People often hear of conditions such as herniated discs, spondylolisthesis, and spinal stenosis accounting for a large amount of back pain in the United States. To be sure, spinal tumors are a less common condition responsible for similar acute or chronic back pain symptoms, but they do happen. One out of every 100,000 people (or about 10,000 people annually in the U.S.) will develop a spinal tumor at some point. Recently, spinal tumors made national news when LPGA golfer Danielle Kang played the first two rounds of the U.S. Women’s Open after having recently being diagnosed with one.
By definition, a spinal tumor involves an abnormal growth of tissue that creates a mass either inside or surrounding the spinal cord. These cells grow uncontrollably and can be malignant (cancerous cells) or benign (non-cancerous cells). Even still, some spinal tumors do not contain any cancer cells. However, even non-cancerous spinal tumors may pose a danger as serious problems can arise if the tumor grows and places pressure on the spinal cord and surrounding spinal nerves.
The term “spinal tumors” encompasses a broad diagnostic category. There are different subtypes of spinal tumors, depending on where the mass grows on the spine.
- Spinal tumors that occur inside the spinal cord are called Intramedullary tumors
- Intradural Extramedullary spinal tumors are located inside the spinal cord and covering, but do not enter the spinal cord
- When tumors occur inside the vertebral column and involve cartilage and bone, they are called Extradural spinal tumors.
The tumor’s location of origin also plays a role. Primary tumors originate in the spinal cord, and Secondary tumors (or metastatic tumors) result from cancer that began in another location in the body but has spread to the spine.
Here’s the tricky part. There is no one specific symptom that distinguishes a spinal tumor. Back pain is the most common early symptom of all spinal tumor types – benign and malignant. However, this back pain experience is not explicitly attributed to injury, stress, or physical activity. As a spinal tumor grows, it may place pressure on the spinal cord, surrounding nerve roots, blood vessels, and spinal bones, causing many similar symptoms to a herniated disc or other spine injuries and conditions. Some of the spine condition symptoms that can also be present in people with spinal tumors include:
- back pain that worsens when lying down;
- back pain that increases with consistent activity;
- muscle weakness/numbness/tingling in the arms or legs;
- back pain that results in difficulty when standing;
- walking challenges that may lead to falls;
- decreased sensitivity to pain, heat, and cold;
- loss of bladder or bowel control; and
- erectile dysfunction.
Having any of the above symptoms does not necessarily mean a spinal tumor is present. Still, because early diagnosis and treatment are critical, it is crucial to schedule an office visit for any pain that is:
- Not activity-related,
- Worsens at night,
- For any patient developing back pain that has a previous cancer history.
Changes or disruptions in bowel or bladder function and progressive muscle weakness also require immediate medical attention.
After a physical evaluation and medical history, an MRI or CT scan may be administered if a spinal tumor is suspected of causing the symptoms (or even rule it out). Such imaging studies are designed to show all parts of the spine and pinpoint the tumor’s location and size. Sometimes these scans can be used with a contrast agent injected into the patient’s vein to highlight specific tissues and make any abnormalities easier to see. After confirming a spinal tumor with these scans, the only definitive way to identify whether a tumor is benign or malignant is through a biopsy to examine a small tissue sample. If the tumor is malignant, the biopsy will also help determine the cancer type present, influencing treatment options and recommendations.
Ideally, the goal of treatment would be to remove the tumor altogether. However, there are some instances where this is not advised. For example, suppose removal of the tumor significantly increases the risk of permanent damage to the spinal cord and spinal nerves, affecting some degree of bodily function. In that case, complete removal may not be the best option. As with many medical treatments, there is no “one size fits all” solution for spinal tumors, and each person needs an individualized plan based on their specific needs. A tailored treatment plan will involve an evaluation of the patient’s age, overall health, and location/origin of the tumor. In general, if a small benign spinal tumor is detected but is not yet causing bothersome symptoms, carefully monitoring it may be the best initial treatment option. Spinal surgery is recommended only when the benefits of removing a spine tumor outweigh the possible risks of damage to the spinal cord or surrounding spine structures. If parts of the tumor remain after surgery, radiation or chemotherapy can be used to eliminate them. Physicians can also use these treatments to attempt to shrink the tumor when surgery is deemed too risky.
Though rare, some spinal tumors can cause severe and permanent disability if they are not promptly diagnosed and treated. My strongest advice to all back pain sufferers is to always err on the side of caution, like Danielle Kang, and visit a spine specialist at the first sign of suspicious symptoms so you can achieve the best possible outcome.