Malignant spinal cord compression (MSCC)
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MSCC can happen when cancer grows in the bones of the spine or in the tissues around the spinal cord. The cancer can press on the spinal cord (compression).
MSCC is a rare condition, but it can be very serious. About 3 to 5 in 100 people with cancer (3 to 5%) develop MSCC. Any type of cancer can lead to malignant spinal cord compression. But it is more common in people with breast cancer, lung cancer and prostate cancer, lymphoma and myeloma.
It is important that you know the symptoms so you can get medical advice as soon as possible. The earlier treatment starts, the more likely it is to be effective.
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The spinal cord is a bundle of nerves that runs from the brain down the back. It has an important role in many of the body’s functions. These include:
- bowel and bladder function
- the sensations of touch, pain and temperature.
The spinal cord is surrounded by the bones of the spine, which protect it.
Symptoms of MSCC depend on which part of the spine is affected. The warning signs could be one or more of the following:
A new, unexplained back or neck pain, which may:
- be mild to start with but becomes more severe
- feel like a band around your chest or tummy (abdomen)
- spread down a leg or arm, or into your lower back and buttocks
- get worse with movement
- get worse when you strain, for example if you lift something heavy, cough or sneeze
- keep you awake at night.
Numbness or pins and needles that is new or quickly getting worse. This may be:
- in your toes
- in your fingers
- over the buttocks.
Feeling unsteady on your feet, including:
- having difficulty walking
- leg weakness
- your legs giving way.
- having difficulty controlling your bladder (incontinence)
- only passing small amounts of urine, or none at all.
Bowel problems, including:
- having problems controlling your bowels (incontinence)
- being newly constipated, or constipation getting worse.
These symptoms can also be caused by a number of other conditions, but you should always get them checked. Even if you have had previous treatment for MSCC you should always get any new symptoms checked.
If you have symptoms of MSCC, you should get medical advice immediately.
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 Emergency Department (A&E) or contact your GP.
When you speak to a health professional:
- tell them you have cancer and are worried you may have spinal cord compression
- describe your symptoms
- 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 can cause permanent problems.
The doctor will examine you. If they think you might have MSCC, they may tell you to lie flat on your back and not move your spine.
Rarely, MSCC is the first symptom of cancer. Your doctor may recommend a biopsy of the spine to give an exact diagnosis.
If you have symptoms of MSCC, your doctor will usually advise you to lie flat on your back. This can help to prevent any further damage to the spine caused by unnecessary movement. The doctors and nurses can help you to change position safely if you need to move.
If the tests confirm that you have MSCC, your doctor and a physiotherapist will decide what movement is safe for you. They will tell you what you can and cannot do.
During and after treatment, your doctor and physiotherapist will examine you regularly. This will include examining your:
- range of movement
- muscle strength
- sensation to touch.
This helps them to see any improvement in your symptoms.
You may be given a collar or brace to wear. This can help to support the neck or spine. Your physiotherapist will discuss this with you.
Treatment should be started as soon as possible after diagnosis. The aim of treatment is to minimise permanent damage to the spinal cord and reduce any symptoms.
Treatment will also help to reduce pain by shrinking the tumour and relieving the pressure on the nerves and spinal cord. Damage to the spinal cord may mean that you have some paralysis at the time of diagnosis. Sometimes this may be permanent.
Treatment will depend on several things, 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. Your doctor or a surgeon will talk to you about treatment options and how much benefit you may get from them.
Treatment to your spine has some risks. Your doctor will talk to you about these. 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.
Treatment usually involves a combination of the following.
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. It can also quickly relieve symptoms such as pain. You may be given a mix of steroid injections and tablets.
After you have started treatment such as radiotherapy or had surgery, the dose of steroids is gradually reduced over time and then stopped, depending on your symptoms.
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 sometimes 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 one or two weeks. It may be given for longer for some types of cancer. Your doctor will tell you how much radiotherapy you will need.
Radiotherapy starts as soon as possible after MSCC is diagnosed.
Surgery is only suitable for a small number of people with MSCC. Whether you can have surgery depends on several things, including:
- the type of cancer you have
- the area of the spine affected
- how stable the spine is.
The aim of surgery is to remove as much of the tumour as possible, and relieve pressure on the spinal cord and nerves.
Surgery aims to remove as much of the tumour as possible. Some people may have several parts of the bones of the spine (vertebrae) removed. Surgeons will aim to do this without weakening the spine. The types of surgery used in this situation are:
- stabilisation and debulking of tumour – the tumour is removed and the spine is stabilised
- decompression laminectomy – a section of bone is removed from one of the spinal bones to relieve pressure on the spinal cord and nerves.
The surgeon may also use metal rods, screws or bone grafts to make the spine stable. 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.
Your doctor or specialist nurse will talk with you about the different treatment options.
If you have pain, your doctor or nurse will talk with you about the ways it can be managed. You may be given different drugs to help with pain. You will be checked regularly to make sure they are working well. Tell the doctor or nurse if you still have pain. They can adjust the doses of the painkillers or change them for ones that work better for you.
You may find it difficult to move around. This is because your muscle strength has been affected. You may not be able to feel and control movement in your muscles as well as you normally can. A physiotherapist will help you adjust to these changes. An occupational therapist can give you practical advice and provide equipment to help you stay as independent as possible. We have information about walking (mobility) problems.
Your doctor and nurse will check how well your bladder is working. If you are having problems passing urine (peeing), you should tell them. A nurse can put a thin, flexible tube (catheter) into the bladder to help drain urine.
You may be given medicine to help with constipation or problems controlling your bowels.
MSCC can affect people differently. You may need some help and support at home. 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 will organise any care you need while at home.
If you lost the ability to walk or move before treatment, this may not improve. In this case, you may need further care and support from staff at your cancer centre, local hospital or hospice. They will work closely with you and your family to plan 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.
It can be difficult to cope with the changes caused by MSCC. You may have many different emotions you may be feeling.
Everyone has their own way of coping with difficult situations. You might find it helpful to talk to family or friends, or you may prefer to get help from people outside your situation. Or you might want to keep your feelings to yourself. 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. Our Online Community is a place to connect with people who understand what you are going through. You can visit our emotional support forum to talk with others.
Below is a sample of the sources used in our malignant spinal cord compression (MSCC) information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
National Institute of Clinical Excellence (NICE). Metastatic spinal cord compression in adults: risk assessment, diagnosis and management. Clinical guidance (CG75). Published November 2008. Accessed January 2020. Available here: Overview | Metastatic spinal cord compression in adults: risk assessment, diagnosis and management | Guidance | NICE
Lawton. A et al. Assessment and management of patients with metastatic spinal cord compression: A multi-disciplinary review. Journal of Clinical Oncology 37, no. 1 (January 01, 2019) 61-71. DOI: 10.1200/JCO.2018.78.1211. Accessed January 2020. Available here: Assessment and Management of Patients With Metastatic Spinal Cord Compression: A Multidisciplinary Review - PubMed (nih.gov)
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.
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