There are a wide variety of tumors that can occur on or near the spine. Knowing what type of tumor you have is key in providing the proper treatment. Each spinal tumor type has its own set of characteristics, from tissue disposition to common growth sites. Knowing what type of tumor is present allows your surgeon to formulate a treatment plan that will give you the very best chance at a full recovery.
There are five spinal tumor types that make up the majority of diagnoses. This list is in no way exhaustive; it does, however, represent the most common tumors and how they are treated.
1. Meningioma
Meningiomas grow from the meninges which are the membranes surrounding the brain and spinal cord. Luckily, meningiomas are often benign in nature and most are slow-growing and may not ever cause problems. In cases where they are large or having an impact on your health, a course of action for treatment needs to be established with your neurosurgeon.
Meningioma Symptoms
Even though meningiomas are usually non-cancerous, they can still cause a wide variety of upsetting symptoms. When they compress the spinal cord they can cause a variety of symptoms depending on the nerves the are affecting. In the spine, meningiomas typically cause symptoms of leg numbness or weakness and instability while walking. Sometimes they cause back or leg pain.
Treatment
Surgery is the best option for most instances of meningiomas that require surgical intervention. Meningiomas that should be removed include tumor with radiographic compression of the spinal cord or tumors with significant growth over time.
2. Schwannomas and Neurofibromas
Schwannomas and neurofibromas are forms of (typically) benign nerve sheath tumors (the tissue that protects the exterior of a nerve) that tend to be slow-growing. Both schwannomas and neurofibromas can occur on any nerve in the body, but have a high incidence of growing on nerves along the spine. In very rare instances, Schwannomas and neurofibromas may present as malignant, but this is quite uncommon.
Schwannoma and Neurofibroma Symptoms
A slow-growing mass, schwannomas can cause several symptoms. These include an electric-like shock sensation (known as a Tinel shock) when the mass or its immediately surrounding area is touched. Other reported symptoms of schwannomas include numbness or slight tingling. Depending on where the tumor is located and how large it is, it can also bright about other neurological symptoms.
Neurofibromas cause fewer symptoms than Schwannomas; many are asymptomatic. In some instances, however, neurofibromas along the spine can result in arm and leg numbness and weakness or back pain.
Treatment
The gold standard for most spinal schwannomas and neurofibromas is surgical removal. In the rare instance that the tumor is malignant, chemotherapy or radiation — or both — may be recommended. Because either of these types of tumors can sometimes grow back, it’s incredibly important to have regular follow-up exams (which may include imaging) to ensure that regrowth hasn’t occurred.
3. Ependymomas
Ependymomas can occur in or around the brain, spinal cord or spinal nerve roots. They are benign and the best treatment is complete surgical removal, but they can be can be difficult to remove completely because they have a tendency to stick to nerves with important neurological functions. Since they can be difficult or impossible to remove completely and safely, the recurrence rate is high. If they cannot be completely removed or if they recur, additional surgery or radiation may be recommended. They almost never spread to other areas of the body, but they can rarely spread through the cerebrospinal fluid and make satellite tumors along the brain or spinal cord distant from their place or origin. They are categorized into three different grade categories, depending on their rate of growth:
If they cannot be completely removed or if they recur, additional surgery or radiation may be recommended. They almost never spread to other areas of the body, but they can rarely spread through the cerebrospinal fluid and make satellite tumors along the brain or spinal cord distant from their place or origin. They are categorized into three different grade categories, depending on their rate of growth:
- Ependymomas – grade I: Slower growth.
- Myxopapillary ependymomas – grade I: Slower growth.
- Ependymomas – grade II: These tumors have a moderate growth rate and are typically the most common. They can be broken down even further into subcategories, including papillary ependymomas, tanycytic ependymomas, cellular ependymomas and clear cell ependymomas.
- Anaplastic ependymomas – grade III: Faster growth than other types and grades.
Ependymoma Symptoms
Ependymomas can occur in all ages, from infants to adults. Spinal ependymomas can present initially with back pain or leg pain, then as they grow more weakness and numbness in the hands, arms, legs or feet.
Treatment
Surgical removal of spinal ependymoms is almost always recommended. If the tumor is completely removed, often no further treatment is needed. If the tumor cannot be completely removed, follow radiation may be recommended.
4. Astrocytomas
Astrocytomas are malignant tumors that occur most commonly in the brain but can occur in the spinal cord.. The seriousness of the tumor is determined by grading it I through IV. This grading is done by determination of how abnormal the cells appear. The different types of astrocytomas include: pilocytic astrocytomas, anaplastic astrocytomas, diffuse astrocytomas and astrocytoma grade IV (glioblastoma).
These tumors can occur in both children and adults; pilocytic astrocytomas are much more common in children and young adults while the other types are more likely to be diagnosed in both men and women over the age of 45. In the spinal cord the vast majority of astrocytomas are grade I or II.
Astrocytoma Symptoms
Astrocytomas in the spinal cord typically present first with back or neck pain but can at any time produce symptoms of numbness, tingling, weakness, and instability while walking.
Treatment
Depending on the type of spinal astrocytoma, different treatment methods are used. For grade I/pilocytic astrocytomas, complete surgical resection is the goal and, if accomplished, no further treatment is needed. Grade II astrocytomas are infiltrative and cannot be completely removed at surgery; therefore, radiation is usually recommended after maximal surgical resection. For Grade II and IV spinal astrocytomas, the benefits of aggressive resection are debatable and many of these are biopsied only, after which chemotherapy and radiation are both options.
