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Treatments and drugs
By Mayo Clinic staffIdeally, the goal in treating a spinal tumor is to eliminate the tumor completely, but this aim is complicated by the risk of permanent damage to the surrounding nerves. Doctors also must take into account your age, overall health, the type of tumor and whether it is primary or has spread to your spine.
Treatment options for most spinal tumors include:
- Monitoring. Sometimes spinal tumors are discovered before they cause symptoms — often when you're being evaluated for another condition. If small tumors are noncancerous and aren't growing or pressing on surrounding tissues, watching them carefully may be the only treatment that you need. This is especially true in older adults for whom surgery or radiation therapy may pose special risks. If you decide not to treat a spinal tumor, your doctor will recommend periodic scans to monitor the tumor's growth.
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Surgery. This is often the first step in treating tumors that can be removed with an acceptable risk of nerve damage.
Newer techniques and instruments allow neurosurgeons to reach tumors that were once inaccessible. The high-powered microscopes used in microsurgery make it easier to distinguish tumors from healthy tissue. Doctors also can test different nerves during surgery with electrodes, thus minimizing nerve damage. In some instances, they may use sound waves to break up tumors and remove the remaining fragments.
Even with advances in treatment, not all tumors can be removed completely. Surgical removal is the best option for many intramedullary and intradural-extramedullary tumors, yet large ependymomas at the end of the spine may be impossible to extricate from the many nerves in this area. Although noncancerous tumors in the vertebrae can usually be completely removed, metastatic tumors are less likely to be operable.
When a tumor has spread to the spine, radiation alone is usually the treatment of choice. However, research has found that surgery combined with radiation may be more effective at preventing loss of nerve function in people who are healthy enough to tolerate an operation and who have tumors that have spread from an unknown location, have some evidence of nerve injury, have tumors resistant to radiation or have recurrent tumors that were previously irradiated.
Recovery from spinal surgery may take weeks or months, depending on the procedure, and you may experience a temporary loss of sensation or other complications, including bleeding and damage to nerve tissue.
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Standard radiation therapy. This may be used following an operation to eliminate the remnants of tumors that can't be completely removed or to treat inoperable tumors. It's also often the first line therapy for metastatic tumors. Radiation may also be used to relieve pain or when surgery poses too great a risk.
Medications can help some of the side effects of radiation, such as nausea and vomiting. And depending on the type of tumor, your doctor may be able to modify your therapy to help prevent damage to surrounding tissue and improve the treatment's effectiveness. Modifications may range from simply changing the dosage of radiation you receive to using sophisticated techniques that offer better protection to healthy tissue, such as 3-D conformal radiation therapy.
- Stereotactic radiosurgery (SRS). This newer method, capable of delivering a high dose of precisely targeted radiation, is being studied for the treatment of spinal tumors. In SRS, doctors use computers to focus radiation beams on tumors with pinpoint accuracy, and from multiple angles. This approach has been proved effective in the treatment of brain tumors. Research is under way to determine the best technique, radiation dose and schedule for SRS in the treatment of spinal tumors.
- Chemotherapy. A standard treatment for many types of cancer, chemotherapy hasn't proved beneficial for most spinal tumors. However, there may be exceptions. Your doctor can determine whether chemotherapy might be beneficial for you, either alone or in combination with radiation therapy.
- Other drugs. Because surgery and radiation therapy as well as tumors themselves can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce the swelling, either following surgery or during radiation treatments. Although corticosteroids reduce inflammation, they are usually used for short periods only to avoid such serious side effects as osteoporosis, high blood pressure, diabetes and an increased susceptibility to infection.
- Brain and spinal tumors: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/brainandspinaltumors/detail_brainandspinaltumors.htm#43233060. Accessed July 25, 2009.
- Welch WC, et al. Spinal cord tumors. http://www.uptodate.com/home/index.html. Accessed July 25, 2009.
- Donthineni R. Diagnosis and staging of spine tumors. Orthopedic Clinics of North America. 2009;40:1.
- Schiff D. Clinical features and diagnosis of epidural spinal cord compression, including cauda equina syndrome. http://www.uptodate.com/home/index.html. Accessed July 25, 2009.
- Detailed guide: Brain / CNS tumors in adults. American Cancer Society. http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=3. Accessed July 25, 2009.
- DeAngelis LM. Tumors of the central nervous system and intracranial hypertension and hypotension. In: Goldman L, et al., eds. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/151491959-3/0/1492/741.html?tocnode=54620820&fromURL=741.html#4-u1.0-B978-1-4160-2805-5..50204-4--cesec51_9020. Accessed July 25, 2009.
- Cole JS, et al. Metastatic epidural spinal cord compression. Lancet Neurology. 2008;7:459.
- Moynihan TJ (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 2, 2009.
