The chief oncologist of the SM-Clinic spoke about bone marrow tumors

Symptoms, diagnosis, treatment, tumor classification Tumors of the spine and spinal cord are relatively rare. They can be primary (starting in the spinal cord) or secondary (cancer metastases from other parts of the body). They grow at different rates. As a rule, malignant tumors grow quickly, while benign tumors can grow slowly, exist for many years, and not make themselves felt.

What is a spinal cord tumor

This neoplasm is a proliferation of pathological tissue, which is located in the spinal region. Pathologies can be completely different, but they definitely require treatment and monitoring from a specialist. The disease may not manifest itself for a long time, and symptoms will appear only when the tumor reaches a large size and it becomes much more difficult to treat. Statistics say that such neoplasms occur in only a tenth of patients with tumors in the central nervous system.

How long do people live with spinal cord cancer?

A favorable prognosis for treatment and further survival can be given when starting treatment at the first and second stages of the pathological process of malignant oncology. At the first stage, treatment gives a prognosis close to 100% for a complete cure for cancer. For the second stage – 85%.

A sharp deterioration in the prognosis begins when the disease enters the third stage of development. When a tumor is detected at the third stage, the survival prognosis does not exceed 30%. For stage 4 – 10%.

In the last stages, patients live 3-4 years for advanced stages of the oncological process. Only 2-3 percent of patients with properly selected treatment pass the statistical indicator of five years.

The indicators described above are typical for the general forecast. To predict the survival of a particular patient, it is necessary to take into account a number of individual factors:

• health status;
• Lifestyle;
• chronic pathologies;
• correctness of treatment;
• the effectiveness of the treatment procedures performed;
• patient's age;
• living conditions;
• anamnesis of the patient's life;
• other factors relevant to a particular patient.

What are the types of spinal cord tumors?

Spinal cord tumors can be classified in different ways. Classification methods are based on different principles and are necessary for correct diagnosis and prescribing the correct treatment. First of all, neoplasms need to be divided into:

1. Primary - such a tumor consists of spinal cord tissue.
2. Secondary – when the neoplasm is only localized in the spinal cord, but is provoked by metastases and is a consequence of a process occurring elsewhere.

If we talk about the localization of the tumor process, we can highlight:

• intramedullary tumor of the spinal cord - in other words, this is an intracerebral formation that develops directly in the spinal cord, it contains spinal cells;
• extramedullary tumor - formed from tissues located near the spinal cord.

If we talk about the prevalence of these two types of disease, then it is worth knowing that intramedullary neoplasms are much less common, accounting for only 20% of all cases of identified spinal cord tumors.
Extramedullary spinal cord tumors account for the remaining 80% of cases. Extramedullary neoplasms can be:

• subdural - localized in the space between the membrane and the spinal substance;
• epidural - fill the space between the membrane and the spine;
• subepidural - located on both sides of the membrane of the brain.

If we consider the relationship of the tumor to the spinal cord itself, they can be:

1. Located inside the canal - intravertebral.
2. Located outside the canal - extravertebral.
3. Located partly inside and partly outside - extraintravertebral.

It becomes clear that in neurology there are a lot of classifications of spinal cord tumors, but such a classification makes it possible to correctly diagnose the disease, as well as predict the treatment of the patient. It is worth taking a closer look at some types of tumors.

Intramedullary type

This tumor grows from the spinal cord itself, so it most often manifests itself as segmental disorders. Often among such tumors there are gliomas, the spinal type of which is more treatable than a similar brain tumor. In addition, ependymomas can occur, which account for about 20% of all spinal tumors.

Extramedullary

There are many options for extramedullary spinal cord tumors. It could be:

• neurofibroma;
• neuroma;
• lymphoma;
• cholesteatoma;
• lipoma;
• osteosarcoma;
• and many others.

The manifestation of each type of neoplasm will differ in its characteristics. The growth of each tumor is accompanied by characteristic signs.

Etiological theories

As with many types of cancer, the etiology of tumors in the spinal cord is not clearly defined. It is known that this is a tumor-like formation that has diverse and multifaceted manifestations, depending on the stage and other significant factors.

The localization of the tumor is the spine (all its bone fragments) or exactly the area where the spinal cord is concentrated.

By the way. An important element of the central nervous system - the spinal cord - is located in a hollow groove called the canal. It is protected from external influences by one hard and one soft shell. Additionally, between them there is also “protection” - liquid liquor.

Anatomy of the spinal cord

The tumor can originate both inside the spinal canal and outside. The disease affects both male and female patients equally. Not in all cases this is a death sentence, but, of course, the disease cannot but have a negative impact on the patient’s quality of life.

There are no exact reasons for the occurrence. Therefore, medicine identifies a long list of factors that can, at least theoretically, cause spinal cancer. These factors are divided into two groups.

Table. Factors provoking spinal cancer.

Hippel-Lindau disease

Tumor symptoms

Symptoms of the disease may vary depending on its type. It is worth finding out exactly how different types of diseases manifest themselves and what symptoms are inherent in them.

Radicular-membranous disorders

If the patient has an extramedullary tumor of the spinal cord, symptoms of this type appear immediately, and if the tumor is intramedullary, they are observed quite late. The nerve root is affected in two stages:

1. The irritation phase is a slight compression of the end, no problems with blood supply.
2. The prolapse phase is when the root is compressed so much that it stops functioning.

When the root is irritated, pain occurs; extramedullary tumors are also characterized by increased pain in a lying position and its weakening in a standing position. The phase of loss is characterized by a complete lack of sensitivity; a person does not feel touch, does not distinguish between cold and hot. As the disease progresses, reflexes decrease and then are completely lost.

Segmental disorders

This kind of deviation is a mandatory symptom of a spinal cord tumor. Compression of certain segments by the tumor leads to disruption of the functioning of the corresponding organs. A doctor who observes changes in the body is able to identify the localization of the tumor process in the spinal cord based on such symptoms.

Each segment of the spinal cord has anterior and posterior processes, some also have lateral ones. Disturbances in the functioning of the posterior processes (horns) lead to problems with sensitivity, the anterior horns are responsible for reflexes - a person may experience uncontrollable twitching, and in the future - a decline in muscle tone. Involvement of lateral processes in the process provokes vegetative problems. Skin temperature and color may change, and the patient may notice excessive sweating or flaking that was not there before.

Conduction disorders

A malignant tumor of the spinal cord is often detected after the patient complains of a disorder in the functioning of the nerve conductors. They are responsible for transmitting information from top to bottom and vice versa. With intramedullary pathologies, descending disturbances of sensitivity are detected - the process goes from top to bottom, gradually affecting new areas of the body. In the case of an extramedullary tumor, the situation is the opposite. Incontinence problems may occur.

Treatment

In the global practice of cancer treatment, there are three main treatment methods. These include:

• surgical intervention;
• radiotherapy (use of radiation);
• chemotherapy (use of cytostatic pharmacological agents).

Surgical intervention

The use of surgery is justified primarily in the early stages of oncology development. Until the 80s of the 20th century, the method was considered the only option for treating oncology. Currently, to prescribe surgery, the full risk of the likely consequences of tumor removal is assessed. When secondary lesions spread, the effectiveness of surgery is much lower, since the tumor spreads to other organs. In this case, the operation will do more harm than good for the patient.

Radiotherapy

This method is based on the principle of the inhibitory effect of an increased dose of radioactive radiation on the ability of a cell to develop and divide in accordance with the life program of the epithelial building material inherent in the genotype. Radiation accumulates in the cytoplasm, which leads to the destruction of its DNA.

It is worth noting that during this treatment procedure, healthy cells are also affected, which leads to a deterioration in their functionality. In the future, a consequence of the use of radiotherapy may be the appearance of another oncological process, since radiation contributes to the occurrence of mutations in the cellular structure of tissues.

There are external radiotherapy and radiotherapy using the contact method. Due to the peculiarities of the structure of the spinal column and spinal cord, the non-contact method (remote) is used more often, since it does not require invasion.

When a positive effect is achieved, the size of the tumor is reduced. In this regard, radiotherapy is prescribed before surgery, which significantly improves the outcome of the operation.

Chemotherapy

This method of treating oncology is a procedure for intravenous administration of a pharmacological drug through a special diffuser into the patient’s body in a clearly defined dosage and at a given speed. The method is not indisputable, as it causes a list of negative consequences from its use:

• nausea;
• diarrhea;
• hair loss;
• chronic fatigue;
• pain;
• allergic reactions.

Chemotherapy is used in courses. 5-6 courses with an interval of 3-4 weeks. The greatest effectiveness is achieved in the first courses of chemotherapy, since the atypical cell of the malignant tumor has not yet acquired immunity to the drugs.

Due to the active substance, the drug accumulates in oncology cells and destroys the structure of the atypical cell from the inside. The cell membrane and nucleus are destroyed. By its nature, a chemotherapy drug is a toxin and causes intoxication of the body.

All cancer treatments are aimed at harming the body in order to destroy cancer cells. The main thing is that the harm from treatment is less than from the disease itself.

How to treat

The prognosis after identifying the symptoms of a spinal cord tumor will be most comforting if treated correctly. It implies:

• surgery to remove pathological tissue - if this cannot be done completely, the largest possible area of ​​the tumor is removed without affecting the spinal cord;
• radiotherapy and chemotherapy;
• drug treatment after surgery to restore blood supply.

The prognosis for getting rid of benign tumors noticed in the early stages will be most comforting. With malignant tumors the situation is somewhat worse.

Description of symptoms

Clinical demonstrations of pathology, unfortunately, are not immediately detected. Of course, both the symptoms and the course of the disease depend to a large extent on the nature of the tumor and its properties, the speed of development of the process and the location of the tumor. But the main reason for the non-absolute cure of cancer in most cases is its late diagnosis, precisely because of the absence of obvious symptoms in the early stages.

Spinal cord tumor clinic

By the way. If a primary tumor has arisen, the process of its development can be extremely slow and take years (although there have been cases where primary spinal cancer developed within a couple of months). If the formation is secondary and metastasizes from other organs, the maximum development period is several months, but generally it occurs in a matter of weeks.

Pain and other symptoms

The first on the list is a direct and unambiguous symptom indicating any pathological process - pain syndrome. With spinal cancer, pain occurs when the growing tumor begins to compress the spinal cord, that is, not immediately from the moment of formation. As the compression grows and increases, the pain syndrome intensifies.

Characteristic signs of spinal cancer

1. Painful sensations of varying nature and strength in the dorsal or vertebral area, radiating to other parts of the body.
2. Reduced muscle activity resulting from compression of the spinal cord.
3. Partial limitation or complete loss of sensation in the limbs, since the spinal roots are compressed.
4. Loss of ability to move or lack of coordination and falling.
5. Loss of tactile sensitivity.
6. Inability to sense changes in temperature.
7. Paralysis and paresis that can occur absolutely anywhere in the body.
8. Dysfunction of the urinary and intestinal systems.

If you want to learn in more detail how to correctly identify spinal cancer, as well as consider the symptoms and manifestations, you can read an article about this on our portal.

Clinic of intramedullary tumors

Sensory disorders

Further distribution

As the disease progresses, symptoms also progress and new ones are added.

1. Pronounced atrophy of all muscles.
2. Nerve conduction disorder.
3. The occurrence of radicular syndrome.
4. Increased intracranial pressure.
5. Absence of joint reflexes.
6. Failure of organs located in the pelvis, urinary and intestinal systems.

Stage of damage to the entire diameter of the spinal cord

Advice. A disease of any nature is much easier to cure if it is diagnosed at an early stage. If even a few of the primary symptoms occur and they recur, it is necessary to visit an oncologist and conduct a thorough diagnosis.

Diagnostic techniques

Detection of tumors in the first stages of their development is quite difficult, since they can be masked by symptoms of radiculitis or the presence of somatic anomalies. Doctors begin to sound the alarm if there is no effect after medical therapy. To examine the patient, a referral is issued to undergo:

• Magnetic resonance scanning of the spinal region is the most effective diagnostic method, helping to detect the exact location, extent of distribution, shape, expected type and level of spinal compression.
• If it is not possible to carry out MRI testing, it is allowed to attend radiography, which will reveal signs of osteochondrosis, but will not be able to accurately indicate the presence of a neoplasm.
• Additionally, electroneuromyography is performed, which allows you to determine the location of the lesion without its appearance.
• Checking the cerebrospinal fluid provides information to rule out an infectious disease.

If the patient has limitations for undergoing a magnetic resonance examination, computed tomography (myelography) is performed. In the presence of neoplasms of vascular origin, angiography will be required. The exact shape of the tumor can only be determined after a histological examination.

Treatment options

Often, medical staff resort to radical treatment - surgery. Laminectomy becomes a surgical intervention. During the procedure, the doctor touches a minimal area of ​​the spinal cord to prevent the formation of injuries. To remove intradural tumors from the patient’s body, a more complex operation will be required, as a result of the need to make an incision on the hard surface and act close to the brain. If there is a formation with two components, its extradural area is first resected.

If the malignant nature of the disease is detected, the patient is prescribed courses of radiation therapy in addition to surgery. Limitations for laminectomy may include a large number of metastases and common malignant neoplasms. In this case, doctors resort to a palliative format, which is aimed at pain relief and decompression. Chemotherapy and radiotherapy are prescribed.

Primary malignant tumors of the spine

Osteogenic sarcoma

The only malignant tumor arising from its own bone tissue.
Osteogenic sarcoma is one of the most malignant and common skeletal tumors with a favorite localization in the metaphyses of long tubular bones, accounting, according to many authors, from 30% to 50% of all bone tumors. In the spine, osteogenic sarcoma is much less common and accounts for 1.7% to 2% of all primary spinal tumors. The tumor is predominantly localized in the lumbar spine. Males are more often affected. This tumor can occur at any age. The clinical picture of osteogenic sarcoma has features characteristic of malignant tumors. The history of the disease is short, from 1-2 months to 1 year. Patients are bothered by intense pain in the affected area, which becomes permanent. There is a restriction in the mobility of the spine, patients take a forced position. Neurological complications appear very quickly in the form of paresis, paralysis, pelvic dysfunction, and a general serious condition.

Combined treatment: after maximum surgical removal of the tumor, radiation and/or chemotherapy are used.

Chondrosarcoma

A malignant cartilaginous tumor that accounts for 7% of all primary spinal tumors and 5% of all skeletal chondrosarcomas.
The tumor is more common in men between 20 and 60 years of age. Chondrosarcoma can affect both the arch with its processes and the vertebral body, with transition to adjacent vertebrae or ribs in the thoracic region. The neoplasm is most often found in the lumbar and sacral regions. Chondrosarcomas are divided into primary, which are much more common, and secondary, which develop as a result of malignancy of osteochondral exostoses. The clinical picture consists of 2 leading symptoms: pain and swelling. Chondrosarcomas are prone to frequent recurrence and are resistant to radiation therapy. You can count on a favorable prognosis only if the tumor is radically surgically removed.

Ewing's sarcoma

A malignant tumor that occurs mainly in childhood and adolescence and very rarely in adults. The tumor is usually localized in long bones; in the spine, Ewing's sarcoma occurs in 6.4% of all spinal tumors. The predominant localization of the tumor is the lumbar and sacral spine. The first symptom of the disease is usually pain, accompanied by a rise in temperature to 38-39C. Subsequently, against the background of increased pain, limited mobility of the spine occurs, and neurological complications due to compression of the spinal cord and roots are added. Given the vagueness of the x-ray picture, the diagnosis is usually clarified by a puncture biopsy. If compression of the spinal cord occurs, urgent surgical intervention is necessary. Given the high sensitivity of the tumor to radiation and chemotherapy, treatment should be combined.

Chordoma

Accounts for 1.3% to 4.1% of malignant tumors.
The tumor is most often localized in the sacrum, less often in the base of the skull and other parts of the spine. Chordoma most often affects men, 3/4 of cases occur between the ages of 45 and 70 years with a disease duration of up to 10 years. The clinical course of chordoma is determined by its localization, direction of growth and relationship with surrounding tissues. The clinical picture of sacrococcygeal chordoma in the initial stages of the disease is similar to discogenic radiculitis, which leads to diagnostic errors and unreasonable treatment. The main complaint is pain in the sacrum, sometimes radiating to the perineum or legs. Sacral root syndrome often develops: nagging pain radiating to the perineum, legs, genitals; sensitivity disorders in the anogenital zone and dysfunction of the pelvic organs. The leading diagnostic method is CT examination. Chordoma is a long-growing, aggressive tumor characterized by infiltrative growth, a tendency to relapse, malignancy and late metastasis. Treatment is surgical.

Primary malignant bone lymphoma (reticulosarcoma, non-Hodgkin's sarcoma)

Frequent malignant lesions of the spine, which account for up to 4-8% of all malignant tumors, arise from the reticular stroma of the bone marrow or its derivatives.
Lymphoma can occur in any age group. Women get sick more often. The leading clinical symptom, as with most bone tumors, is aching pain, which is periodic for a long time (from 1.5 to 4 years). A number of patients experience limited spinal mobility and reflex scoliosis. The general condition remains satisfactory for a long time and only in the later stages is weight loss and anemia noted. By destroying a vertebra, lymphoma often causes a pathological fracture, which dramatically changes the clinical picture and causes the addition of neurological symptoms.

Lymphoma is highly sensitive to radiation therapy. Some authors indicate that it regresses without surgical intervention. However, if compression syndrome occurs, the first step is surgical treatment.

Lymphogranulomatosis (Hodgkin's disease)

It is a systemic disease of reticuloendothelial tissue, which predominantly affects the lymph nodes with frequent involvement of the skeletal bones (the frequency of localization of lymphogranulomatosis in the bones is 15-35%).
There are both multiple (more often) and single lesions. The localization of the tumor in the spine is the most common among all bone lesions with predominant localization in the thoracic and lumbar regions. Clinical manifestations of lymphogranulomatosis of the spine are diverse and depend on the localization and extent of the process. The earliest clinical symptom is pain, which quickly becomes constant and increases in intensity. The most characteristic radiological sign is the osteolytic type of destruction, with preservation of the intervertebral discs. Pathological fractures of one or more vertebrae often occur. Often, the process spreads paravertebrally and to the ribs.

Generalized cases are treated with chemotherapy. If pathological fractures and neurological complications occur, surgical intervention is required.

Plasmacytoma and myeloma (Rustitsky-Kahler disease)

Refers to malignant tumors consisting of immunocompetent (plasma) cells and is characterized by multiple diffuse lesions of the bone marrow. Currently, plasmacytoma (solitary myeloma) and multiple myeloma are considered not as separate nosological forms, but as variants of the manifestation of the same tumor process. The criterion for classifying a tumor as solitary is the mandatory histological confirmation of the presence of a single focus of destruction, identified using X-ray, radioisotope and other research methods. Plasmacytoma is usually observed in adulthood, although it also occurs at an earlier age. Mostly men get sick. Most often the tumor is localized in the thoracic region, which determines the initial symptoms in the form of periodic pain between the shoulder blades of moderate intensity. As the process progresses, the pain becomes constant, debilitating, and sharply intensifies with movement. Sometimes there is an asymptomatic course of the disease and the tumor is detected only when a pathological fracture occurs with the development of neurological complications. During X-ray examination, the vertebral body is almost always affected; sometimes the arch, processes, and adjacent discs are involved in the process. In half of the cases, solitary plasmacytoma is polycystic in nature. In advanced stages, the height of the vertebrae decreases sharply with the formation of the so-called. "fish vertebrae" Most patients develop multiple myeloma after a latency period of 5-10 years.

Metastatic lesion of the spine

Metastatic lesions can affect various structures of the spinal column.
Up to 50% of patients who have compression lesions of the vertebrae as a result of metastatic lesions do not have a verified primary tumor site. The most common sources of metastases are tumors of the breast, prostate, lungs and kidneys - they cause up to 80% of metastases of the entire skeletal system. The duration of the disease ranges from 2 months to 3 years. The clinical picture of metastatic lesions of the spine does not have specific symptoms and is characterized by a short history, intense pain, impaired spinal mobility and neurological complications resulting from compression by a pathological fracture.

Radionuclide scintigraphy helps to identify common lesions of skeletal bones in metastatic disease, however, due to the lack of specificity, it does not exclude myeloma and other diseases with polyostotic lesions. MRI plays a leading role in the diagnosis of metastases, as it allows one to accurately localize the lesion in large parts of the spine, determine its nature and relationship with the structures of the spinal cord.

brief information

The disease begins its development in individual structures that are located near the spinal cord (vessels, surface layer, paraspinal fiber, nerve endings). In general, this form of tumors accounts for up to 80% of the entire class, and neoplasms of intramedullary origin account for 20%. The anomaly affects any age category of the population. Sometimes doctors observe a multiple type of disease (formation of metastases, Recklinghausen disease, etc.). Often, the disorder is of benign origin, but in some situations a harmful element can provoke the progression of irreversible degenerative deformations. They begin due to high load. The course of treatment is controlled by doctors from the neurological, neurosurgical and oncological fields.