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Spinal tumours
A guide for patients and carers
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Possible treatments
There are different treatment options for spinal tumours and specific treatment pathways will differ for each individual. Your medical team will discuss your best treatment options with you.
These will differ depending on the type of tumour you have and other factors such as the size of the tumour, its exact location and which part of your spine is affected.
Spinal tumours can be serious and life-threatening. It is not always possible to treat them successfully.
The four main treatment options for spinal tumours are
These will differ depending on the type of tumour you have and other factors such as the size of the tumour, its exact location and which part of your spine is affected.
Spinal tumours can be serious and life-threatening. It is not always possible to treat them successfully.
The four main treatment options for spinal tumours are
- surgery,
- radiotherapy,
- radiosurgery, and
- chemotherapy.
Surgery
The aim of surgery is to remove the tumour without damaging the spinal cord or the nerves surrounding the tumour. Surgery is most commonly used to treat benign spinal tumours but it might be used to treat some malignant tumours (for example, a chordoma tumour in the bone). Surgery is not suitable for everybody and you might be advised against it because of the risks associated with your individual situation. Your medical team will discuss the best treatment options with you.
The surgery is carried out by a neurosurgeon who specialises in surgery on the brain and spine. The operation is carried out under a general anaesthetic which means you will be asleep throughout and will not feel anything. An incision (cut) is made at the point where it is easiest to reach the tumour. This might be on your back, your neck or your side.
Often benign tumours can be removed completely by surgery. However, this is not always possible and, in some circumstances, it is safer to leave a small amount of the tumour behind than to risk causing damage to the spine or nerves. Tumours within the spinal cord are particularly difficult to treat with surgery and a complete removal of the tumour might not be possible. The neurosurgeon will remove as much of the tumour as they judge to be safe. The partial removal of a tumour is called debulking.
Spinal tumours in the bone can be very difficult to remove with surgery. Often, the difficulty is a combination of the size of the tumour, access to it (tumours in the bone can extend around the spinal cord from the front to the back of the spine), and the need to preserve the stability of the vertebrae (spinal bones). In some cases, the spine will need to be strengthened by an implant. This would usually involve a longer, more complicated operation and a longer recovery period.
Even if the complete removal of a spinal tumour is not possible, the partial removal of the tumour (debulking) can relieve pressure on the spinal cord and increase the chances of people recovering from weakness and paralysis.
Spinal tumours and surgery to treat them can cause damage to the supporting structures of the spine.
This results in weakness and instability and allows abnormal movement of the spine which can cause further damage to the spinal cord and nerves. To help provide support and stability, some people have metal supports implanted into their spine at the time of their surgery. Some people might also wear an external brace or reinforced jacket after their surgery to provide extra support while they are recovering strength and stability.
This results in weakness and instability and allows abnormal movement of the spine which can cause further damage to the spinal cord and nerves. To help provide support and stability, some people have metal supports implanted into their spine at the time of their surgery. Some people might also wear an external brace or reinforced jacket after their surgery to provide extra support while they are recovering strength and stability.
Radiotherapy
Radiotherapy is often used to treat malignant tumours. It might also be used after surgery to try to deal with any remaining tumour. If you have had surgery, you will be given time to recover and for your wounds to heal before receiving radiotherapy treatment. If you have been diagnosed with a primary cancer elsewhere in your body, you might also receive radiotherapy treatment for this cancer.
Radiotherapy treatment is planned and carried out by a radiotherapist who might also be an oncologist (a doctor who specialises in cancer). It is likely that your radiotherapist will have a specific interest in tumours of the central nervous system (the brain and spinal cord). They will explain the radiotherapy treatment to you, discuss the treatment with you, and talk through any worries or concerns you might have.
Radiotherapy will not always be available at the same hospital where neurosurgery is carried out but there is always a close link between the hospitals providing your treatment.
Radiotherapy uses X-rays and gamma rays to damage or destroy the tumour. The effect on the tumour is to slow its growth and lengthen the time before it regrows. In some circumstances, radiotherapy can cure the tumour.
The exact method of radiotherapy treatment will differ for each individual depending on factors such as the type of tumour, its size and location. The specific purpose of the treatment might also differ for individuals. For example, to relieve pain, someone might be given a single dose of radiotherapy. To cure a tumour, someone might require daily radiotherapy over a course of several weeks.
Common side effects of radiotherapy are a temporary worsening of the existing symptoms and inflammation of the skin, similar to sunburn.
Most people feel tired towards the end of their course of radiotherapy. Other side effects can include bone fractures and changes in the bone marrow.
Radiosurgery (gamma knife)
Radiosurgery is a technique for treating spinal tumours which is only available in a few specialised neurological centres in the UK. The two main methods of carrying out radiosurgery are by gamma knife and by modified linear accelerator (linac). Both methods use a high energy dose of radiation that can be focused on a very precise point in the spine.The linac uses only one beam of high energy radiation which arcs around a single point, treating that specific area but not affecting the surrounding tissue. The gamma knife uses hundreds of energy beams which combine to form a high energy point at their focus, each individual beam being too weak on its own to damage any healthy tissue in its path.
Unlike radiotherapy, which might require several sessions over weeks and months, radiosurgery is completed in one session and does not require an overnight stay in hospital. People are able to return to their normal routine immediately after the treatment without experiencing any of the side effects of surgery or radiotherapy.
It can take a long time for radiosurgery treatment to work and tumours might shrink in size slowly over months and years.
Radiosurgery is not suitable for everyone and your doctor will discuss your best treatment options with you.
Intensity Modulated Radiotherapy (IMRT) is a newer form of very precise radiation treatment carried out with the linac. Energy beams of varying strengths (modulated beams) and three-dimensional scans are used to focus the radiation on the specific shape of individual tumours and minimise damage to the surrounding healthy tissue.
Chemotherapy
Chemotherapy is the use of drugs to destroy tumour cells in a way which is similar to the use of antibiotics to kill bacteria.
Chemotherapy is mostly used for people with spinal tumours caused by primary cancers elsewhere in the body.
There are different types of chemotherapy. Some are taken by mouth and others are given via a drip into a vein. Chemotherapy is usually prescribed by an oncologist who has expertise in both radiation and chemotherapy. The consultant in charge of giving chemotherapy will be happy to discuss the treatment with you.
The possible side effects of chemotherapy vary considerably depending on the particular drug used. They include nausea (feeling sick), tiredness, hair loss, and a reduced resistance to infection. You should discuss these possible side effects with the specialist providing your treatment.
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