Primary spinal tumors are rare. Statistics show that up to 90% of malignant tumors of the spinal column are metastases of cancer located in other organs.
Many types of cancer metastasize to the bones, most often to the vertebrae. In most cases, tumor cells spread hematogenously - through the bloodstream. Secondary lesions weaken bone tissue, which threatens pathological fractures of the vertebrae, which lead to severe pain, a significant decrease in quality of life, and compression of the spinal cord and nerve roots.
In 95% of cases, metastases in the spine are extradural , that is, they are located outside the dura mater. In more than half of the cases, the lesions are localized at different levels of the spinal column.
Some numbers and facts:
- The spine is in third place on the list of organs to which various malignant tumors most often metastasize. The first two places belong to the lungs and liver.
- 70% of all bone metastases are metastases in the spine.
- 5–30% of patients suffering from stage 4 cancer have metastases in the spinal column.
- Secondary lesions in the spine are more common in men than in women. Most cases occur between the ages of 40–65 years.
- Only 10% of patients experience symptoms.
- About 70% of lesions that cause symptoms are found in the thoracic region, 20% in the lumbar region, and 10% in the cervical region.
- In 60% of cases, the lesions are located in the anterior part of the vertebral body.
Classification of metastases in the spine
Metastases spread throughout the human body because malignant cells enter the bloodstream and lymph. Just one atypical cancer cell is enough for the process of tumor formation to begin, after which at a certain stage it begins to reproduce its own kind. The type of metastases in the spine can be different; there are two types:
- Osteoclastic.
- Osteoblastic.
Osteoclastic metastases lead to the activation of giant bone cells, as a result of which the process of bone dissolution begins.
X-rays show that the height of individual vertebrae has decreased significantly. Osteoblastic metastases cause bone cells to grow in a chaotic manner. As a result, the density of the affected vertebrae increases greatly, and the volume and shape change. A so-called “spotting” appears, which can affect all components of the vertebra. The type of metastases depends greatly on the type of primary malignancy.
MRI of the spine
This is one of the modern methods for diagnosing metastases and is the safest and most harmless. After which a conclusion is made, and the attending physician can prescribe a further course of treatment based on the results. An MRI of the spine can determine the extent of damage or compression of the spinal cord.
The specialists of our clinic will carry out an accurate diagnosis, and subsequent treatment, if necessary, will take place exclusively under the supervision of doctors. Treatment can take place in several stages, and at each of them one or another method or a combination of several will be used. The qualifications of our clinic’s doctors allow us to effectively eliminate cancer cells and prevent their possible spread throughout the body. You can always get a detailed consultation from the right clinic specialist by making an appointment at a convenient time. Be attentive to yourself and promptly pay attention to the slightest symptoms, identification of which at an early stage saves lives.
Symptoms
Symptoms of metastases in the spine are usually pain. They can be of a different nature, often reminiscent of the symptoms of osteochondrosis, but they are characterized by rapid progression. Over time, a person begins to experience severe pain at night.
Cervical region
If metastases are located in the neck, pain may radiate to the upper extremities. People often complain of decreased sensitivity in their limbs, as if they were wearing a glove. Redness of the skin may occur, and a person’s mobility is noticeably reduced.
Thoracic region
If symptoms and manifestations of metastases in the spine occur, a person may complain of a girdling type of pain. The problem is often mistakenly looked for in diseases of the chest organs, wasting precious time. There is also a decrease in sensitivity and numbness in certain areas of the skin.
Lumbar
Metastasis in the lumbar region leads to innervation in the legs. The person becomes less mobile because every movement is accompanied by pain. If the lumbar region is affected, incontinence may occur.
Vertebral metastases: characteristics of the disease
Vertebral metastases occur quite often. The main route of distribution is through the bloodstream, less often through the lymph flow. Malignant tumors are not detected immediately, but only through radiation diagnostics.
Spinal metastases are characterized by destruction of bone substance. The vertebrae that are most susceptible to negative effects are the upper lumbar and lower thoracic. This is due to the fact that they often undergo deformation, for example, during fractures, which leads to compression of the spinal cord nerves.
Reasons for appearance
The appearance of vertebral metastases is a common occurrence in the presence of tumor formations in the following organs:
- Lungs;
- Kidneys;
- Thyroid, mammary or prostate glands;
- Genitourinary system;
- Mammary glands.
Another reason for metastases is the diagnosis of myeloma or lymphoma.
Stages of development
In medicine, the following stages of the disease are distinguished:
- The first is accompanied by the least complications;
- The second and third – they are characterized by the appearance and development of complications;
- The fourth is the heaviest.
The life expectancy of a patient with a malignant tumor depends on several factors:
- Severity of the disease (stages);
- Methods of treatment;
- Qualifications and skills of the attending physician.
If the fourth stage is diagnosed, you have a few months to live.
Symptomatika
At the initial stage, the appearance and development of metastases is characterized by:
- Dull pain in a specific area of the spine;
- Increased pain at night.
The last sign allows you to distinguish vertebral metastases from osteochondrosis, which is also accompanied by back pain.
The stronger the pain with the tumor, the greater the stage of destruction. An exacerbation of the disease is observed in the final stages and is expressed in various forms, including paralysis and numbness. This is due to the fact that the tumor grows, the space becomes smaller, the nerve endings are compressed, due to which sensitivity is dulled.
The main signs of vertebral metastases include:
- Pain in the spine;
- Digestive problems;
- Functional dysfunction of the genitourinary system in terms of urination;
- Damage and atrophy of tissue formations;
- Paralysis.
Diagnosis
It has been established that it is possible to identify a secondary tumor earlier than the primary one in diseases such as cancer:
- skin;
- cervix;
- ovaries;
- mammary glands.
It is recommended that at the first sensation of pain in the spinal column, you contact a health care facility, where a doctor will conduct the necessary examination and find out the causes of the inconvenience.
To identify vertebral metastases, the following methods are used:
- Radiography;
- Tomography (computer, radionuclide, NMR).
Other research methods are also common, each of which makes it possible to find out different facts about the course of the disease:
- Blood test - presence of tumor markers;
- Ultrasound of organs - spread of metastases;
- Puncture - examination of fluid from the spinal cord;
- Spinal cord biopsy.
Therapeutic measures
Treatment is prescribed to the patient taking into account all factors known to the doctor, including the stage of the disease and the nature of the tumor. Advantage is given to an integrated approach.
The following types of therapy are used:
- Chemo-;
Its effectiveness lies in significantly slowing down and reducing the growth and development of cancer cells. Management - according to an individual protocol.
- Radio-;
The method is bloodless. It is carried out using a specific device that directs rays (gamma or beta) to the affected area of the spine.
- Hormone-.
The need for surgical intervention cannot be ruled out.
According to statistics, recovery is possible in 80 cases out of 100. In this case, the malignant tumor is subjected to both treatment and removal, and the vertebrae deformed by metastases are restored or replaced.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Diagnostics
Timely detection of metastases in the spine (the prognosis for life in this case will be more favorable) allows treatment to begin without delay. To identify the disease, the doctor may prescribe:
- blood tests for tumor markers - allows you to identify oncology as such;
- X-ray – effective in later stages of the disease, when metastases are already visible;
- angiography using a contrast agent - will determine the condition of the vessels through which the neoplasm is supplied with blood;
- radionuclide method - allows you to identify the exact localization of metastases and the level of tissue damage;
- biopsy - doctors take a small area of the tumor for examination for detailed study;
- Ultrasound of the peritoneum or chest x-ray to identify the location of the primary and secondary tumors.
Based on the diagnostic results, doctors immediately choose the optimal treatment tactics, since delays in such a situation worsen the overall prognosis.
Metastatic cancer - what is it?
Almost any late-stage cancer is called metastatic. From Greek metastasis means – meta stateo – “I stand at a distance.” In this case, damage to organs somewhat distant from the main tumor is observed; this is due to the spread of malignant cells from the tumor through the lymphatic or blood vessels.
This can be illustrated with the following example. The woman was diagnosed with breast cancer; she has a tumor in her right gland. After some time, repeated examination shows that secondary formations have appeared in the liver. It is incorrect to consider this the appearance of cancer in the liver - in this case, the progression of breast cancer is observed. After such a phenomenon is detected, the diagnosis of “breast cancer” is changed to “metastatic breast cancer.”
Treatment
To make the prognosis for life after diagnosing metastases in the spine more favorable, one should not delay in starting treatment. The therapy will allow the patient to remain active for as long as possible. The faster metastases and their cause are identified, the easier it will be to eliminate them. Treatment may involve one or more of the following:
- Operational.
- Radiotherapy.
- Chemotherapy.
- Hormone therapy.
Treatment in each specific case is prescribed individually, since much depends on the type of primary tumor, the condition of the patient, how many secondary tumors are present, etc.
Development of metastases
When the problem develops to the level of stage 3 cancer with metastases, the tumor becomes very active, quickly increases in size, growing into nearby tissues. In most cases, screenings are observed in distant lymph nodes. The prognosis takes into account factors such as the degree of differentiation and location of the tumor, and the general condition of the patient. These moments can both aggravate and reassure the patient’s situation. Successful treatment here is still quite possible.
Prognosis for metastases in the spine
The prognosis for treatment of spinal metastases is not very favorable. Unfortunately, metastases in bone tissue appear in the late stages of cancer, when it is difficult to treat. One of the main tasks of a doctor can be considered to be prolonging the patient’s normal life, eliminating spinal cord injuries as much as possible, as well as reducing pain. It is difficult to give a definite answer regarding the patient’s lifespan, since so many factors can influence the indicator. These include:
- type of primary oncology, its localization, size, presence of growths into adjacent tissues and glands;
- the number of secondary neoplasms in the spine, as well as their sizes;
- what treatment methods were and are being used, how effective they were and whether a change in treatment tactics is necessary;
- what condition the patient is in – his level of immunity, the presence of concomitant diseases, the age of the cancer patient and other factors.
Treatment of spinal metastases allows only 1/5 of patients to live more than a year after diagnosis of the disease. Without treatment, the pathology can lead to death within a few months. However, the use of all known treatment methods rarely prolongs the patient’s life to 2 years. Early accurate diagnosis and successful treatment allow only 80% of patients to prolong life to 5 years. The disease is very insidious and does not manifest itself for a long time, and serious symptoms appear only in the later stages.
First stage of pathology
The first stage of cancer development is the presence of a tumor node. At the same time, the lymph nodes are not yet affected and there are no metastases in the body. Recently, the number of detected and treated tumors has increased significantly. This indicates an increase in people's awareness of this issue and their ability to take care of their health. Competent treatment helps in most cases.
Methods of treating prostate cancer with metastases
The main treatment for prostate cancer metastases is the combination of docetaxel with antihormonal (castration) therapy.
Docetaxel belongs to the cytostatic antitumor drugs from the taxane group. It blocks the proliferation of malignant cells, thereby preventing the spread of the tumor. The drug is prescribed in a standard dosage of 75 mg/m2.
As for antihormonal therapy, its effect is to suppress the production or block the action of sex hormones, which are not only responsible for normal processes in the male body, but also stimulate the growth of cancer cells. This treatment does not destroy the tumor, but blocks its progression for some time and slows down the development of the disease, in some cases for many years.
The effectiveness of antihormonal therapy is monitored by reducing PSA levels. Ideally, it should be less than 0.1 ng/ml after 1.5-2 months from the start of therapy. Most often, such results are achieved when treating localized forms of prostate cancer. A drop in PSA to 0.5 ng/ml is also a very favorable sign.
Antihormonal therapy can be carried out using several methods:
- Chemical or injection. The patient is given drugs that block testosterone production. After 3-4 weeks from the start of such treatment, its level decreases to a minimum. In this case, surgical removal of the testicles is not performed.
- Surgical castration. During surgical castration, both testicles are removed. The operation is usually performed under local anesthesia with intravenous sedation. Removal can be done through one incision near the root of the scrotum, or through two incisions located on the sides of the scrotum. After surgery, testosterone levels decrease quickly and irreversibly. The disadvantage of this type of treatment is the risk of bleeding and infectious complications, as well as the emotional unpreparedness of men for such a radical step.
- Maximum androgen blockade. Sex hormones are mainly synthesized by the testes, but a small part (about 5%) is produced by the adrenal glands. To prevent their effect on the tumor, special drugs are prescribed - antiandrogens, which prevent the binding of the hormone to the perceiving cellular receptors. Thus, maximum androgen blockade is achieved.
Unfortunately, in some cases, several years after the start of antihormonal therapy, the tumor begins to progress. To stop its growth again, the following methods can be used:
- Cancellation of antiandrogens. A third of patients experience tumor regression after discontinuation of antiandrogens. The effect can last up to 4 months. A slightly better effect is observed when antiandrogens are discontinued with the simultaneous addition of ketoconazole. This treatment allows more patients to respond.
- Replacement of drugs for antihormonal treatment. For most patients, it is still recommended to continue antihormonal therapy for the rest of their lives.
- Prescription of estrogens. This treatment increases the two-year survival rate to 63%, but there is a risk of thrombosis.