Neuroendocrine (NETs) Tumors Guide
97% of all spinal tumors have metastatic nature.
Up to 56% of primary spinal tumor cases are benign.
About 80% of primary spinal tumors are asymptomatic.
The average recurrence rate of spinal tumors is about 25%.
Brief info about spinal cord
The spinal cord is second among the essential elements of the human nervous system. Together with the brain, it is a part of the central nervous system. The spinal cord is about 43-45 cm long. It went inside the backbone's spinal canal and separated into 31 segments. The spinal canal also contains cerebrospinal fluid, which is necessary for the adequate functioning of the nervous system.
Among the main functions of the spinal cord are:
- Nerve signals' transmission. The spinal cord helps to transmit nerve signals from the brain to the body parts and backward.
- Reflexes' coordination. Some reflexes are even entirely independently controlled by the spinal cord.
- Movement coordination. The spinal cord helps coordinate the movements of the body's muscles, including the diaphragm.
- Sensory coordination. The spinal cord is essential in gathering and passing sensory information to the brain.
Each segment of the human spinal cord creates two pairs of nerve roots that merge into spinal nerves. The connection between nerve roots and the spinal cord is where the central nervous system proceeds to a peripheral nerve system.
In case of severe spinal cord damage due to trauma, neurological disease, or any other reason, there is a vast probability that all lower segments will be disabled. As a result, the patient can lose their ability to move, sensitivity, or both.
Main details about spinal tumors and their types
Spinal tumors might be related to the spinal cord or the backbone. They could be non-cancerous (benign) or cancerous (malignant). Spinal cancer is also divided into primary (only up to 15%), meaning the leading site of the disease is located in the spine, or secondary (up to 85%), meaning that a primary tumor is elsewhere in the organism.
- Extradural. Those spinal tumors develop outside the covering surrounding the brain and spinal cord (dura mater). About 55% of all spinal tumor cases are extradural.
- Intradural-extramedullary. Those spinal tumors develop inside the dura mater but outside the spinal canal. About 40% of all spinal tumor cases are intradural-extramedullary.
- Intramedullary. Those spinal tumors develop inside the spinal canal. Only about 5% of all spinal tumor cases are intramedullary.
Spinal tumors are also can appear on different levels: the thoracic level (60-80%), the lumbosacral level (15-30%), and the cervical level (up to 10%).
Spinal tumor biopsy helps to identify the exact tumor type. Suspicious cells are studied under the microscope and help oncologists confirm whether the tissues are benign or malignant and know their kind. There are more than 120 verified histological types of spinal tumors, but among the most frequent are schwannomas (29%), meningiomas (25%), exophytic ependymomas (13%), and sarcomas (12%).
Most crucial risk factors for spinal tumor
Risk factors for developing spinal tumors vary depending on the tumor type. For example, 30 - 70% (depending on the primary cancer site and type) of all patients with cancer will develop secondary (metastatic) spinal tumors during their post-diagnostic lifetime.
Still, some risk factors are equally dangerous for all patients
- Family history. Patients with close relatives with a previous history of spinal tumors tend to be more predisposed to this condition.
- Certain age. Up to 85% of all patients with spinal tumors were 65+ years old or up to 14 years old.
- Certain hereditary syndromes. Patients with Cowden, Turcot, Gorlin, Li-Fraumeni, tuberous syndromes and neurofibromatosis type I or II are likely to develop spinal tumors during their lifetime.
- Weak immune system. Patients after organ transplantations, AIDS, and other diseases and states related to weakened immunity tend to develop spinal tumors 3 to 5 times more often than patients with a regular immune system.
Various environmental impact factors also significantly increase the probability of spinal tumors. For example, among the patients who used to survive the severe impact of electromagnetic or radiation exposure during their childhood, the number of those who developed spinal tumors was much higher than the rest of the population.
How to prevent spinal tumors?
Unfortunately, there are no precise ways to prevent the development of spinal or brain tumors. Still, various general anti-cancerous measures could help avoid spinal lumps. Among them are a healthy lifestyle, avoiding smoking, regular exercising, etc.
Timely and competent treatment of any diseases associated with inadequate immune response, cancer of other sites, and hereditary cancer syndromes will decrease the possibility of spinal tumor occurrence. In addition, avoiding excessive radiation and electromagnetic exposure, especially at an early age, will be pretty helpful in preventing cancer.
At an early age, regular examinations by parents, but primarily medical practitioners, to discover any lumps on the spine or other similar signs might help decrease the possibility of spinal tumor deterioration in kids from the risk group. Also, patients must undergo regular full-body check-ups if diagnosed with cancer and successfully overcome the disease. It will help to prevent sudden relapse and to avoid a metastatic spinal tumor.
What are the main spine tumor symptoms?
Most primary spine tumors are benign and asymptomatic and could be found only during examinations or tests for other reasons. Still, some spine tumors (both benign and malignant) can potentially lead to a wide range of clinical symptoms.
Most frequent symptoms of spinal tumors
- Back pain. Back pain is the hallmark symptom of spine tumors found in 80-95% of patients. Back pain always accompanies patients with a tumor on the lower back.
- Motor dysfunction (deterioration or the entirely lost ability to move). Any difficulties with movement are the second most frequent symptom, and 35-75% of patients complain about it.
- Sensory dysfunction (deterioration or the fully lost ability to sense pain, temperature, and touches). This is one of the symptoms that often accompany spinal cord compression.
- Bladder/bowel dysfunction. Those symptoms usually appear only when spinal tumor volume reaches a significant size or has a specific localization.
- Weakness. One of the most frequent symptoms is when spinal tumors begin to advance. In the late stages of cancer, it can be found in 60-85% of patients.
In most cases, to understand what kind of symptoms could a spine tumor cause, it's essential first to know more about the tumor's localization. For example, up to 80% of intramedullary spine tumors lead to motor and sensitivity dysfunctions after they reach a specific size.
Also, it's important to remember that signs of the primary tumor will always accompany metastatic spinal cancer symptoms.
Best ways to diagnose spinal tumors
Unfortunately, due to a specific site of the spinal tumors, it's usually almost impossible to verify diagnosis with the most accurate method —traditional biopsy. So mostly, neurosurgeons perform surgical treatment, if possible and required, and combine it with a biopsy. In other cases, spinal tumors are verified with various methods of medical imaging:
Diagnostic scans used to confirm cancer in the spine
- X-ray. One of the cheapest and easy-to-perform diagnostic methods, but with a low sensitivity rate (44-50%).
- Computer tomography (CT). CT is better for verifying lesions of the backbone but still shows a significantly higher sensitivity rate compared with an x-ray (up to 73%).
- Magnetic resonance imaging (MRI). MRI is considered the most sensitive method of spinal tumor detection, with a rate of up to 82%.
- Positron emission tomography (PET). The method is one of the most valuable for determining metastatic spinal tumors, especially in vertebras.
The role of a distant medical opinion for spinal tumor patients
Using various contrast dyes and substances to get the most apparent imaging and verify spinal tumors is essential. Also, a distant opinion from world-class specialists might be precious to get the most precise diagnosis and, as a result, the most suitable spinal cord tumor treatment.
It’s worth mentioning that many patients tend to have a second opinion to get the answer to the most critical questions:
- Do I require spine surgery?
- Is there any alternative to surgical treatment?
- What is the success rate of the surgery in my case?
About spinal tumors staging
When speaking about spinal tumor staging, it's essential to know that malignant and benign spinal tumors have different approaches to establishing a stage. But, because most of the primary spinal tumors spread out of the nervous system and backbone very rarely, primary spinal tumors get an outline of grades that mainly uses worldwide instead of stages:
- Grade 1. The tumor is more likely benign and won't show a tendency to expansive growth or aggressive spreading on the nearby tissues. Those spinal tumors can be entirely removed during surgeries.
- Grade 2. The tumor in the spine is more likely to show a slow-growing tendency, potentially leading to severe conditions and symptoms. Pretty rare cases of malignancy and metastatic spread are also possible.
- Grade 3. Those spinal lumps often increase their size quickly and are likely to spread across the nearest tissues. Still, distant metastases are rare.
- Grade 4. Spinal tumors of grade 4 increase their size very aggressively and tend to spread very quickly across the human body, including distant metastases.
A classical approach for tumor staging (TNM) that includes info regarding the volume and size of primary spinal tumors, state of nearest lymphatic nodules, and presence of metastatic lesions also uses in some cases.
Doctors carefully evaluate each patient with spinal tumors to set a valid stage. At the same time, each case of a metastatic spinal tumor considers stage IV, according to the TNM staging system.
Countries with the most developed spinal tumors treatment
Spinal cord tumor treatment options: What are traditional ways?
A potential treatment for spinal cord tumors depends on many factors, including the patient's age, general state, histological type, localization, and the number of lesions. Also, the nature of spinal tumors is vital to consider. As a result, treatment for spinal tumors of metastatic nature might significantly vary compared to primary spinal tumors.
Combined treatment is one of the most widely used methods to treat spinal tumors. Integrative treatment approaches might include chemotherapy, radiotherapy, surgery, stereotactic radiosurgery, and other methods. About 52% of patients receive various types of combined therapy during their lifetime after getting a spinal tumor diagnosis.
Some treatment methods are statistically more suitable for specific types of spinal tumors. For example, surgical removal shows excellent results as a single non-cancerous spinal cord tumor treatment method. At the same time, surgical removal of spine tumors is essential to prevent or remove spine compression due to aggressive and expansive tumor growth. Still, it often requires additional methods to get dissent results. So, we present spinal tumor treatment methods depending on the most sensitive and responsive spinal lesion types while being used.
Best non-cancerous spinal cord tumor treatment
Non-cancerous spinal tumors are mostly not dangerous, don't show a frequent tendency for fast growth, and never tend to give metastasis. As a result, most often, those spinal tumors might only be dynamically observed for a long time.
About 45% of patients with non-cancerous spinal tumors didn't require anything more. But if non-cancerous spinal tumors create compression and cause motor or sensitive dysfunctions, patients might require active treatment.
Among the best treatment options for non-cancerous spinal tumors are:
- Surgery. Due to the high possibility of various complications, surgical treatment of spinal cord tumors remains among the rarest methods, but at the same time, one of the most effective. Furthermore, only 3-15% of surgically removed tumors tend to relapse.
- Open surgery. During open surgery, medical practitioners receive a clear view of spinal tumors and get the possibility to remove their mass entirely. So, doctors perform all further actions through a big cut above spinal tumors.
- Minimally invasive surgery. Most minimally invasive surgeries are performed through a small aperture while observing with a camera or under the control of MRI or plain radiography.
Sometimes neurosurgeons can't entirely remove spinal tumor masses due to a specific localization or other reasons. As a result, patients might require an additional radiation therapy session to prevent possible relapse in that case. Still, in 80% of non-cancerous spinal tumors, a single surgery remains a sufficient treatment to achieve positive outcomes.
Most effective cancerous and metastatic spinal tumors treatment methods
Surgery is the less effective method to achieve excellent results in treating late-stage or high-grade cancerous and metastatic spinal tumors. Still, doctors might use it to decompress the spine or remove a primary tumor in other parts of the patient's body.
So, among the most effective methods of spinal tumor treatment without surgery are:
- Chemotherapy. Many pharmaceutical substances could help patients with inoperable spinal tumors suppress the disease's further development. Up to 83% of patients reported clinical benefits after chemotherapy.
- Radiotherapy. Radiotherapy is a method of choice for patients with multiple metastatic spinal tumors. Beams of radiation exposure on the patient's spine to achieve treatment effects.
- Brachytherapy. If the patient's condition is too poor to receive chemotherapy or radiation therapy, a small radioactive capsule might be placed inside their spinal tumors.
- Stereotactic radiosurgery (SRS). It's a type of radiotherapy that uses a focused beam of ionizing radiation that affects spinal tumors. Compared with traditional radiotherapy, SRS tends to inflict fewer side effects and shows up to a 90% response rate. The Gamma Knife is one of the most advanced apparatuses for SRS developed recently.
- Proton therapy. One of the most widely used methods of particle therapy for cancer treatment. Doctors use particle accelerators to create and maintain the proton beam and point it directly at spinal tumors or other lesions under various angles. Up to 85% of patients reported five years of recurrence-free status after proton therapy.
In some instances, patients might also receive so-called adjuvant radiotherapy. The main goal of adjuvant radiotherapy is to destroy those tumor cells that weren't affected by the primary treatment. Only 5,4% of patients who undergo adjuvant radiotherapy got a relapse of a spinal tumor. Adjuvant radiotherapy courses might vary from a few weeks to up to 10 years.
Sometimes a proper treatment of spinal tumors might require prolonged support and care from medical practitioners. In addition, weakness and cachexia (a significant decrease in body weight, productivity, and muscle atrophy) might result from the disease and some therapy. So, rehabilitation might also be a part of necessary treatment in some cases.
Best spinal cord tumor centers and treatment facilities worldwide
New spinal tumor treatments
Due to their innovative nature, many spinal tumor treatment methods aren't widely spread globally. In addition, it requires more time to teach medical practitioners and get proper apparatuses and supplements to perform some of them. Still, some of them show great results and need to be considered by patients with spinal tumors.
Among new treatment methods are:
- Transarterial chemoembolization (TACE). During embolization, doctors block blood flow to spinal tumors. It prevents oxygen and nutrients from reaching the tumor's cells and helps to prevent its further growth. Medical practitioners reach blood vessels that deliver blood to the spinal tumor via the nearest artery and block it by injecting chemical agents.
- Kyphoplasty. During this minimally invasive surgery, doctors insert a balloon to elevate the upper vertebrae and reconstruct the damage due to spinal tumor vertebrae using medical cement. Only patients with backbone spinal tumors are applicable for this treatment method. The average success rate of kyphoplasty is 66%.
- Cryoablation. A small needle is inserted inside the spinal tumor, and a cold substance delivers inside. As a result, spinal tumors stop their progression and disappear.
- CyberKnife. The newest technic of CRC combines traditional, focused radiation exposure with high-precision guidance. CyberKnife alow to treat spinal tumors from up to 1,400 possible angles and doesn't require further rehabilitation.
- Endovascular coiling. The method primarily uses to treat various cavernous malformations in the spine. During the procedure, doctors insert a flexible, soft, long wire until the cavity is entire. The wire prevents spinal tumors from further growth and remains inside the cavity. Treatment shows up to 85% of the efficiency rate.
- MRI-guided laser ablation. Medical practitioners might use the energy of lasers to destroy spinal tumors. The treatment performs under the observation of MRI. Unfortunately, less than 1% of patients with spinal tumors are applicable for this treatment.
- Cancer vaccines. Various substances can help activate the human immune system to fight malignant spinal tumors. Cancer vaccines are among them. But, unfortunately, most cancer vaccines will get wide distribution only in the nearest future. For now, only five categories of anticancer vaccines are actively used worldwide.
- CAR T-cell therapy. During this treatment, doctors took patients' immune cells from their blood and enchased them by adding specific gen. Those immune cells become effective in finding and destroying tumor cells.
- Tumor-infiltrating lymphocytes therapy (TIL). According to trials, lymphocytes gathered around the tumors could significantly impact further growth and development of the tumor's mass. So, doctors took those lymphocytes, enchased them, and reinserted them into the tumor site.
Various alternative treatments for spinal tumors include immunotherapy, target therapy, stem cell-based therapy, and many others available worldwide. Unfortunately, many treatment methods still need to finish a clinical trial stage. Still, AiroMedical will gladly help reach doctors who guide those trials and become a part of experimental treatment if necessary.
Best doctors for spinal tumors treatment all around the globe
Spinal cord tumor treatment prognosis and statistics
Non-cancerous or cancer lumps on the lower back might cause many issues in everyday life. Yet, lots of treatment methods, conservative and newly developed, could potentially bring the cure to almost any case.
The five-year survival rate of patients with spinal tumors is strictly related to the histological type of tumor and its nature. For example, only 10% of patients with osteosarcomas in their spine live longer than five years after treatment. At the same time, up to 70% of patients who undergo treatment due to benign spinal tumors live longer than five years.
The average treatment methods use rate for patients with spinal tumors worldwide
That data shows how frequently doctors use one or other treatment solution in case of tumors in the spine. The numbers are the following:
- Combined treatment - 52%
- Radiosurgery - 19%
- Radiotherapy - 12%
- Chemotherapy - 10,8%
- Surgery alone - 6,2%
As you can see, combined treatment is the most frequent approach among patients worldwide. So, trying other treatment options is always necessary and possible to find a cure for spinal tumors. AiroMedical will assist you in determining the best possible treatment options and getting an appointment with the best professionals in the world of neurosurgery, orthopedic surgery, oncology, and rehabilitation.
AiroMedical is not limited to specific clinics, medical centers, and countries. As a result, the patient will get all the best treatment options for his particular case regardless of outer circumstances.
References:
- Wewel JT, O'Toole JE. Epidemiology of spinal cord and column tumors. Neurooncol Pract. 2020;7(Suppl 1):i5-i9. Published 2020 Nov 18. doi:10.1093/nop/npaa046
- Ciftdemir M, Kaya M, Selcuk E, Yalniz E. Tumors of the spine. World J Orthop. 2016;7(2):109-116. Published 2016 Feb 18. doi:10.5312/wjo.v7.i2.109
- Furlan JC, Wilson JR, Massicotte EM, Sahgal A, Fehlings MG. Recent advances and new discoveries in the pipeline of the treatment of primary spinal tumors and spinal metastases: a scoping review of registered clinical studies from 2000 to 2020. Neuro Oncol. 2022;24(1):1-13. doi:10.1093/neuonc/noab214
- Raj VS, Lofton L. Rehabilitation and treatment of spinal cord tumors. J Spinal Cord Med. 2013;36(1):4-11. doi:10.1179/2045772312Y.0000000015
- Amadasu E, Panther E, Lucke-Wold B. Characterization and Treatment of Spinal Tumors. Intensive Care Res. 2022;2(3-4):76-95. doi:10.1007/s44231-022-00014-3
