumors can also be classified based on their location inside or outside the spinal cord.
Extradural Tumor
A spinal tumor that forms outside the spinal cord’s outermost protective layer (dura) is known as an extradural tumor (epidural tumor). These tumors are commonly metastatic and have spread from cancer located in another part of the body.
Intradural-Extramedullary Tumor
An intradural-extramedullary (inside the dura) tumor grows under the outermost layer (dura) that covers the spinal cord but outside of the spinal cord. Usually these tumors are benign and slow-growing. They can cause symptoms of pain and weakness.
Common intradural-extramedullary spinal tumors are:
Meningiomas that occur in the membranes surrounding the spinal cord and are more common in women who are middle age or older.
Nerve sheath tumors (schwannomas and neurofibromas) that arise from the nerve roots that come off the spinal cord. These tumors may be present for many years before causing neurological symptoms.
Intramedullary Tumor
An intramedullary tumor grows inside the spinal cord and typically arises from the cells that provide physical support and insulation for the nervous system (glial cells). These tumors occur most often in the cervical spine (neck). They tend to be benign, and surgery to remove the tumor may be difficult. The two most common types of intramedullary tumors are astrocytomas and ependymomas.
Collecting as much information about the spinal tumor’s type and location, as well as the symptoms it is causing, is critical for reaching an accurate diagnosis.
Spinal Tumor Diagnosis
Getting an accurate diagnosis for a spinal tumor is important for determining an effective treatment plan. This process typically involves taking the patient’s history, performing a physical exam, medical imaging, and possibly a biopsy if a suspected tumor is found.
Patient History
Taking the patient’s history is an important first step when new back pain has developed. Some basic info is gathered, including current symptoms, pre-existing conditions, past illnesses, injuries, medications, diet and lifestyle, and family history.
For patients with a current or previous history of cancer in another region of the body, it typically raises the risk of developing a spinal tumor. Depending on the stage or severity of the cancer, the treatments may vary.
Physical Exam
A doctor will palpate along the back (or neck) and observe for any lesion, bump, instability, or other abnormalities. Clinical tests may also be performed to test the arms and/or legs for:
Strength
Sensation
Reflexes
Any abnormal neurological functioning could indicate inflammation or compression of the spinal cord and/or a spinal nerve, and may need further investigation.
Medical Imaging
When back pain is suspected to be caused by a spinal tumor, various medical imaging technologies may be considered.
Magnetic resonance imaging (MRI) scan. MRI scans are the best at viewing soft tissues and can be particularly helpful in distinguishing tumors from other neurovascular structures. A gadolinium contrast-enhanced MRI scan can help identify whether a tumor is outside the spinal cord or inside the spinal cord.
Computed tomography (CT) scan. CT scans are increasingly being used as first-line imaging for suspected spinal problems because, compared to x-rays, they give an enhanced view of the bones. A CT scan uses x-rays and a computer to create a series of cross-section images for greater detail.
Positron emission tomography (PET) scan. PET scans can be useful in confirming whether an abnormality that has shown up on other imaging is a tumor. The patient is injected with a small amount of a radioactive tracer, typically a type of sugar, which flows through the bloodstream. A special camera is then used to identify areas of the body where the radioactive tracers have collected, which are more likely to be in tumor cells.
Bone scan. This scan involves injection of a radioactive substance (tracer) that flows through the bloodstream and is absorbed by bones. Then a special camera is used to clearly see the bones and any areas of abnormal changes in the them, called hot spots.
Biopsy
When a spinal tumor is suspected based on imaging, a biopsy may be requested for verification and/or to learn more about the tumor. Two general types of biopsies for spinal tumors include:
Percutaneous needle biopsy. A needle is inserted through the skin and into the tumor using CT guidance. Percutaneous needle biopsy is the most common type when trying to diagnose a spinal tumor.
Open biopsy. This biopsy is considered open surgery and usually occurs when another surgery is already planned. Open biopsy may be incisional (remove part of the tumor) or excisional (remove all of the tumor).
Blood Tests
Blood tests may also be part of the diagnostic process for spinal tumors to help screen for cancer. It is also possible for a blood test to help confirm where a metastatic (secondary) tumor in the spine originally came from, such as the breast or prostate.
Treatments for Spinal Tumors
Spinal tumor treatments vary based on the tumor’s type and location, as well as other serious health conditions that may be present.
Nonsurgical Treatments for Spinal Tumors
While surgery is the main-stay of all kind of spine tumors, nonsurgical treatments may be used in conjunction with surgery for spinal tumors.
External Beam Radiation Therapy
External beam radiation therapy (EBRT) involves using a machine to send a beam of radiation into the body and target the tumor. The goal is to destroy the tumor cells and/or shrink the tumor.
Another form of radiation therapy, called stereotactic radiosurgery, involves sending multiple beams from multiple angles with the purpose of preserving as much healthy tissues as possible while targeting the tumor. Each individual beam of radiation is low power but many such low-power beams can meet at the tumor and intensify there.
Radiation is commonly used after spinal tumor surgery as a way to destroy any remaining tumor cells. It may also be used in cases where the spinal tumor is considered inoperable, or as a way to shrink the tumor before surgery.
Medications
Medications that may be considered as part of a treatment plan for spinal tumors may include:
Corticosteroids may be prescribed to help reduce inflammation and possibly the size of the tumor.
Pain medications may help reduce pain from a spinal tumor. Examples include nerve pain medications, opioids, and NSAIDs (nonsteroidal anti-inflammatory drugs).
Chemotherapy drugs, which may be taken intravenously or orally, target cancer cells throughout the body. While chemotherapy has not been shown to specifically target spinal cord tumors, it may be considered as part of an overall treatment plan for cancer.
Immunotherapy drugs, which aim to stimulate the immune system into attacking abnormal cells, are a newer treatment and still being studied. Some evidence suggests that immunotherapy is capable of shrinking spinal tumors, but more research is needed.
Some patients may be candidates for clinical trials in which experimental drugs may be tested for treating spinal tumors.
Palliative Care
When a spinal tumor develops as a result of advanced cancer, or alongside other serious health problems, the patient’s overall health and life expectancy may need to be considered. If a patient’s overall health suggests that surgery or other aggressive spinal tumor treatments will not be beneficial, palliative care may be chosen. Palliative care tends to focus on pain management with medications and keeping the patient as comfortable as possible.
Surgery for Spinal Tumors
When surgery is performed on a spinal tumor, there are typically 3 goals:
Remove all of the tumor (or as much as possible)
Preserve neurological function
Maintain spinal stability
Numerous surgical techniques are available, depending on the type of spinal tumor and its location. Some surgeries for spinal tumors can be done using minimally invasive methods, whereas others may require more extensive surgery or a combination of techniques.
One of the most common surgeries for spinal cord tumors is laminectomy and excision of the tumor. This procedure involves removing the back part of a vertebra, including both laminae and the spinous process and then taking out the tumor.
If any of the tumor remains after surgery, it may be treated with radiation or, less commonly, chemotherapy.
Following metastatic spinal tumor surgery, it may take some time for the nerves to heal. Usually rehabilitation and time help to improve a patient’s neurological function.