Spinal cord tumours

Although rare, several types of tumour can start in the spinal cord. The most common types are:

  • astrocytomas
  • ependymomas
  • meningiomas
  • nerve-sheath tumours, such as schwannomas.

These tumours usually cause problems by pressing on the nerves that run from the brain down the middle of the back to different areas of the body.

Symptoms may include back or neck pain, and numbness, tingling or weakness in the arms or legs.

You will have tests to diagnose a spinal cord tumour. This will include an MRI or CT scan. Treatment depends on your age and general health, and the position, size and type of the tumour. Usually you have surgery to remove the tumour, or as much of the tumour as possible. Radiotherapy may be used after surgery or as the main treatment if surgery is not possible. Sometimes anti-cancer drugs such as chemotherapy or targeted (biological) therapies are used. Your doctor may also give you steroids to help control any symptoms.

Differences between spinal cord and spinal bone tumours

This information is about tumours that start in the spinal cord.

Some types of cancer can affect the bones around the spinal cord (spinal vertebrae). We have other information about all these types:

  • secondary bone cancer – cancer can spread to the bones around the spinal cord from a cancer that started somewhere else in the body
  • myeloma – cancer of plasma cells can affect the bones around the spinal cord
  • primary bone cancer – rarely, a cancer starts in the bones around the spinal cord.


The brain and spinal cord

The brain and the spinal cord make up the central nervous system (CNS). The brain controls how we think, feel, learn and move. It also controls lots of other things in the body without us having to think about it, such as our breathing and heart rate.

The spinal cord is made up of nerves (nervous system) that run down the middle of your back (spine). Messages between the brain and other parts of the body travel through the spinal cord. The spinal cord starts at the base of the brain and goes down to the small of your back. The bones of the backbone (spinal vertebrae) protect the spinal cord.

The brain and spinal cord are covered and protected by three layers of tissue (membranes) called the meninges. The area between two of these layers is called the subarachnoid space. It contains a fluid called cerebrospinal fluid (CSF) which acts as a protective cushion. It also circulates nutrients and removes waste products.

The spinal cord and central nervous system
The spinal cord and central nervous system

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Understanding spinal cord tumours

Spinal cord tumours are rare. They can start in the nerves of the spinal cord or in the meninges that cover and protect the spinal cord.

Not all spinal cord tumours are cancer. A tumour that is not cancer (benign) may grow but doesn’t spread to anywhere else. It may cause a problem by putting pressure on nearby nerves or the bones of the spine.

A spinal cord tumour that is cancer (malignant) can grow into nearby tissue. Cancer cells from the tumour may spread from where the cancer first started to other parts of the spinal cord or brain. Spinal cord cancers do not usually spread to other parts of the body.

There are several different types of tumour that can start in the spinal cord. The most common are:


Causes of spinal cord tumours

The cause of spinal cord tumours is not known, but research is being done to find out more.

In a small number of cases, spinal cord tumours may be linked with inherited (genetic) conditions such as neurofibromatosis and von Hippel-Lindau syndrome. People affected by these have a higher risk of some types of spinal cord tumour.


Signs and symptoms of spinal cord tumours

Symptoms depend on the position of the tumour in the spinal cord. Spinal cord tumours often cause symptoms by pressing on the spinal nerves. This can cause back or neck pain, and numbness, tingling or weakness in the arms or legs.

Other symptoms can be clumsiness and difficulty walking. Tumours in the lower part of the spinal cord may cause loss of bladder and bowel control (incontinence).


Tests for spinal cord tumours

Your doctors need to find out as much as possible about the type, position and size of the tumour, so they can plan the best treatment for you. You may have a number of different tests.

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. 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. We have more detailed information about having a CT scan.


Treating spinal cord tumours

Your treatment will depend on your age and general health, and the position, size and type of the tumour. Your specialist doctor and nurse will explain the aims of your treatment and what it involves. They will talk to you about treatment benefits and disadvantages. They will also explain the risks and side effects.

You will have time to talk this through with them before you make any treatment decisions. You may be given a choice of treatment options. Let your specialist know if you need more information or time.

The main treatments used for spinal cord tumours are surgery, radiotherapy and steroids.

Surgery

The aim of surgery is to remove the tumour without damaging the spine or spinal cord. If possible, the surgeon will remove the tumour completely. If not, it’s often possible to remove part of it (debulking surgery). This can improve your symptoms by relieving the pressure on the nerves, and can slow down the progress of the tumour. During surgery, a sample of cells from the tumour (biopsy) is taken and examined under a microscope. This allows your doctors to see the type of tumour and to plan further treatment if needed.

Your surgeon will explain exactly what your operation will involve. They will talk to you about the possible complications and risks.

After surgery, you may be looked after in a high dependency unit for a few days. Your surgeon will give you more information about what to expect. You may have some pain after surgery, but this will be controlled with painkillers. There are various ways of giving painkillers. Always let the nurse know if you are still in pain. Before you go home, your pain will be controlled by tablets. You’ll be given a prescription for painkillers you can take at home as needed.

You will be encouraged to get up fairly soon after your operation. The ward staff will help you with this at first. Once you are moving about more freely, you’ll probably be able to manage this for yourself. Some people may need extra support to help with their recovery. This may be from a physiotherapist who can help you to improve your balance, walking or strength. Occupational therapists can provide equipment and help you become more independent.

Your wound will be closed using clips or stitches. Your surgeon or nurse will explain how to look after the wound when you are home. It's important to let your nurse or doctor know straight away if your wound becomes hot, painful, or begins to bleed or leak any fluids, even after you go home.

It can take a while to recover after surgery so it’s important to take good care of yourself. Get plenty of rest, try to eat well and follow the advice given by your surgeon and specialist nurse.

Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells. You may have this after surgery to treat any remaining tumour cells or if the tumour comes back after surgery. Even if all the tumour was removed with surgery, you may have radiotherapy to reduce the risk of it coming back. Sometimes radiotherapy is used as the main treatment when surgery isn’t possible.

You normally have radiotherapy in the hospital radiotherapy department as a series of short, daily sessions over several weeks. Treatment is usually given from Monday to Friday, with a rest at the weekend.

Radiotherapy has to be carefully planned to make sure it’s as effective as possible. On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. Your radiotherapy team use this scan to plan your treatment.

At the beginning of each treatment session, you lie in the same position but under the radiotherapy machine. The treatment itself only takes a few minutes. You’ll be left alone in the room but you can talk to the radiographer who will watch you from the next room. Radiotherapy is not painful, but you have to be very still for a few minutes during the treatment.

Radiotherapy can cause side effects or make your symptoms worse for a time. This can carry on for some weeks after it finishes. Your specialist doctor and nurse will talk to you about the side effects of radiotherapy and how they can help you cope with them. They may give you steroids to improve your symptoms after treatment.

Side effects of radiotherapy may include skin reactions, feeling sick and feeling tired. Some people find the side effects temporarily get worse after their treatment has finished. You may feel low or worry your treatment isn’t working. But it’s usually a reaction to the radiotherapy or because your steroids may have been reduced or stopped. It’s important to let your doctor or nurse know straight away if your side effects get worse.

Steroids

Doctors prescribe steroid drugs to reduce the swelling around spinal cord tumours. They reduce the symptoms caused by increased pressure and make you feel better. They may be given before or after surgery, and during or after radiotherapy. 

It’s important to take them exactly as your doctor has explained. Your pharmacist or nurse will give you a steroid card. The card should be carried with you at all times so that in an emergency a doctor will know you are having steroid treatment. A card is not necessary if you are only having a short course of steroids.

Never stop taking your steroids suddenly as this can make you very ill. Your doctor will gradually reduce the dose.

Possible side effects include:

indigestion – take them with food and tell your doctor if you have stomach problems as they can prescribe a drug to help with this

increased appetite and weight gain – this is more common when steroids are taken over a longer time and will improve when your steroids are reduced

difficulty sleeping – avoid taking your steroids after 6pm

feeling restless or agitated – let your doctor know if this is a problem

• a higher level of sugar in the blood – you will have blood or urine tests for this.

Talk to your doctor or specialist nurse if you’re worried about any side effects. These will go away gradually as your doctor reduces your steroid dose.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy is occasionally used for certain types of spinal tumours. 

Chemotherapy can cause different side effects. These vary depending on the drugs you have. Your cancer doctor will tell you more about treatments that may be useful for you.

Some side effects are more common than others but you won’t have them all. They can be reduced and controlled with drugs. Your doctor or nurse can tell you how to manage them. The most frequent ones include:

• increased risk of infection

• anaemia (reduced number of blood cells)

• hair loss or thinning

• feeling sick or vomiting

• mouth ulcers

• tiredness.

Most side effects are short term and will improve gradually when the treatment is over.


Clinical trials

Research into treatments for spinal cord tumours is ongoing and advances are being made. But because spinal cord tumours are rare, there may not always be a relevant clinical trial in progress. If there is, you may be asked to take part.

Your doctor will discuss the treatment with you so that you have a full understanding of the trial and what it means to take part. You may decide not to take part, or to withdraw from a trial at any stage. In this case, you'll still receive the best standard treatment available.


Driving

You may not be allowed to drive for a period of time. Although this can be upsetting, it’s important to follow the advice you are given.

You will need to contact the Drivers and Vehicle Licensing Association (DVLA) if you live in England, Scotland or Wales. If you live in Northern Ireland you will need to contact the Driver and Vehicle Agency (DVA). They will advise you of any restrictions on your right to drive:

If you’re not sure what you should do, check with your cancer doctor or specialist nurse. They will explain things to you.


Follow-up

After your treatment has finished, you’ll have regular check-ups, tests and scans. These appointments are a good opportunity to talk to your doctor about any worries or problems you have.

Many people find they get very anxious before appointments. This is natural. It can help to get support from family, friends or specialist organisations:

  • The Brain and Spine Foundation (brainandspine.org.uk) offers an information service for patients, carers and healthcare professionals. It also has an education programme for GPs and medical undergraduates, and workbooks for schools and colleges.
  • The Neuro Foundation (nfauk.org) offers information and advice about neurofibromatosis.
  • VHL UK/Ireland (vhl-uk-ireland.org) provides support and advice about von Hippel-Lindau syndrome.

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