Malignant spinal cord compression (MSCC) – diagnosis and treatment

If you have any of the symptoms of malignant spinal cord compression (MSCC), get medical advice straight away. The earlier MSCC is diagnosed, the better the chances are of treatment being effective.

You may be asked to lie flat on your back until tests can be done to tell if you have MSCC or not. This can help to prevent further damage to the spine being caused by unnecessary movement.

Treatment should be started as soon as possible. Treatment will be given to minimise permanent damage to the spinal cord. Steroids, radiotherapy, surgery and chemotherapy may all be used, depending on your particular situation. Your doctor will discuss any risks with you first.

MSCC can affect people in different ways. You may need support and care after treatment. Before you go home from hospital, a team of professionals will work with you to plan your care and rehabilitation.

If you have symptoms of MSCC

If you develop any of the symptoms of MSCC you should get medical advice immediately. Contact someone straight away, even if it is the weekend or a holiday.

You should contact the hospital team where you usually go for cancer treatment and follow-up appointments. If you are unable to get in touch with anyone, go to the nearest A&E department or contact your GP.

When you speak to a health professional:

  • Describe your symptoms.
  • Tell them you have cancer and are worried you may have spinal cord compression.
  • Tell them that you need to be seen straight away.

Do not wait for further symptoms to develop. The sooner MSCC is diagnosed, the sooner treatment can begin. If left untreated, MSCC will cause permanent problems.


How MSCC is diagnosed

Before your doctor can be sure whether these symptoms are caused by spinal cord compression, a number of tests will have to be done. These may include the following:

MRI scan

This scan uses magnetism to build up a detailed picture of areas of your body. You may be given an injection of dye, into a vein, to improve the images from the scan. This test is painless and will take around 30 minutes. We have more detailed information about having an MRI scan.

CT scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. This scan takes around 30 minutes and is painless. We have more detailed information about having a CT scan.

Bone scan

This scan does not diagnose MSCC, but it may be done to check if there are any abnormal areas inside the bone. A mildly radioactive substance is injected into a vein. A scan of your bones is taken two or three hours later. We have more detailed information about having a bone scan.

Rarely, MSCC is the first symptom of cancer. Your doctor may recommend a biopsy of the spine to give an exact diagnosis. During a biopsy, a small piece of tissue or a sample of cells is removed so that it can be examined under a microscope.


Lying flat

Your doctor will usually advise you to lie flat on your back until tests have shown whether you have MSCC or not. This can help to prevent any further damage to the spine caused by unnecessary movement.

If the tests confirm that you have MSCC, your doctor and a physiotherapist will decide what movement is safe for you. They will let you know what you can and can’t do.

During and after treatment, you will have regular physical examinations by your doctor and physiotherapist. They will carry out a detailed check of your nervous system. This will include examining your:

  • range of movement
  • muscle strength
  • co-ordination
  • sensation to touch.

This helps them to see any improvement in your symptoms.

Collars and braces

Some people may be given a collar or brace to wear that can help to support their neck or spine. Your physiotherapist will discuss this with you.


Treatment

Treatment should be started as soon as possible after diagnosis. The aim of treatment is to minimise permanent damage to the spinal cord. Treatment will also help to reduce pain by shrinking the tumour and relieving the pressure on the nerves. In some people, the damage to the spinal cord means they will have some paralysis at the time of diagnosis. This may be permanent.

Treatment will depend on several factors, including:

  • the type of cancer you have
  • the area of the spine affected
  • your general fitness.

The most common treatment is radiotherapy. Surgery and chemotherapy are also sometimes used.

There are some risks associated with treatment to the spine and your doctor will discuss these with you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.

You are free to choose not to have the treatment and the staff will explain what may happen if you do not have it. Although you don’t have to give a reason for not wanting to have treatment, it can be helpful to let the staff know your concerns so they can give you the best advice.

Treatment usually involves a combination of the following:

Steroids

Steroids are chemicals naturally produced in the body that help control and regulate how the body works. The doctors will usually give you high doses of a steroid (dexamethasone) straight away if they think you may have MSCC. This helps reduce pressure and swelling around the spinal cord, and can quickly relieve symptoms such as pain. After you’ve started treatment such as radiotherapy or had surgery, the dose is gradually reduced over time and then stopped, depending on how your symptoms are.

Radiotherapy

Radiotherapy is the use of high-energy rays to destroy cancer cells. It is the most common treatment for MSCC. It may be used on its own, or occasionally alongside other treatments such as surgery. It is given by directing radiotherapy rays at the tumour from outside the body. This is called external radiotherapy.

Radiotherapy for MSCC is usually given as a short course of treatment. This can range from one single treatment to one treatment a day for two weeks. It may be given for up to four weeks for myeloma and lymphoma.

Radiotherapy will be started as soon as possible after MSCC is diagnosed.

Surgery

Surgery is only suitable for a small number of people with MSCC. Whether you can have surgery depends on several factors, including the type of cancer you have, the area of the spine affected and how stable the spine is.

The aim of surgery is to remove as much of the tumour as possible and relieve pressure on the spine.

Surgery may involve removing several parts of the bones of the spine (vertebrae), along with as much of the tumour as possible, without weakening the spine. The types of surgery used in this situation are:

  • anterior stabilisation and debulking of tumour – an operation to remove the tumour and stabilise the spine
  • decompression laminectomy – a section of bone is removed from one of the vertebrae to relieve pressure on the nerves.

The surgeon may also stabilise the spine further by using metal rods or bone grafts. Your doctor or specialist nurse will explain the operation in more detail if surgery is appropriate for you.

You may have radiotherapy after surgery if some of the tumour cannot be removed, or if the tumour comes back after initial treatment.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It’s occasionally used to treat spinal cord compression. It may be used for tumours that are sensitive to chemotherapy, such as lymphoma or small cell lung cancer.

Other treatments

Hormonal therapy can be used, often in combination with chemotherapy, for certain cancers such as breast and prostate cancers.

Drugs that help to strengthen the bones, such as bisphosphonates and a drug called denosumab, may sometimes be used.

Your doctor or specialist nurse will talk to you about the different treatment options.


Coping with symptoms

Pain

If you have pain, your doctor or nurse will discuss ways of controlling this with you. You may be given different drugs to help with pain and these will be assessed regularly to make sure they are working well.

If you have breast cancer or myeloma, your doctors may prescribe bisphosphonate drugs to treat your pain and the weakened vertebrae. Bisphosphonates can also be used in prostate cancer if painkillers don’t work. The drug denosumab can also help reduce pain caused by secondary bone cancer.

Loss of mobility

Your mobility may be affected by changes in your muscle strength and your ability to feel and control movement in your muscles. Your physiotherapist will help you to adjust to these changes. An occupational therapist can give practical advice and supply aids to help you. This can help you to be as independent as possible.

Bladder changes

Your doctor and nurse will monitor how well your bladder is working. If you’re having problems passing urine, a nurse can put a thin, flexible tube (catheter) into the bladder to help drain urine.

Bowel changes

You may be given medication to help with constipation or if you’re having difficulty controlling your bowels.


After treatment has finished

Spinal cord compression can affect people differently. The care you need after treatment will depend on how well the treatment has worked and your mobility. Before you leave the hospital, the staff should organise any care you will need while at home.

Some people who lose the ability to walk or other movement before treatment may not get this back. In this case, you may need further care and support from staff at your cancer centre, local hospital or hospice. This will involve a team of healthcare professionals working closely with you and your family to organise a plan of care and rehabilitation to suit your needs.

If you have any questions about your care, you should discuss this with your doctor, nurse or physiotherapist.


Your feelings

It can be difficult to cope with the changes caused by MSCC. You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to accept and manage their condition.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.