What is malignant spinal cord compression (MSCC)?

Sometimes a cancer grows in the bones of the spine or in the tissues around the spinal cord. The cancer can cause pressure on the spinal cord. This is called malignant spinal cord compression.

The spinal cord is a bundle of nerves that runs from the brain down the back. It plays an important role in many body functions. These include:

  • movement
  • 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.

Illustration of malignant spinal cord compression

About 3 to 5 in 100 people with cancer (3 to 5%) develop MSCC. Any type of cancer can spread to the bones of the spine (vertebrae), which may lead to spinal cord compression. But it is more common with certain cancers, including breast, lung and prostate cancer, lymphoma and myeloma.

Signs and symptoms of MSCC

Depending on which part of the spine is affected, symptoms of MSCC could be any one or more of the following:

A new, unexplained back or neck pain

This may:

  • be mild to start with but become 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
  • in your buttocks.

Feeling unsteady on your feet

This may include:

  • having difficulty walking
  • leg weakness
  • your legs giving way.

Problems passing urine

This may include:

  • having difficulty controlling your bladder (incontinence)
  • only passing small amounts of urine or none at all.

Bowel problems

This may include:

  • 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.

If you have symptoms of MSCC

If you get any of the symptoms mentioned above, 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 contact anyone, go to the nearest Accident and Emergency Department (A&E) 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.

Diagnosis of MSCC

The doctor needs to examine you. They will also arrange an urgent scan of your spine. This is usually an MRI scan, but may be a CT scan if you cannot have an MRI.

Rarely, MSCC is the first symptom of cancer. Your doctor may recommend a biopsy of the spine to give an exact diagnosis.

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 tell you what you can and cannot do.

During and after treatment, you will have regular, detailed physical examinations by your doctor and physiotherapist

Some people 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 for MSCC

Treatment should start 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 and spinal cord. In some people, the damage to the spinal cord means they will have some paralysis at the time of diagnosis. Sometimes 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 radiotherapySurgery and chemotherapy are also sometimes used. There are some risks associated with treatment to the spine. 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. We have more information about consent.

Treatment usually involves a combination of the following:

Steroids

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 how your symptoms are.

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 1 or 2 weeks. It may be given for longer for some types of cancer. Your doctor will tell you how much radiotherapy you will need.

Radiotherapy will start 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
  • 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 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:

  • 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 spinal cord and nerves.

The surgeon may also stabilise the spine further by using metal rods, screws 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 is sometimes used to treat MSCC. It may be used for tumours that are very sensitive to chemotherapy, such as lymphoma or testicular 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 of MSCC

Pain

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 to ones that work better for you. 

We have more information about pain.

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. A physiotherapist will help you adjust to these changes. An occupational therapist can give practical advice and provide equipment.

Bladder changes

Your doctor and nurse will check how well your bladder is working. If you are 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 difficulty controlling your bowels.

After treatment for MSCC

Malignant spinal cord compression (MSCC) 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 will organise any care you will 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 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 and MSCC

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. We have more information about the different emotions you may be feeling.

How we can help

Macmillan Grants

If you have cancer, you may be able to get a Macmillan Grant to help with the extra costs of cancer. Find out who can apply and how to access our grants.

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