Spinal Cord Tumors

Treatment

Treatment of spinal cord tumors depends on whether the tumor is primary or metastatic (spreading from a cancerous tumor elsewhere in the body), as well as its exact location and type. Treatment options include:

Observation

Some spinal cord tumors are discovered incidentally, in the process of evaluating a person for another medical condition, and the tumor is very small with subtle symptoms. Careful observation over time may be appropriate for some people who have slow-growing, benign tumors that produce few symptoms. A small tumor diagnosed in an elderly person may only require observation if disabling symptoms are not present. If the tumor is not growing, treatment and its potential risks and complications can be avoided. For these people, regular MRI scans are done to monitor tumor growth.

Surgery

Surgery to remove as much tumor as possible is usually the first step in treating a tumor that can be removed without unacceptable risk of neurologic damage. Research has led to advances in neurosurgery that enable doctors to reach many tumors once considered inaccessible. These new techniques and tools equip neurosurgeons to operate in the tight, vulnerable confines of the spinal cord. Various surgical approaches include:

• Microsurgery
  Viewing the operating area through a high-powered microscope helps the surgeon more easily see and remove tumor tissue while saving surrounding healthy tissue.
• Ultrasonic aspirators
  Ultrasonic aspirators use sound waves to vibrate and break up tumors and then, like a vacuum, suck up the tumor fragments.
• Evoked potentials
  During surgery, physicians use this test to determine the role of specific nerves, while avoiding nerve damage. Small electrodes are used to stimulate a nerve so its electrical response (evoked potential) can be measured.
• Computer-assisted stereotactic neurosugery
  Computer technology helps the surgeon precisely locate tumors and safely remove them.

Surgery may be the only treatment if a biopsy shows a benign tumor. If the tumor is malignant, doctors may recommend additional treatment, including radiation, chemotherapy or experimental treatments (clinical trials).

Radiation Therapy

Radiation therapy is often used as follow-up after surgery to eliminate remaining tumor cells, or it may be used to treat inoperable tumors. Conventional radiation uses linear accelerators to produce external beams of high-energy rays aimed at the tumor. A treatment lasts only 15 to 20 minutes and usually begins a shortly after surgery, and continues for about two to six weeks. The dosage is fairly uniform throughout the treated areas, making this therapy especially useful for tumors that are large or have infiltrated into surrounding tissue.

Depending on the type of tumor, physicians may choose a modified form of radiation therapy to help prevent damage to surrounding tissues and improve the effectiveness of treatment. Modifying therapy can be as simple as changing the dosage schedule and amount of radiation that a person receives. As with neurosurgery, research has led to many advances in tumor imaging, sophisticated computer systems to plan the radiation treatments, and improvements in the radiation machines that deliver the treatments. These advances have increased the accuracy of treatment and decreased the risks.

Chemotherapy

Chemotherapy may be used before, during or after surgery and radiation therapy. Tumor-killing drugs are given orally or injected into the bloodstream. Physicians often use a combination of drugs.

Chemotherapeutic drugs generally kill cells that are growing or dividing. These drugs are more deadly to malignant tissue, which contains a high proportion of growing and dividing cells, than to most normal cells.

Other Drugs

Tumors, surgery and radiation therapy can all result in swelling inside the spinal cord. Physicians may prescribe cortisone-like drugs (corticosteroids or steroids) to reduce this swelling. Steroids may be administered temporarily following surgery or during radiation to reduce swelling, or they may be used long term to relieve symptoms.