I thought it would be helpful to consider this very serious and important topic.I’m going to base it around the questions I get asked by patients, so here goes!
What is spinal cancer?
The common misconception is that the cancer has developed in the spine. Actually this is rarely the case. In 95% of cases, the cancer has spread (we call this metastasise) from another part of the body. As a rule of thumb, in 70% of cancer deaths, there will be spread to the bones of the skeleton. In 70% of these cases, this is the spine.
The five common cancers which spread to bones are breast, lung, thyroid, kidneys, prostate and a sixth is sometimes the bowel. (Figure 1 shows a breast cancer which has spread to the spine)
Generally speaking when a cancer has spread from one part of the body to another (in this case the spine) the cancer is no longer curable. Cancers of the blood system such as myeloma and lymphoma can also appear in the spine. In less than 5% of cases, the cancer has arisen from some part of the spinal structure, such as the bone, the cartilage or a nerve. It may be possible to remove this type of cancer. This type of problem is normally managed in specialist tumour centres.
How is spinal cancer diagnosed?
Most patients present to their doctor with back pain which is constant and unremitting and often worse at night. Another so-called ‘red flag’ is thoracic pain, or the first presentation of back pain over the age of 55 years. Doctors are trained to be suspicious when ‘red flags’ are present.
Some patients will have a history of the cancers mentioned above and may have completed treatment within the last few years. For some, this will be the first presentation.
Back pain arises from the growing cancer which can also press on nerves and cause nerve pain. The cancer can also weaken the bones in the back and lead to a painful fracture. The diagnosis is made by having imaging of the spine which might include, X-rays, MRI or CT scans. Further investigations usually include CT imaging of the rest of the body, trying to determine if the cancer has spread from somewhere else in the body. Such as the lungs, prostate, breast, kidneys, etc
Blood tests are also very important looking for ‘tumour markers’. These are chemicals which are produced by some types of cancer. PSA is good example and may indicate prostate cancer if raised. Myeloma can also be diagnosed from analysing both the blood and urine. Very often we will arrange a biopsy so we can look at the cancer under a microscope and make a more accurate diagnosis.
What treatment is available for spine cancer?
So I am referring now to the most common type of cancer which has spread to the spine from elsewhere. This may be referred to as ‘secondaries in the spine’, the ‘primary’ being the original tumour eg. Breast. Sadly it is rarely possible to cure someone with secondary cancer.
All treatment is aimed at reducing pain and suffering, and prolonging life. If the spine has fractured or collapsed because of the tumour, or the spinal cord is being compressed it may be helpful to operate on the spine.
Surgery often involves a combination of rods and screws (metalwork) with perhaps cement to try and stop the spinal column collapsing any more. Some of the cancer may also be removed (we call this ‘debulking’) to free up trapped nerves. This type of surgery is ‘palliative’ (reduces pain and suffering) and sadly not curative.
Cancer doctors (Oncologists) will be central to providing ongoing care. Depending on the type of cancer patients may also have radiotherapy and chemotherapy (drugs) to shrink the tumour.
How long will I live with my cancer?
This is a tough question for a patient to ask and even harder for the specialist to answer. Specialists may avoid putting a number on this as a prediction is often wrong.
The most important factors here are
- ‘the type of cancer’ (eg. breast, lung, etc)
- how quickly (aggressively) it grows (called ‘Grading’)
- the amount of spread through the body (called ‘Staging’)
- The tumour response to treatment
As an example, a patient with aggressive lung cancer in the spine is unlikely to survive for more than 6 months but a patient with myeloma could survive 3-5years or longer.
Summary
Metastatic spinal cancer is difficult for patients and doctors. Treatment requires very careful consideration and a coordinated approach between specialists. Quality of life can be much improved with optimal care.
Mr Caspar Aylott is a Consultant Spine Surgeon working in Cheltenham and London. He can help you with most types of spinal problems. Please call his secretary Victoria at 01242 371281 who can advise you further.
If anything mentioned here has affected you and you want to know more, you can book an appointment by clicking below.
