The spine is a crucial part of our body, responsible both for movement and responding to the world around us through the many nerves contained within the spinal cord1. Damage to the spine can, therefore, massively impact quality of life. One form of damage is spinal tumors. Abnormal cells can grow and form tumors in the spine; these can be cancerous or noncancerous (benign), but can both cause detrimental effects.
Here, we’ll review the basics of spinal anatomy and discuss the most common signs and symptoms of spinal cancer. We’ll then talk about ways to diagnose spinal cancer with early detection and how being proactive about your health can lead to better outcomes.
The Basics of Spinal Column Anatomy
The spinal cord is a long, thin structure that starts at the brainstem and continues through the lumbar region of the spine. Together with the brain, the spinal cord comprises the central nervous system (CNS). The spinal cord is primarily protected by the spine, which consists of 33 vertebrae (bones of the spine). These bones are stacked on top of each other with discs in between for cushion and support that are made up of cartilage1.
Nerve roots branch out from the spinal cord between the vertebrae, supplying messages to the rest of the body. These nerves are responsible for sending motor commands to the muscles and receiving information like sensory input1. This complex system allows us to move, feel pain, distinguish temperature, and sense vibrations.
What Are the Different Types of Spinal Tumors?
Spinal tumors can be either benign (noncancerous) or malignant (cancerous), and either primary or secondary. Primary tumors are spinal cord tumors or spinal column tumors that start in the spine itself. Secondary tumors of the spine have spread from a cancer coming from another part of the body; this is relatively common, with 30-70 percent of people with cancer developing a secondary tumor in the spine2. The most common secondary tumors of the spine come from breast cancer, lung cancer, and prostate cancer.
Primary Tumors of the Spine
There are many different types of primary spinal tumors. Up to 80 percent of these are benign tumors3. However, these types of tumors can still cause symptoms and may require some sort of treatment or surgical intervention.
Benign spinal tumors include2:
- Hemangioma – growth of abnormal blood vessels in the spinal column
- Osteoid osteoma – small tumor in the bone
- Osteoblastoma – larger and more aggressive tumor in the bone
- Meningioma – tumor in the lining of the spinal cord (known as the meninges)
- Nerve sheath tumors (including Schwannomas and neurofibromas) – form on nerve cells exiting the spine
- Ependymomas/Subependymomas – tumors in the lining of passageways connecting the brain and spinal cord
- Astrocytomas (these can also sometimes be cancerous) – common spinal cord tumors found in children
Malignant spinal tumors include2:
- Osteosarcoma – a type of bone cancer
- Multiple myeloma – cancer affecting plasma cells in the blood which collect in the bone marrow of the spine
- Chondrosarcoma – tumor arising from the cartilage surrounding the bone
- Chordoma – a type of bone cancer that can develop at any point along the length of the spinal column
- Lymphoma – cancer affecting cells of the immune system which can develop in the spine
- Ewing Sarcoma – cancer affecting bone and the soft tissue surrounding the bone
Metastatic Spinal Tumors
Spinal cancer is most commonly due to cancer that has spread from another part of the body. Breast, lung, and prostate cancers are the most common cancers that metastasize to the spine. Research suggests that up to 30 percent of people with known breast cancer or prostate cancer who present with back pain may have spinal bone metastases4.
Is Spinal Cancer Hereditary?
The specific causes of spinal cancer have not been discovered, and, while genetics may play a role, it is not exclusively a hereditary disease. Specific forms of spinal cancer, such as ependymomas, are thought to have a higher genetic component5, and some hereditary diseases, such as Neurofibromatosis type 1 and type 2, increase the risk of developing spinal cancer6. However, the development of spinal cancer is not guaranteed in people with these disorders. In the majority of cases, spinal tumors are not hereditary.
What Are the Symptoms of Spinal Cancer?
Spinal tumors can cause many different symptoms depending on their location in the spine and whether the spinal cord is involved. For example, a spinal tumor in the neck or cervical region can produce different symptoms than a spinal tumor in the thoracolumbar or mid-back region.
Cervical spine (C1-C2)
The first two vertebrae, the atlas (C1) and axis (C2), are specialized for head rotation. The rest of the cervical spine supports the head and neck movements and transmits nerve signals from the brain to the body.
Tumors in this area can significantly affect neck mobility and function. Symptoms may include neck pain, stiffness, and restricted movement. Since this section also houses crucial nerves and arteries, tumors here can lead to neurological symptoms like weakness in the arms and hands, tingling, or numbness. In severe cases, it can affect breathing and swallowing7.
Thoracic spine (T1-T12)
The thoracic spine provides stability and support for the upper body and aids in protecting the thoracic organs (heart, lungs, esophagus, trachea, thymus). It consists of 12 vertebrae attached to the rib cage, located in the mid-back area.
Being the attachment site for the rib cage, tumors in the thoracic spine often present with back pain, especially in the mid-back region. If the tumor compresses the spinal cord, it can lead to symptoms like numbness or weakness in the mid-back which can spread to the areas connected to the nerves being compressed, such as the legs8.
Lumbar spine (L1-L5)
The lumbar spine comprises five large vertebrae in the lower back, known as the main weight-bearing section. It supports the torso's weight, allows flexibility and movement in the lower back, and plays a crucial role in lower limb movements.
This section bears the most weight, so tumors here often cause lower back pain, which can be exacerbated by standing or walking. Lumbar spine tumors can also lead to sharp pain radiating down the legs. As the lumbar spine is connected to the lower limbs, tumors can also cause muscle weakness or loss of sensation in the legs and feet. Severe cases can lead to a loss of bladder or bowel control8.
Sacrum (S1-S5)
A triangular bone formed by joining five vertebrae, the sacrum is at the base of the spine. Functions include connecting the spine to the pelvis, supporting the upper body's weight, and distributing this weight across the pelvis and lower limbs.
Tumors in the sacral region can cause pain in the lower back, buttocks, or legs. They may also affect bowel and bladder function due to the proximity of nerves controlling these functions. In some cases, sacral tumors can cause sexual dysfunction9.
Regardless of the location, pain is still the most common symptom of spinal cancer. This pain can be deep and aching; often worse at night and may wake a person from sleep. The pain can also be sharp and shooting if the tumor is pressing on the spinal cord. A serious complication of spinal tumors is spinal cord compression which, in addition to pain, can cause symptoms ranging in severity from mild weakness and numbness to complete paralysis10.
Other symptoms of spinal cancer may include:
- Difficulty walking or unsteady gait
- Numbness or tingling
- Loss of feeling to hot or cold temperatures
- Bent-over appearance due to spinal deformity
What Is The Prognosis of Cancer of the Spine?
The prognoses for spinal cancer are often reported in combination with brain cancer, making it difficult to isolate specific spinal cancer prognoses. Estimates for 5-year survival of a primary spinal cord tumor are around 95 percent and for 10-year survival, 90 percent11. However, life expectancy for someone with spinal cancer will vary widely depending on the specific type of spinal cancer, how aggressive the cancer is, where on the spine the tumor is found, and whether it is a primary or secondary tumor. For example, the 1-year survival rate for someone with cancer that has metastasized to the spine is only 50 percent.
Understanding the differences in prognosis between benign and malignant tumors — and the potential complications associated with each — is crucial for patients and healthcare providers. Managing these complications effectively is key to improving patient outcomes and quality of life.
Diagnosing Spinal Cancer: What’s Involved in the Process?
The road to diagnosis can be a scary one. Fortunately, it can be a relatively straightforward process due to accurate imaging tests.
When someone first presents with potential symptoms of spinal cancer, a detailed historical and physical exam is necessary. A neurological and musculoskeletal exam may demonstrate symptoms, such as muscle weakness or loss of sensation12. Laboratory tests and imaging tests may include:
- Blood and urine tests
- Lumbar puncture (to obtain cerebrospinal fluid)
- X-ray of the spine
- PET or computed tomography (CT) scans
- CT myelography
- MRI of the spine
- Surgical biopsy
It’s important to note that masses in the spine do not always mean cancer. There are many other conditions that can cause masses in the spinal column. These can include2:
- Eosinophilic granuloma (benign lesions)
- Epidural lipomatosis (excessive growth of fat)
- Cysts
- Inflammatory conditions, such as multiple sclerosis or transverse myelitis (inflammation of the spinal cord)
Imaging tests can often differentiate between these possibilities. CT scans (computerized tomography) and MRI (magnetic resonance imaging) of the spine can detect spinal tumors and different characteristics that can point to a certain diagnosis.
Is Spinal Cancer Aggressive?
The aggressiveness of spinal cancer depends on the type and grade of the tumor. For example, Grade I benign tumors will be slow-growing and unlikely to spread to other tissue, whereas Grade IV tumors are malignant, so will grow fast and spread quickly13. Particularly aggressive tumors include glioblastomas, dedifferentiated chordoma, and metastasized (ie secondary) spinal tumors12,14.
Who Does Spinal Cancer Affect?
The American Cancer Society estimates that approximately 24,820 malignant brain and spinal cord tumors will be diagnosed in 2025, and that 18,330 people will die from brain and spinal cord tumors15. Although these stats do not differentiate brain and spinal cord cancers, it has been estimated that only 15-20 percent of these tumors are in the spinal cord16. Anyone can develop a spinal tumor, however, the risk is increased in people who already have cancer, leading to a secondary spinal tumor. Primary spinal tumors are rare; the age groups most at risk are adults aged 65-74 and children aged 10-1612.
What Are The Risk Factors for Spinal Cancer?
Understanding your risk factors is important for the early identification and successful treatment of spinal cancer. The most common risk factors cause abnormal growths in nerve tissues, elevating the risk of both benign and cancerous spinal tumors. Risk factors for spinal cancer include12:
Metastatic cancer: This is when cancers originate elsewhere in the body and spread to the spine. Those with cancer in the breast, lung, prostate, and myeloma (plasma) are at the highest risk of spinal cancer.
Neurofibromatosis type 1: While this condition is characterized by benign tumors, they increase the risk of getting spinal cancer on nerve tissue, leading to various skin and neurological symptoms.
Neurofibromatosis type 2: A rare inherited disorder characterized by the development of tumors on the nerves responsible for hearing and balance, often leading to hearing loss and balance problems
Von Hippel-Lindau disease (VHL): A hereditary condition that causes the growth of tumors and cysts in multiple organs, particularly in the kidneys, eyes, and pancreas, often requiring medical intervention.
How Do You Treat Spinal Tumor Pain?
When it comes to spinal tumors, pain can be a major and debilitating factor. However, there are several ways to manage both the pain and potential complications. Medications can be beneficial in pain control, ranging from non-steroidal anti-inflammatory medications to steroids and narcotics.
Steroids can help decrease swelling and may also decrease the size of some tumors. If the tumors are malignant, cancer treatment may include radiation therapy, chemotherapy, and various types of surgeries. Surgical treatment options may include partial or complete removal of the tumor or relieving pressure on the spinal cord16.
Be Proactive and Plan For Your Future
The spine is a complex and important structure that is responsible not only for our mobility but also for protecting the spinal cord, which helps control our movements and sensations. Spinal tumors can range in severity depending on whether they’re benign or malignant and where they’re located. Spinal cancer symptoms often include pain, usually in the middle to lower back, while other symptoms can include trouble walking or muscle weakness.
Early detection of primary tumors decreases the risk of metastasis and improves the prognosis. Cancer screening is key to the early identification of spinal cancers and other cancers with a high risk of metastasizing to the spine.
With Ezra’s Full Body MRI scan, crucial health information about 13 major organs can be gathered in just one hour. The scan is simple, fast, and can be an effective tool for people who are ready to take charge of their health.
Book an Ezra Full Body MRI to receive a wealth of information that could help you get your health on track.
