• Information
• Publications
  • Brain and Spine Booklets
  • Forthcoming titles
  • Get involved publications
  • Case studies
• Glossary
• Neurological centres
• Headstrong
• Information Access toolkit
• Communication skills project

|

The word "tumour" strictly means "a swelling".The body is made up of individual cells.These cells multiply for normal growth and to repair tissues, allowing for normal wear and tear. If the control of these processes is lost, the cells may multiply abnormally, forming a growth or tumour.A lesion is another word for an abnormal area and can be, amongst other things, a tumour. Inflammatory lumps sometimes occur too (e.g. from infection). For the remainder of this booklet, the term tumour is used to mean an abnormal growth. A cyst is a fluidfilled sac. It may be a simple benign cyst, but if the wall is made of tumour cells, it is a cystic tumour.

The spine is made up of the bony structures (and enclosed spinal cord and nerve roots) extending from the base of the skull down to and including the sacrum and coccyx (see Figure 1).The sacrum is the back part of the bony pelvic "ring".The spinal column consists of bones, discs and joints and encloses the spinal cord and nerve roots in the spinal canal.The spinal cord ends just below the thoracic segment of the spine, above the small of the back. Below this only nerve roots are found in the spinal canal.

Types of spinal tumours
Tumours affecting the spine can arise either locally, from the structures of the spine (primary tumours), or spread to the spine from elsewhere in the body.When they are found away from the original cancerous growth, these tumours are sometimes called secondaries or metastases.

Secondary deposits from cancer
These may be multiple and typically come from cancers of the lung, breast, prostate or bowel. Since most of these spinal secondaries are in the bone, there may be weakness of the structure of the spine. There may also be compression of the spinal cord or spinal nerve roots in the spinal canal.

Benign spinal tumours
These usually occur inside the membrane surrounding the spinal cord and nerves. They occur much less frequently in the bones of the spine. Consequently, benign spinal tumours rarely disturb the strength of the bony structure of the spinal column. However, sometimes surgical removal of them can do so and benign tumours can also cause nerve disturbance, depending on their size and location.

Spinal lesions
The word "lesion" is often used when the nature of the abnormality is unknown. Although a tumour may be suspected, it may turn out that there has been bleeding (for example, inside the spinal cord) or infection. Usually a confident diagnosis can be reached, but this may involve taking a biopsy sample.

How common are spinal tumours?
About 750 primary spinal tumours are diagnosed annually in the UK. Secondary tumours are rather more common.

What causes spinal tumours?
The basic reasons why tumours occur are not yet known with any certainty.Why some tumours are benign and others malignant, is also unclear. Unlike lung cancer, where there is a strong link with smoking, it is not possible to pinpoint clear risk factors for the development of spinal tumours.

Can tumours be passed on?
In the main, tumours are not inherited. If a relative has also had a brain or spinal tumour, it is more likely to be coincidence than an inherited problem. Only a minority of tumours are linked to the presence of an abnormal gene which may affect other family members. If there is a family history of tumours, or a person has more than one spinal tumour, there may be a genetic cause.The most common type of tumour to fall into this category is called a schwannoma, also sometimes known as a neurofibroma. Even so, most schwannomas seem to occur randomly.

If the tumour is a "secondary" deposit from a tumour that began somewhere else in the body (e.g. lung, bowel, breast or prostate), then the underlying cause relates to the primary cancer. Although some benign tumours can grow for many years, they rarely reach a large size in the spine before being detected, because the space in the spinal canal is rather limited. However, tumours in the sacrum may grow considerably before they produce any noticeable symptoms from which a diagnosis arises. Malignant tumours tend to grow more rapidly and will therefore have been present for a shorter period.The speed at which the symptoms develop does not necessarily relate to the speed of growth, nor does it necessarily determine the effect of treatments for the tumour.

Where do spinal tumours arise?
Any section of the spine can be affected, from the top of the neck down to the sacrum. Bone tumours are the most common type and these are usually secondary deposits from tumours originating elsewhere in the body. Primary bone tumours are rare.

Tumours can occur in the spinal canal, outside the membrane (dura),
enclosing the spinal canal and nerve roots (extradural or epidural). They can be inside the dura (intradural), and very occasionally they may arise within the spinal cord (intramedullary).The following table lists some of the types of spinal tumour and where they are found.