What You Should Know About Cancer and Spinal Cord Tumors

When confronted with a spinal cord tumor diagnosis, patients often question if cancer is the underlying cause. Although certain tumors develop gradually without invading healthy tissue, others can grow rapidly and infiltrate nearby structures and bones. Differentiating between benign and malignant (cancerous) tumors is crucial for determining treatment approaches and predicting outcomes. In this article, we explore cancerous spinal tumors and their implications for treatment and quality of life.

A tumor on or near the spine is a serious matter. Your spinal cord is a long bundle of nerves that runs from the base of your skull to just above your pelvis. The spinal cord branches as it travels through passageways in your spine called foramen. Branches of the spinal cord form at many levels and relay messages between your body and brain to facilitate movement, sensation, and many of your vital bodily functions.

Tumors can grow anywhere within your spine, including on or within the spinal cord, near the nerve branches (peripheral nerves), and within the bones of the spine. When a tumor grows on the nerves or spinal cord, it can place pressure on the surrounding tissues, interfering with nerve conduction and impairing function. A tumor that develops within the vertebrae can cause structural instability of the spine.

Given the limited space for nerves traveling within the spine, even a benign tumor poses a significant risk to your health and quality of life if it is left to grow. Spinal cord tumors can cause a variety of symptoms, including the following.

• Pain and discomfort that is persistent and might become worse at night
• Stiffness in the back or neck
• Tingling or numbness in the arms and legs
• Muscle spasms
• Difficulty bending over, standing, or walking
• Loss of bladder and/or bowel function
• Paralysis in various parts of the body

Malignant tumors can grow very quickly and invade nearby tissues. They present with many of the same risks as benign tumors, but in greater severity. Cancerous spinal cord tumors can also lead to the following problems.

• Rapid onset of neurologic dysfunction
• Rapid onset of back pain, often worse at night
• Pathological fractures of the spine
• Structural instability

Before we discuss which spinal cord tumors are cancerous, it is important to understand some common terminology used to classify them. Spinal tumors can be considered primary or secondary tumors.

• Primary spinal tumors—grow directly on the spine from cells of the nerves, their protective myelin sheath, or the vertebrae; they are typically the result of a sporadic genetic mutation or hereditary disorder that causes abnormal cell growth
• Secondary spinal tumors—when cancer develops in another part of the body, malignant cells can enter the bloodstream or lymphatic system and migrate to the spine (called metastasis); growth of these cancerous cells in the spine leads to a secondary spinal tumor

Secondary tumors are the predominant type of tumors found in the spinal column, accounting for 97% of all cases. These tumors arise due to metastatic disease, indicating an advanced stage of cancer in general. Primary tumors of the spine are infrequent, and cancerous primary spinal cord tumors are even more rare but have been estimated to occur in up to 20% of cases. Several different types of primary cancerous tumors can occur in the spine.

An astrocytoma develops from astrocytes, which are cells (called glial cells) that work to support the nervous system. Although they grow most often in the brain, an astrocytoma can sometimes arise from the astrocytes of the spinal cord. While most lower-grade astrocytomas are benign, there are 2 types of this lesion that can be malignant.

• Anaplastic astrocytomas—typically occur as a result of mutations in a lower-grade astrocytoma
• Glioblastomas—considered the most invasive and aggressive type of astrocytoma

A chordoma is a type of malignant bone cancer that can develop anywhere in your spine but is found most commonly in the tailbone (sacrum) or at the base of the skull. Chordomas arise from remnants of the notochord, a flexible rod-like structure that plays a crucial role in the early development of the spine.

Chordomas are exceedingly rare; only 1 per 1 million people are diagnosed each year. In addition, they grow very slowly and often exist for years without causing significant symptoms.

An ependymoma is a primary central nervous system tumor that arises from cells that line the passageways of your brain and spine and help to produce cerebrospinal fluid (called ependymal cells). Ependymomas can be 1 of 3 different grades; grade 3 ependymomas are the most malignant. They usually develop at the base of the brain but can develop within the spinal cord.

Ewing sarcoma is a malignant tumor that occurs in the bones or soft tissue surrounding the bones. Although it appears most frequently in the long bones of the arms and legs, such as the femur (thigh bone) or tibia (shin bone), it can also affect the spine. Unlike chordomas, Ewing sarcomas are seen more often in children and young adults (most commonly between the ages of 10 and 20 years) than in adults.

Osteosarcoma is one of the most common types of bone cancer, but it rarely occurs in the spine. Instead, this cancer tends to develop in the major bones of the arms or legs, such as the femur and humerus. 

Similar to Ewing sarcomas, osteosarcomas occur most frequently in children and adolescents; the median age of diagnosis is 15 years. However, some adults older than 60 years can also develop an osteosarcoma, particularly those who have undergone radiation treatment for a different condition. In addition, patients with a family history of sarcoma have a higher chance of being diagnosed with osteosarcoma. 

Most spinal cord tumors are slow-growing and noncancerous. Certain tumor types, such as meningiomas, neurofibromas, and schwannomas, are more likely to be associated with these benign features. However, they can become malignant in very rare cases.

Meningiomas—tumors that develop from tissues that make up the outermost layer of protection around your brain and spinal cord (meninges)

Neurofibromas and schwannomas—tumors that arise from cells of the nerve sheath; a genetic condition called neurofibromatosis type 1 (NF1) increases the likelihood of developing multiple neurofibromas

Being told that you have a malignant spinal cord tumor can raise questions about whether treatment benefits are worth the risk, especially when considering limited time if the disease is at an advanced stage.

When facing a malignant spinal cord tumor, treatment decisions can become more complex and require careful consideration. It becomes essential to have open and honest discussions with your medical team to understand the potential outcomes, limitations, and side effects of each treatment option.

Although benign tumors are commonly treated by surgical removal, the management of malignant tumors often involves a combination of radiation and chemotherapy; surgery is considered in rare cases. However, some patients might decide to not pursue aggressive treatments that attempt to prolong life.

Instead, the focus may shift toward optimizing quality of life and managing symptoms. Palliative care, which aims to provide comfort, pain management, and supportive care, becomes crucial in this context. This approach prioritizes your well-being and ensures that you receive the best possible support throughout your journey.

It is important to have a thorough discussion with your medical team about your goals, values, and preferences when considering treatment options. They can provide you with the necessary information to make informed decisions that align with your unique circumstances and help you navigate the complex choices associated with having a malignant spinal cord tumor.

• Malignant spinal cord tumors are cancerous growths that can invade nearby tissues and spread to other parts of the body
• Most malignant spinal cord tumors arise from an original tumor in another part of the body
• Treatment typically involves a combination of radiation and chemotherapy but ultimately depends on your personal preferences and goals

• American Association of Neurological Surgeons (AANS): Spinal tumors
• National Cancer Institute: Related organizations
• Cancer Support Community: Brain and spinal cord tumors
• Glioma Foundation Center
• Collaborative Ependymoma Research Network (CERN) Foundation