Treatment should be started as soon as possible after diagnosis, with the aim of minimising permanent damage to the spinal cord. Treatment will also help to reduce pain by shrinking the tumour and relieving the pressure on the nerves. The damage to the spinal cord means that some people will have some paralysis at the time of diagnosis. This may be permanent in some people.
The choice of treatment depends on several factors including the type of cancer, the area of the spine affected and your general fitness. The most common treatment is radiotherapy, although surgery and chemotherapy are also sometimes used.
There are some risks associated with treatment to the spine, which your doctor will discuss 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:
Your doctor will usually advise you to lie flat on your back until tests have shown whether you have a spinal cord compression or not. This is to reduce movement of the affected area of the spine and to prevent an increase in symptoms.
If the tests confirm that you have spinal cord compression, your doctor and 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 where they will carry out a detailed check of your nervous system. This will include examining your range of movement, muscle strength, co-ordination and 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.
Steroids are chemicals naturally produced in the body that help control and regulate how the body works. High doses of a steroid called dexamethasone are usually started immediately if spinal cord compression is suspected. The steroid helps reduce pressure and swelling around the spinal cord, and can quickly relieve symptoms such as pain. The dose is gradually reduced over time and then stopped depending on the improvement of symptoms, and after starting other treatment such as radiotherapy and surgery.
Radiotherapy is the use of high-energy rays to destroy cancer cells. It is the most common way to treat spinal cord compression. It’s usually 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 - known as external radiotherapy. Radiotherapy 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 is only suitable to treat a small number of people for their spinal cord compression. This will depend on several factors, including the type of tumour, where it is situated and how unstable the spine may be.
The aim of surgery is to remove as much of the tumour as possible and relieve pressure within the spinal canal.
Surgery may involve removing several parts of the vertebrae, as well as removing as much of the tumour as possible, without weakening the spine. The common surgical techniques used in this situation are called anterior stabilisation and debulking of tumour, or decompression laminectomy.
This surgery may also involve stabilising the spine further by using metal rods or bone grafts. Your doctor or nurse will explain the operation in more detail if surgery is appropriate for you.
If some of the tumour cannot be removed by surgery, or if the tumour comes back after initial treatment, radiotherapy is sometimes given.
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.
Chemotherapy and hormonal therapy can also be used after radiotherapy/surgery for certain cancers, such as breast and prostate cancers.