Spinal tumor

Disease Description (Causes and Symptoms)

• Definition summary
  Spinal tumors are tumors that develop in the vertebrae or around the spinal cord. They are divided into primary tumors (starting in the spine) and metastatic tumors (spread from other organs). Primary tumors may be benign (e.g., hemangioma, giant cell tumor) or malignant (e.g., chordoma, chondrosarcoma). The most common primary cancers that metastasize to the spine include breast cancer, lung cancer, prostate cancer, and kidney cancer.

• Pathophysiology (why symptoms occur)
  As the tumor destroys or expands the vertebrae:

  • Weakening of the bone structure → pathological fractures and instability
  • Epidural or intradural invasion/compression → neurological deficits (decreased sensation, muscle weakness, paralysis)
  • Inflammation and swelling of surrounding tissues → worsening pain and neurological symptoms

• Main symptoms

  • Localized lower back pain or neck pain that worsens at night
  • Radiating pain (when a nerve root is compressed)
  • Abnormal sensations (tingling, decreased sensation), muscle weakness, and difficulty walking
  • Bowel or bladder dysfunction (in cases of severe spinal cord/cauda equina compression)
  • Fatigue, loss of appetite, and weight loss (associated with metastatic or systemic cancer)

Treatment Methods

• Diagnostic summary (essential before establishing a treatment plan)

  • MRI (evaluation of the spinal cord and soft tissues; confirmation of bone marrow involvement and epidural lesions) — standard imaging test
  • CT (evaluation of bone destruction and bone structure)
  • PET/CT (evaluation of systemic metastasis)
  • Targeted tissue biopsy (before surgery or to confirm the diagnosis)
  • Blood tests (including tumor markers)

• Standard treatment principles (individualized according to the tumor type, location, and neurological status)

  1. Surgery
     • In cases of emergency neurological deficits (acute spinal cord compression), prompt decompression (decompression surgery) and, when necessary, stabilization (spinal fusion using screws and other instruments)
     • If complete resection is possible for a primary malignant tumor, wide en bloc resection may be considered
     • Surgical stabilization or minimally invasive procedures are performed for pathological fractures and instability
  2. Radiation therapy
     • Conventional external-beam radiation (depending on the tumor’s radiosensitivity)
     • High-precision, high-dose radiation therapy (SBRT/SRS): high local control rates for limited lesions
     • For control of residual tumors after surgery or for pain relief
  3. Medication and systemic treatment
     • Metastatic tumors: systemic chemotherapy, hormone therapy (e.g., for prostate or breast cancer), targeted therapy, and immunotherapy according to the primary cancer
     • Relief of bone lesions: bisphosphonates (e.g., zoledronic acid) or denosumab (to reduce skeletal-related events)
     • Pain management: nonsteroidal anti-inflammatory drugs, opioids, and anticonvulsants or antidepressants for neuropathic pain
  4. Steroid therapy
     • Short-term administration of high-dose steroids to reduce swelling and prevent neurological deterioration in cases of acute spinal cord compression (under a doctor’s direction)
  5. Minimally invasive procedures
     • Percutaneous vertebroplasty or kyphoplasty for pain relief from pathological compression fractures
  6. Rehabilitation and supportive care
     • Physical therapy, occupational therapy, walking aids, and support from pain specialists, hospice services, and psychosocial services

• Lifestyle management and precautions

  • Avoid lifting heavy objects and sudden bending or twisting movements to reduce the risk of intervertebral and pathological fractures
  • Follow the doctor’s instructions when taking medications or using steroids (comply with the prescribed dose and duration)
  • Prevent falls (organize the environment and use assistive devices)
  • Emergency symptoms (acute sensory or motor impairment, urinary or bowel dysfunction, or progressive paralysis) require an immediate visit to the emergency room

• Complications

  • Permanent neurological deficits (paralysis and loss of sensation)
  • Pathological fractures and spinal instability
  • Surgical complications (infection, bleeding, nerve damage, and hardware failure)
  • Local recurrence or systemic worsening of the primary cancer

Outpatient Visit Checklist (Including Recommended Items and Sample Questions)

• Recommended items to bring

  • List of current medications (including dose and frequency) and allergy records
  • Recent imaging materials (original CD/USB or essential test reports: MRI, CT, PET, etc.)
  • Previous biopsy and pathology reports and related medical records (including a history of primary cancer diagnosis)
  • Records of symptom changes (when they began, affected areas, aggravating factors, and pain intensity (0–10))
  • Whether assistive devices are being used (cane, walker, etc.)

• Items to note in advance for the outpatient visit

  • When symptoms began and how they have progressed (e.g., pain is worse at night, walking difficulty is gradually worsening)
  • Recent weight changes and systemic symptoms such as fever or night sweats
  • Any changes in urination or bowel movements
  • Limitations in daily activities (getting dressed, climbing stairs, etc.)

Examples of General Questions to Ask the Doctor

• Is this lesion primary, or has it spread from another cancer?
• What treatment options are recommended in my case, and what are the advantages and disadvantages of each?
• If surgery is needed, what will the recovery period and rehabilitation plan be?
• What are the expected effects and side effects of radiation therapy (including SBRT)?
• What medications or procedures do you recommend to reduce the pain?
• Should I use bone-related medications (bisphosphonates/denosumab)? What are their side effects?
• What is your assessment of the prognosis (survival rate and likelihood of functional recovery)?

Examples of Disease-Specific Questions

• What type of tumor was confirmed by biopsy (e.g., breast cancer metastasis, chordoma, etc.)? Should additional molecular testing be performed to determine whether targeted therapy is possible?
• If my neurological symptoms suddenly worsen, what emergency measures should I receive immediately (such as steroid administration or surgery)?

(The information above is a guide compiled based on general clinical evidence and standard treatment principles. Decisions about individual medical care and treatment should be made in consultation with the treating medical team.)