If you’ve recently been diagnosed with spinal cancer, you’re not alone. Close to 24,000 people per year develop spinal or brain cancer in the United States. While it can be a frightening and confusing diagnosis, advancements in cancer treatments, in general, have allowed doctors to offer more options than ever before.
From surgery to chemotherapy to radiation, or a combination of these, the ability for cancer specialists to custom tailor a spinal cancer treatment plan for your individual circumstances will give you the best chance at recovery.
What Are the Most Common Types of Spinal Cancer?
Cancers of the spine can present themselves in different forms:
Metastatic Tumors
Spinal cancer is usually a result of metastatic disease (cancer that has traveled from somewhere else in the body). Following the lung and the liver, the spine is the third most common place that cancer spreads to. The most common cancer types to affect the spine are cancers from lung, breast, prostate and kidney. Optimal treatment of spinal metastases is highly variable and is considered on a case-by-case basis. Usually treatment consists of radiation of some kind with or without surgery. Whether or not surgery is advised depends on the following:
- Radiation sensitivity – If the spinal metastasis is radiosensitive, radiation can be used as either a primary treatment option or as a secondary treatment (after surgery). Depending on the location that the tumor has metastasized from, radiation alone may not always be an effective option for treatment.
- Spinal Stability – If your tumor is rendering the spine unstable, your surgeon may recommend surgery to stabilize the spine regardless of the type of tumor it is. This surgery would typically require metal implants.
- Neurological Symptoms – If neurological symptoms are being caused by the spinal metastasis, surgery is usually recommended as the fastest way to relieve pressure on your nerves or spinal cord.
Bone Marrow Cancers
Bone marrow tumors are usually treated with radiation, unless there is a neurological problem or too much bone destruction. Bone marrow cancers include:
- Multiple myeloma: A round cell tumor, this is the most commonly found bone cancer in adults. This can exist diffusely throughout bones in the body or it can form a mass. When Multiple Myeloma forms a distinct mass, that mass is sometimes referred to as a plasmacytoma.
- Lymphoma: Most typically non-Hodgkin’s tumors, these round cell tumors are not usually limited to the spinal region due to the extensive nature of the lymphatic system.
Primary Bone Tumors
Primary bone tumors are rare tumors that originate from the bone. When possible, these tumors are treated with a complete en bloc resection. A complete en bloc resection involves removing the entire tumor, in one piece, at one time. Some types of primary bone tumors include:
- Chondrosarcoma: A slow-growing tumor, these are most commonly found in the sacral section of the lower spine, as well as the middle and lower regions of the spine. Surgery is the most effective means of treatment but can be tricky due to the proximity to nerves.
- Chordoma: Much like the chondrosarcoma, chordomas are slow-growing. They’re almost always found in the sacrum and require surgical excision.
- Osteosarcoma: Osteosarcoma is a cancer of the bone tissue in the spine (or other areas of the body). Given their high rate of malignancy, they require aggressive treatment that can include surgery, radiation and chemotherapy.
Your Options for Spinal Cancer Treatment
Because there are so many different types of spinal cancers, no single treatment will address all forms. Some respond better to certain treatments than others, making it doubly important to find an excellent oncologist in addition to a neurosurgeon to address your unique cancer care needs. Luckily, with an arsenal including surgery, chemotherapy and radiation, the treatment success rates have improved drastically over the last 20 years.
Factors That Affect Treatment Options
Depending on the type of cancer you have been diagnosed with, it’s location, the size of the tumor(s) and myriad other factors, treatment may include one or more methods. In some cases, immediate treatment may be indicated, while in others, observation may be suggested. How your provider chooses to implement the protocol for your individual case will be carefully planned and considered. Some other factors that will determine the appropriate treatment option include, but are not limited to:
- Type of cancer – Depending on the type of tumor and where the tumor is located, treatment options will vary.
- Tumor is radiosensitivity – If the tumor is radiosensitive, it has the potential to respond well to radiation, making radiation a possible treatment option.
- Patient prognosis – Patients with a good prognosis will likely have more flexibility when deciding upon a treatment option.
- Neurological issues – Any neurological issues will have to be considered when deciding upon a treatment option to ensure that the problem is not made worse.
- Spine stability – If the spine is not stable certain treatment options will not be recommended.
Surgical Intervention
In many instances of spinal cancer treatment, surgery will be recommended at some point. Whether it is used on its own or in conjunction with other treatment methods will depend on the many factors discussed above.
Minimally invasive spinal surgery is sometimes an option when treating spinal cancer, but most cancer operations are still traditional open surgeries. Advances in radiation therapy, however, have made these surgeries smaller than they needed to be in the past.
If you’ve been recommended for surgical treatment, it’s essential that you find the best surgeon possible. Many neurosurgeons will have some experience in operating on malignant tumors, but to ensure the best outcome, it’s wise to find a surgeon who specializes in spinal tumor removal.
Traditional Radiation Therapy
Traditional radiation therapy uses relatively low doses of radiation applied over a general area in many separated doses. This treatment strategy causes cells that are rapidly dividing to die, sparing cells that are slowly dividing or not dividing at all. Thus cancer cells are targeted more than the body’s normal cells. Traditional radiation works well for some kinds of cancer and not as well for others. Cancers that are very sensitive to radiation can be treated with radiation alone much of the time. Radiation insensitive cancer require other treatment strategies.
Spinal Stereotactic Radiosurgery
A newer form of radiation therapy that has been a big advancement in treating malignant spinal tumors is spinal stereotactic radiosurgery. The process is generally used for spinal metastases and uses a single high dose of radiation to directly target the spinal tumor. Due to the accuracy of the procedure, high doses of lethal radiation can be applied specifically to the tumor, and the surrounding areas are only minimally affected by the radiation.
The procedure is noninvasive, requires minimal recovery time and often can be done in one session. Furthermore, since a lethal dose of radiation is given, the radiation sensitivity of the tumor is much less important. Spinal stereotactic radiosurgery can be used for pain relief, as a first line treatment option, and to treat recurrence of a spinal tumor. It often used in conjunction with surgery to treat tumors that are not sensitive to traditional radiation therapy.
Chemotherapy
Chemotherapy has been used for cancer treatment for close to 70 years. Initially an accidental finding, chemo has changed the face of cancer medicine forever. The premise of chemotherapy is that it targets specific cells and either kills or damages them. With advances in cancer research and the development of more targeted drugs, chemotherapy has become a mainstream option for combating this insidious disease. Your particular form of spinal cancer may or may not respond well to chemotherapeutic agents. Once a definitive diagnosis of your cancer has been made, your team of cancer specialists will be able to determine if this is a viable option for you.
