Spinal tumor

A spinal tumor is a growth that starts in or around the spine, which includes the backbone, spinal cord and nerves. These tumors make up only 2% to 4% of all primary central nervous system tumors. They are rare tumors that begin in the brain or spinal cord rather than spreading from elsewhere.

Some spinal tumors grow slowly and are noncancerous, also called benign. Others are cancerous, also called malignant, and can spread. The term "spinal tumor" covers both types, while spinal cancer usually refers to a malignant tumor that started in or spread to the spine. Spinal cord tumors are a type of spinal tumor that starts in or right next to the cord. About 95% of spinal cancers begin as tumors in other parts of the body and spread to the spine. These are called metastatic spinal tumors.

Spinal tumors can occur anywhere along the spine but are most common in the middle part of the spine behind the chest. Another common location is the lower back. Less often, they affect the neck. Rare types include chordoma and osteosarcoma.

A spinal tumor can press on the spinal cord or nerves and cause back or neck pain, weakness, numbness, or changes in walking or balance. Pain that worsens at night or when lying down can be an early sign of a spinal tumor.

Treatment depends on the tumor's size, type and location. Options may include surgery, radiation therapy or medicine. Small or slow-growing tumors may only need regular MRI monitoring.

The outlook for spinal tumors varies. Many benign tumors can be removed or monitored safely, while spinal cancers often need long-term care. Finding and treating a tumor quickly can help people stay mobile, keep their strength and protect their nerves. Treatment aims to slow or stop tumor growth and reduce pressure on the spinal cord.

Types

Spinal tumors are grouped by where they start growing in the body:

• Vertebral tumors. These begin in the bones of the spine. Benign types of vertebral tumors include osteoid osteoma and hemangioma. Malignant examples of vertebral tumors include osteosarcoma and cancers that spread to the spine from other areas of the body, also called metastatic.
• Intradural extramedullary tumors. These grow inside the covering of the spinal cord, also called the dura, but outside the cord itself. MRI is the best imaging test for finding these tumors and seeing spinal cord compression. Benign examples include meningioma, schwannoma and neurofibroma. Rare malignant examples include malignant peripheral nerve sheath tumors.
• Intramedullary tumors. These start inside the spinal cord tissue. Low-grade examples such as ependymoma tend to grow slowly and are less likely to spread. They can still cause symptoms by pressing on the cord. Malignant examples include astrocytoma and high-grade ependymoma.

A spinal tumor can cause different symptoms depending on where it grows and how much pressure it puts on nerves or the spinal cord. Some spinal tumors grow slowly and may not cause symptoms at first. Others cause pain or nerve symptoms early on.

The most common symptom is back or neck pain that doesn't go away. This pain may feel dull, sharp or burning. Other symptoms can include:

• Pain that gets worse at night or when lying down.
• Pain that radiates from the spine to the arms, legs, chest or hips.
• Numbness or tingling in the arms, legs, hands or feet.
• Muscle weakness or trouble walking.
• Trouble with balance or coordination.
• In severe disease, loss of bladder or bowel function.
• Reduced sensitivity to pain or temperature.
• Muscle spasms.

Not everyone has all of these symptoms. Even small tumors can cause symptoms if they press on a nerve.

How do I know whether back pain is cancer or just regular pain?

Most back pain is not caused by cancer. The cause of back pain often is something such as muscle strain, arthritis or a bulging disk. But back pain might be a sign of a spinal tumor if:

• It gets worse at night or doesn't improve with rest.
• It keeps getting worse over time.
• It comes with numbness, weakness or tingling.
• It comes with feeling very tired or weight loss that happens without trying.
• It gets worse when you cough, sneeze or strain.
• It doesn't get better with medicine.

If back pain doesn't go away after a few weeks or is getting worse, it's important to talk with a healthcare professional.

Is a lump on the back of the neck a spinal tumor?

A lump on the back of the neck can happen for many reasons. It can be a cyst, swollen lymph node or muscle knot. It usually is not a spinal tumor. Most spinal tumors grow inside the spine, so they don't form a lump you can see or feel. But if the lump keeps getting bigger, feels hard, or comes with pain, numbness or weakness, a healthcare professional should check it.

Are lesions on the spine a symptom of spinal cancer?

Lesions on the spine can be a sign of spinal cancer — especially if they are seen on an imaging test such as an MRI or a CT scan. These lesions may be tumors that started in the spine or spread from cancer in another part of the body. Not all spinal lesions are cancer though. Some may be not cancerous, also called benign. Your care team may order a biopsy or more tests to find out.

Why is spinal tumor pain worse at night?

Spinal tumor pain often feels worse at night or when lying flat. That may happen because of changes in spinal fluid pressure, less movement or less distraction from pain during sleep. Some tumors also release chemicals that cause more pain when the body is at rest. Ask your care team to look for the cause of nighttime pain that wakes you up or doesn't improve with position changes.

When to seek care

Seek care for back pain that you can't explain if it lasts more than a few weeks, gets worse over time, or doesn't improve with rest or movement.

Most back pain is not caused by cancer. But if you notice these signs, it's important to get checked. Early testing can help find the cause and prevent serious nerve damage.

A spinal tumor happens when cells in or around the spine start to grow out of control. These cells form a lump, known as a tumor, that can press on the spinal cord or nerves. But for many tumors, the exact cause is not known.

Some spinal tumors begin in the spine itself. These are called primary spinal tumors. Experts don't always know why they form, but they may be linked to changes in the body's genes or to rare inherited conditions.

Other spinal tumors start in another part of the body and spread to the spine. These are called metastatic or secondary tumors. These are the most common spinal tumors in adults. Cancers that often spread to the spine include:

• Breast cancer.
• Lung cancer.
• Prostate cancer.
• Kidney cancer.
• Thyroid cancer.
• Gastrointestinal cancer.
• Multiple myeloma.
• Lymphoma.

If you've had one of these cancers, your care team may advise checking your spine if you have new back pain or nerve symptoms.

A risk factor is something that may increase your chances of getting a spinal tumor. Having one or more risk factors doesn't mean you will get a tumor — but it may raise the chances.

Can other cancers spread to the spine?

Yes. One of the biggest risk factors for spinal cancer is having another type of cancer that can spread to the spine, especially breast, lung, prostate, kidney and thyroid cancers. When these cancers spread to the spine, they are called metastatic spinal tumors. They make up most spinal tumors in adults.

Other risk factors for spinal tumors may include:

• Genetic conditions such as neurofibromatosis type 2 (NF2) and Von Hippel-Lindau disease, which can lead to tumors in the spine or brain. Most people with spinal tumors do not have a family history of these conditions.
• A weakened immune system, especially in people with certain infections or who take long-term immune-suppressing medicines, may increase cancer risk overall and the risk of certain lymphomas that may affect the spine.
• Previous radiation therapy, especially if it involved the head, neck or spine area, can increase the risk of future tumors in the area that was treated.
• Rarely, a family history of spinal tumors.

Many people with spinal tumors have no clear risk factors. But knowing the possible links can help with early diagnosis.

Spinal tumors can cause serious symptoms if they press on the spinal cord or nerves. These complications depend on the tumor's size, location and how fast it grows. Even benign tumors can lead to complications if they're not treated.

Common complications of spinal tumors include:

• Nerve damage and spinal cord compression. This is a medical emergency. A growing tumor can press on spinal nerves or the spinal cord, causing numbness, weakness, balance trouble or, when severe, paralysis. New symptoms or fast changes need urgent evaluation by your care team.
• Back or neck pain. Pain from spinal tumors may get worse over time and may not go away with rest. Pain also can spread to the arms, legs or chest.
• Loss of movement or coordination. Tumors that affect the spinal cord can make it hard to walk, use the hands or keep balance.
• Loss of bladder or bowel function. If a tumor compresses certain nerves, it may cause trouble with bladder or bowel function. Changes in bladder and bowel function can be long lasting if not treated quickly.
• Spinal instability or fractures. Tumors in the bones of the spine can make them weaker or more likely to break, especially if the tumor is cancerous or has spread from another part of the body.

These symptoms may come on slowly or suddenly. Getting diagnosed and treated early can help prevent long-term damage and improve recovery.

Most spinal tumors cannot be prevented. Many spinal tumors develop without a clear cause. Some are linked to rare genetic conditions, and others start as cancer in another part of the body and later spread to the spine.

While you can't always prevent a spinal tumor, there are steps you can take to lower your overall cancer risk:

• Avoid tobacco use.
• Eat a healthy diet with plenty of fruits and vegetables.
• Exercise regularly.
• Keep a healthy weight.
• Limit alcohol use.
• Manage long-term health conditions with help from your care team.

If you have a history of cancer, regular follow up care can help find tumors that spread to the spine early — before they cause serious symptoms.

For people with a family history of rare conditions such as neurofibromatosis type 2 (NF2) or Von Hippel-Lindau disease, genetic counseling may be helpful.

There is no guaranteed way to prevent spinal tumors. But staying aware of symptoms and keeping up with routine care can make a difference in catching tumors early.

Diagnosing a spinal tumor starts with a medical history and a physical exam. If a spinal tumor is suspected, imaging tests are the next step, and a biopsy may be used to confirm the tumor type.

Tests for spinal tumor can include:

• Medical history and neurological exam. Your care team asks about back or neck pain, weakness, numbness, balance, and changes in bladder or bowel function. The team checks strength, reflexes and sensation to look for signs of nerve or spinal cord conditions.
• MRI. MRI, usually with dye, shows the spinal cord, nerves and soft tissues in detail. It's the most accurate test for finding tumors and spinal cord compression. If you can't have MRI, you may have CT myelography. This is an imaging scan that uses dye and X-rays to show the spinal cord and nerves clearly.
• CT. CT helps show bone changes and check spinal stability.
• Biopsy. A small tissue sample may be taken to confirm the tumor type before your care team plans treatment.

Can an X-ray show a tumor on the spine?

An x-ray can sometimes show changes in the bones of the spine that suggest a tumor, such as:

• Damage or breakdown of the bone.
• Compression fractures.
• Areas that do not look typical.

However, X-rays cannot show soft tissue growths or tumors inside the spinal cord, so they may miss smaller or early tumors. The main imaging test used to diagnose spinal tumors is an MRI, which provides clear pictures of both bone and soft tissue.

If a spinal tumor is suspected, the care team may advise an MRI of the whole spine to find the exact location and size of the tumor and tell whether it is pressing on nerves or the spinal cord. A biopsy is sometimes done to confirm the tumor type before planning treatment.

What are the different stages of spinal cancer?

Healthcare teams use staging systems to describe how far a spinal tumor has grown and whether it has spread. Staging is usually done as part of diagnosis if your spinal tumor is cancerous.

For primary spinal cancers, which are tumors that start in the spine, the Enneking system is often used. It groups tumors by grade, which tells how aggressive they are. It also groups them by location, which tells whether the tumor has stayed within the bone or grown into nearby tissue, and by spread, which tells whether it has reached other parts of the body.

The Enneking system stages include:

• Stage 1 (1A/1B). The tumor grows slowly. Stage 1A means it stays inside the bone. Stage 1B means it has started to grow outside the bone into nearby tissues.
• Stage 2 (2A/2B). The tumor grows faster. Stage 2A means it is still inside the bone. Stage 2B means it has grown beyond the bone.
• Stage 3. The tumor has metastasized, or spread to lymph nodes or other parts of the body.

For spinal tumors that have spread, care teams use simple scoring systems rather than a stage to plan care. These scoring systems include the Tomita system and the Bilsky scale.

• The Tomita system shows how far the tumor has grown in or around the bone and may be used to help plan surgery.
• The Bilsky scale shows how much the tumor is pressing on the covering of the spinal cord or the cord itself.

These scores help your care team decide whether you need surgery, radiation or both, and how urgent treatment is.

Care for spinal tumors often involves a multidisciplinary team — including neurosurgeons, radiation oncologists, medical oncologists and rehabilitation specialists — who work together to plan treatment and support recovery.

Treatment for spinal tumors depends on several factors:

• The type of tumor.
• Whether the tumor started in the spine or spread from another area.
• Your overall health.
• The aggressiveness of the tumor.

The goal is to relieve pain, protect the spinal cord, and improve mobility and quality of life. Many people benefit from a combination of surgery, radiation therapy, targeted drugs and chemotherapy.

There are several treatment options available for spinal tumors.

Radiation therapy

Radiation therapy uses high-energy X-rays or protons to damage the DNA inside tumor cells so they stop growing. Over time, the body clears the damaged cells. Radiation may be used to control tumor growth, relieve back or nerve pain, and reduce the risk of nerve injury — especially when surgery isn't possible or after surgery to treat any tumor cells left behind.

Types of radiation

• External beam radiation. A machine outside the body sends radiation to the tumor to destroy the tumor cells while limiting damage to nearby healthy tissues.
• Stereotactic body radiation therapy (SBRT). SBRT uses very focused, high-dose radiation. Treatment usually lasts between one and five sessions. It targets the tumor precisely while protecting the spinal cord and nearby nerves.
• Proton therapy. This therapy uses charged particles that release most of their energy at the tumor, which can limit how much energy reaches nearby healthy tissue.

Possible side effects of radiation therapy include tiredness, skin redness over the treatment area, and short-term soreness are the most common. Very high doses can sometimes irritate the spinal cord or nearby nerves, though this is not common.

Medicines

Medicines for spinal cancer can help slow or stop tumor growth, protect the spinal cord, and ease pain. These treatments are mainly used for spinal tumors or cancers that have spread to the spine from other parts of the body. Treatment may include:

• Chemotherapy. Chemotherapy uses strong medicines that travel through the bloodstream to kill fast-growing cancer cells or slow their growth.
• Targeted therapy. Targeted therapy blocks specific changes or proteins in cancer cells that help them grow and spread, causing fewer side effects than standard chemotherapy does.
• Immunotherapy. Immunotherapy helps the body's own immune system find and attack cancer cells more effectively.
• Steroids. Steroids reduce swelling around the spinal cord and nerves, easing pain and protecting movement while you wait for other treatments take effect.

These treatments are often used together to manage symptoms and improve movement and quality of life. Medicines can be given by IV or pills, and your team watches for side effects and progress.

What to expect with medicines for spinal tumors: Chemotherapy may cause nausea. Immunotherapy often causes fewer whole-body side effects but can still lead to fatigue, skin changes or swelling. Most side effects improve after treatment. Your care team can adjust the medicines to help keep you more comfortable.

Steroids

Steroids, including dexamethasone, are often started early when a spinal tumor causes swelling. They help lessen inflammation, ease pain and protect nerve function while other treatments — such as surgery or radiation — are planned.

What to expect with steroids for spinal tumors: Steroids usually work quickly to ease pain and improve strength. They can raise blood sugar and cause mood changes or sleep trouble with longer use. Your care team tapers the dose slowly and watches for side effects.

Surgery

Surgery takes pressure off the spinal cord and supports weak bones. The care team uses it only for certain conditions, such as when the tumor is squeezing the spinal cord, the spine is unstable or radiation doesn't do enough to treat the condition. Usually, a team of specialists reviews your condition together before advising surgery. Your team may choose from these surgery options for spinal tumors:

• Decompression surgery removes tumor tissue that is pressing on the spinal cord or nerves so you can keep strength and movement.
• Stabilization with implants uses rods, screws or cages to hold the spine steady after the pressure from the tumor is eased.
• Vertebroplasty or kyphoplasty injects bone cement to support a cracked or weak vertebra, which can ease pain and prevent more collapse. Vertebroplasty and kyphoplasty are not used when there is spinal cord compression because they do not ease pressure.
• En bloc removal takes out the whole tumor in one piece, then rebuilds and stabilizes the spine. This approach can lower the risk of the tumor growing back in the same area.

What are the side effects of radiation or chemotherapy for spine cancer?

Radiation therapy can cause tiredness, changes in skin color over the treatment area and temporary soreness. Very high doses can sometimes affect the spinal cord or nearby nerves. With modern, precise treatment, this is not common.

Side effects of chemotherapy and other medicines for spinal tumors depend on the medicine. Common side effects are nausea, low blood counts, hair loss and fatigue. Newer targeted drugs and immunotherapies often have fewer whole-body side effects than do older treatments.

Can metastatic spine cancer be cured?

Most spinal metastases, which are tumors that spread to the spine from another cancer, can't be cured. But they can often be controlled for a long time. The main goal of treatment is to ease pain, protect the spinal cord and nerves, and help you keep walking and being active.

Sometimes — such as when a single, small metastasis is found early — surgery and focused radiation may remove or destroy all visible cancer.

Modern treatments combine surgery, radiation, targeted therapy, and newer systemic drugs that can shrink or slow cancer. Many people now live months to years longer with good quality of life thanks to these options.

Prognosis and survival

Prognosis and survival with a spinal tumor depend on the tumor type, its grade and where it's found in the spine. Prognosis and survival also depend on whether the tumor started in the spine or spread there from another place in the body.

Some slow-growing primary tumors can be managed for many years. When cancer spreads to the spine, outcomes vary widely. Some people live months while others live years. Outcomes depend on the original cancer and overall health.

Finding a tumor early and starting treatment quickly can protect walking and independence.

Some people whose cancer has spread to just one spot in the spine and nowhere else live about 30 months after surgery on average. About 1 in 5 are alive at five years.

Being able to walk at the start of treatment is a strong predictor of outcome. Up to 80% of people who are walking when radiation starts keep walking. About 5% to 20% who are paralyzed are able to walk again.

Potential future treatments

Researchers are looking for safer, more precise ways to treat spinal tumors. The goal is better tumor control with fewer side effects. Treatments in research for spinal tumors include:

• Sharper planning and imaging. Daily imaging and careful planning help line up treatment for each radiation session and keep radiation away from the spinal cord. This preparation helps target the tumor more accurately.
• Next-generation proton therapy. New types of proton delivery, such as proton SBRT and proton arc therapy, are under study. These may focus radiation even more tightly on the tumor while sparing healthy tissue.
• Combining radiation with newer drugs. Some tumors may respond better when radiation is paired with targeted therapies or immunotherapy. These combinations are being explored to improve control of the disease and reduce symptoms.

Many people living with spinal cancer use integrative or complementary therapies alongside standard medical treatment to manage pain, stress and fatigue. Evidence-based options such as acupuncture, massage and mind-body techniques can improve comfort and quality of life when used safely under a care team's guidance.

Some people with certain medical conditions, such as low blood counts, may need to take special precautions. Always discuss any integrative therapy with your care team.

• Acupuncture. Acupuncture can help reduce cancer-related pain for some people. It may also lower stress and improve well-being. Seek this treatment from a licensed acupuncturist who knows your cancer history.
• Acupressure. Acupressure is a needle-free option. Pressing on specific points can help with pain and tension. You can learn simple techniques to use at home.
• Massage therapy. Gentle massage can ease muscle tightness and help with pain. Use light pressure and avoid areas that are tender, have tumors, or were treated with surgery or radiation.
• Mind-body therapies. Guided imagery, relaxation training, mindfulness and music therapy can help people cope with pain and stress. These can be used along with standard pain medicines.
• Hypnosis. Hypnosis can reduce pain and anxiety for some people. It is safe when done by qualified hypnosis professionals.

These approaches do not replace surgery, radiation or medicine, but they can support healing and well-being during and after treatment.

While spinal cancer itself often can't be prevented, healthy daily choices can lower overall cancer risk and improve strength during treatment. Eating a healthy diet, staying physically active, keeping a healthy weight and limiting alcohol can all help the body cope better with therapy.

Stay active

Gentle movement — such as short walks, stretching or light yoga — can reduce fatigue and improve balance. Ask your care team which exercises are safe for your spine. Avoid heavy lifting or twisting.

Healthy eating at home

Choose small, frequent meals with lean protein, vegetables and whole grains. Drink plenty of fluids and limit high-sugar, high-fat and processed foods. Preparing food at home instead of eating out can help you manage calories, salt and added sugar.

Learning that you have a spinal tumor can feel overwhelming. But you can take steps to cope after your diagnosis. Consider trying to:

Find out all you can about your spinal tumor

Write down your questions, bring them to your appointments and ask your healthcare professional your questions. Take notes or ask a friend or family member to come along to take notes.

The more you and your family know and understand about your care, the more confident you'll feel when it is time to make treatment decisions.

Get support

Find someone you can share your feelings and concerns with. You may have a close friend or family member who is a good listener. Or speak with a clergy member or counselor.

Other people with spinal tumors may be able to offer unique insights. Ask your healthcare team about support groups in your area and online.

Take care of yourself

Eat nutritious foods. Check with your healthcare professional to see when you can start exercising again. Get enough sleep so that you feel rested.

Reduce stress in your life by taking time for relaxing activities, such as listening to music or writing in a journal.

Make an appointment with your care team if you have any symptoms that worry you. If your healthcare professional thinks you might have a condition affecting the spinal cord, that person may refer you to a neurologist. A neurologist is a doctor who specializes in conditions that affect the brain, spinal cord and nerves.

If you learn that you have a spinal tumor, you might meet with surgeons. These may be surgeons who operate on the brain and spinal cord, called neurosurgeons, and surgeons who operate on the spine, called spinal surgeons.

Other specialists who care for people with spinal tumors include doctors who use medicine to treat cancer, called medical oncologists, and doctors who use radiation to treat cancer, called radiation oncologists.

Here's some information to help you get ready for your appointment.

What you can do

• Write down any symptoms you have and how long you've had them.
• List your key health information, including all conditions you have and the names of any medicines you're taking.
• Note any family history of brain or spinal tumors, especially in a first-degree relative, such as a parent or sibling.
• Take a family member or friend along. Sometimes it can be hard to remember all of the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Questions to ask at your first appointment include:

• What may be causing my symptoms?
• Are there any other possible causes?
• What kinds of tests do I need? Do these tests require any special preparation?
• What do you recommend for next steps in determining my diagnosis and treatment?
• Should I see a specialist?

Questions to ask a specialist include:

• Do I have a spinal tumor?
• What type of tumor do I have?
• How will the tumor grow over time?
• What might be the results of having the tumor?
• What are the goals of my treatment?
• Do you advise surgery? What are the risks?
• Do you advise radiation? What are the risks?
• Will I need chemotherapy? What are the risks?
• What treatment approach do you recommend?
• If the first treatment doesn't work, what will we try next?
• What is the long-term outlook for my condition?
• Do I need a second opinion?

In addition to the questions that you've prepared, ask any additional questions that come up during your appointment.

What to expect from your doctor

Be prepared to answer some questions about your symptoms and your health history, such as:

• What are your symptoms?
• When did you first notice these symptoms?
• Have your symptoms gotten worse over time?
• If you have pain, where does the pain seem to start?
• Does the pain spread to other parts of your body?
• Have you had any weakness or numbness in your legs?
• Have you had any trouble walking?
• Have you had any trouble with your bladder or bowel function?
• Have you been diagnosed with any other medical conditions?
• Are you currently taking any medicines?
• Do you have any family history of spinal tumors?