诊断

椎骨肿瘤有时可能会被忽视,因为它们的症状类似于更常见的情况。因此,您的医生务必了解您的完整病史并进行一般体格检查和神经系统检查,这尤其重要。

如果医生怀疑您有椎骨肿瘤,以下一项或多项检查可帮助确诊并确定肿瘤的位置:

  • 脊髓磁共振成像 (MRI)。MRI 利用强大的磁铁和无线电波来生成脊柱、脊髓和神经的准确图像。MRI 通常是诊断椎骨肿瘤的首选检查。在检查过程中,可将有助于突出某些组织和结构的造影剂注入手或前臂静脉。

    一些患者可能觉得 MRI 扫描仪内的密闭空间很恐怖,或发出的巨大声响令人心烦。耳塞、电视或耳机可帮助减少噪音。通常可使用温和的镇静剂来缓解幽闭恐惧症的焦虑。

  • 计算机断层成像(CT)扫描。这项检查利用窄波束生成脊柱的详细图像。有时还会联合注射染料造影剂,使椎管或脊髓的异常变化更容易显现。CT 扫描可与 MRI 联合使用。
  • 活检。通常,确定肿瘤类型的唯一方法是在显微镜下检查一个小组织样本(活检)。活检结果将有助于确定治疗方案。

    采集活检样本的方法对整个治疗方案的成功实施至关重要。您应向医生以及外科手术团队详细咨询活检方面的信息,以防止潜在的并发症。在大多数情况下,放射科医生会实施细针活检提取少量组织,通常在 X 线或 CT 扫描成像的指导下进行。

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of a vertebral tumor. Imaging tests might include:

  • X-ray.
  • MRI.
  • CT scan.
  • Positron emission tomography scan, also called PET scan.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For vertebral tumors, the tissue is often removed using a thin needle. The needle goes through the skin and into the tumor. A healthcare professional uses an imaging test, such as a CT scan, to guide the needle to the right spot. The health professional uses the needle to draw out a sample of the tumor cells.

The biopsy sample goes to a lab for testing. Tests can show the type of tumor and whether it is cancerous. Other special tests give more details. Your healthcare team uses these results to make a treatment plan.

Determining the kind of biopsy you need and the details of how to do the biopsy requires careful planning by the healthcare team. Healthcare professionals need to perform the biopsy in a way that won't interfere with future surgery to remove the tumor. For this reason, ask for a referral to a healthcare team with extensive experience in treating vertebral tumors before your biopsy.

治疗

在理想情况下,脊柱肿瘤治疗的目标是彻底消灭肿瘤。但由于这种治疗可能会对脊髓或周围神经造成永久性损伤,所以情况可能会有些复杂。医生还必须考虑您的年龄、整体健康状况、肿瘤的类型以及肿瘤是原发性或是源自身体其他部位扩散或转移到脊柱。

大多数椎骨肿瘤的治疗方案包括:

  • 监测。有些肿瘤可在引起症状之前便被发现,往往是在您就其他状况接受评估时发现。如果体积较小的肿瘤具有非致癌性,并且没有生长趋势或压迫到周围组织,则只需对此等肿瘤进行密切观察。

    尤其是对老年人来说,采用外科手术或放射疗法可能会带来特殊风险。在观察期间,医生可能建议以适当的频率定期进行 CT扫描 或磁共振成像扫描,从而监测肿瘤的发展情况。

  • 外科手术。如果可切除肿瘤并且脊髓或神经损伤的风险亦可接受,外科手术通常是首选治疗方法。

    随着更先进的技术和器械问世,神经外科医生现已能够触及曾经被认为无法触及的肿瘤。为了能更容易区分肿瘤与健康组织,外科医生有时可能会在显微手术过程中使用高倍显微镜。

    医生还可以在手术期间监测脊髓和其他重要神经的功能,从而尽量减少这些功能受到的损伤。在某些情况下,手术期间可能会利用超声波消灭肿瘤并清除碎片。

    但尽管外科手术和技术已取得进步,但仍然无法完全去除所有肿瘤。有时可能需要在手术后,继续采用放射疗法或化疗,或同时进行两种疗法。

    脊柱手术后的恢复可能需要花费数周或更长时间,具体取决于手术过程或发生的并发症,如出血和神经组织损伤。

  • 放射疗法。这种疗法可用于清除术后未能完全切除的肿瘤残留物,治疗不能通过手术切除的肿瘤或采取手术面临太大风险的肿瘤。

    这种疗法也可能是治疗某些椎骨肿瘤的首选疗法。当手术面临太大风险时,也可采用放射疗法来缓解疼痛。

    药物可能有助于减轻放射疗法带来的一些副作用,如恶心和呕吐。

    为了防止周围组织因为放射疗法受到损害并提高治疗的有效性,医生有时可能会调整放射疗法方案。调整的范围可能包括简单地调整所接受的辐射剂量,也可能使用三维适形放射疗法等精密技术。

    一种称为质子束疗法的特殊型放射疗法也可以用于治疗一些椎骨肿瘤,如脊索瘤、软骨肉瘤和一些需要脊柱放射治疗的儿童癌症。质子束治疗能够更好地将放射性质子瞄准肿瘤部位,而不会像传统放射疗法那样损害周围组织。

  • 立体定向放射治疗(SRS)。这种治疗实际上并不是一种外科手术,而是提供高剂量的精确靶向辐射。在立体定向放射治疗过程中,医生可借助计算机从多个角度精确地将辐射束瞄准肿瘤。

    放射外科治疗可使用不同类型的技术提供立体定向辐射,以治疗椎骨肿瘤。

    立体定向放射治疗仅用于治疗特定大小和类型的肿瘤。但这种治疗在适当的情况下被证明特别有效。现在越来越多的研究都支持将这种方案用于治疗脊柱肿瘤。

    但这种治疗方案也存在一定风险,例如会导致发生脊椎骨折的风险增加。需要开展进一步研究以确定最有利于立体定向放射治疗消除椎骨肿瘤的技术、放射剂量和时间安排。

  • 化疗。化疗是针对各种癌症的标准治疗方法,其原理是利用药物消灭癌细胞或使癌细胞停止生长。医生可以确定化疗是否可能对您有益,是该单独使用化疗方案还是与其他疗法结合使用。

    化疗带来的副作用可能包括疲劳、恶心、呕吐、感染风险升高和脱发。

  • 其他药物。由于外科手术和放射疗法以及肿瘤自身都可能导致脊髓内部出现炎症,因此在外科手术之后或放射治疗期间,医生有时会开一些皮质类固醇来减少肿胀。

    虽然皮质类固醇可降低发炎几率,但它们通常仅供短期使用,以避免出现严重的副作用,如肌无力、骨质疏松症、高血压、糖尿病或易感染性增加。

Careful monitoring

Many vertebral tumors are found before they cause symptoms. They might not need treatment right away. Instead, your healthcare team might carefully monitor the tumor to see if it grows. Some vertebral tumors never require treatment.

Careful monitoring might be the right approach for small tumors that aren't cancerous. It also might be right for slow-growing tumors that aren't causing symptoms.

Surgery

The goal of surgery is to remove all of the vertebral tumor. Surgeons take care not to hurt the spinal cord or surrounding nerves during surgery.

Sometimes it's not possible to remove all of the tumor. In these situations, the surgeon might remove as much of the tumor as possible. Other treatments might be used after surgery to hurt any tumor cells that are left. Options might include radiation, chemotherapy or ablation treatments.

Surgery also might be used to relieve symptoms caused by a vertebral tumor. If the tumor causes pain that isn't relieved by other treatments or if the tumor presses on the spinal cord, surgery might help provide relief.

Vertebroplasty

Vertebroplasty is a treatment that injects bone cement into a cracked or weakened spinal bone. A similar procedure is called kyphoplasty. These procedures might help strengthen a bone that's weakened by a tumor. They can help relieve pain.

Ablation treatments

Ablation is a procedure that applies treatment directly to the tumor cells in order to hurt them. Some types of ablation apply energy to the tumor cells that causes them to heat up. Procedures that do this include radiofrequency ablation and microwave ablation. Using extreme cold to hurt the tumor cells is called cryoablation. Sometimes ablation involves using alcohol to hurt the tumor cells.

Radiation therapy

Radiation therapy treats tumors with powerful energy beams. The energy can come from X-rays, protons or other sources.

For vertebral tumors, radiation therapy may be used after surgery. It can hurt any tumor cells that might be left. When surgery isn't an option, radiation therapy might be used instead. Radiation therapy also is used to help relieve symptoms caused by a vertebral tumor. It can slow the growth of a vertebral tumor and relieve pain.

Healthcare teams take great care to aim the radiation to the exact spot needed to control the tumor. They work to limit how much radiation reaches nearby organs, including the spinal cord. This helps reduce the risk of complications caused by radiation therapy. Types of radiation therapy that can help in this way include stereotactic body radiotherapy and proton beam radiation therapy.

Chemotherapy and other medicines

Chemotherapy treats cancer with strong medicines. This therapy might be an option for the treatment of cancerous vertebral tumors. It can help slow the growth of the cancer. Most vertebral tumors that aren't cancerous don't respond to chemotherapy treatments.

Targeted therapy medicines also may be an option for treating cancerous vertebral tumors. Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Your cancer cells may be tested to see if targeted therapy is likely to help you.

临床试验

探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法,旨在预防、检测、治疗或控制这种疾病。

替代医学

尽管没有任何替代药物被证明可以治愈癌症,但一些替代疗法或补充疗法可能有助于缓解某些症状。

其中一种疗法就是针刺疗法。在针刺疗法治疗过程中,医生会在精确位点上将小针头插入您的皮肤。研究表明针刺疗法可能有助于缓解恶心和呕吐。针刺疗法还有助于缓解癌症患者某些类型的疼痛。

在您考虑尝试某种补充或替代疗法之前,一定要与医生讨论它的风险和益处。有些治疗方法(例如草药)可能干扰您正在服用的药物。

妥善处理与支持

知道患上脊柱肿瘤可能让人崩溃。但您可以在确诊后采取一些应对措施。您不妨尝试:

  • 尽可能多地了解脊柱肿瘤。写下您的问题,并带着这些问题去就诊。在医生回答您的问题时,注意记录或让陪同的家人朋友记录。

    您和家人对治疗了解得越多,您在做出治疗决定时就会越自信。

  • 获得支持。找一个可以与其分享自己感受和担心的人。您可能需要一位善于倾听的亲密朋友或家人。您也可以向神职人员或咨询师倾诉。

  • 照顾好自己。尽量选择富含水果、蔬菜和全谷物的健康饮食。咨询医生何时可以重新开始锻炼。保证睡眠充足,休息好。

    花一些时间放松自己,例如听音乐或写日记,缓解生活的压力。

准备您的预约

如果您出现椎骨肿瘤的常见症状(如无法解释的持续背痛、腿部无力或麻木,或肠道或膀胱的功能改变),请立即联系医生。

在对您进行检查后,医生可能将您转诊给在诊断和治疗癌症(肿瘤医生)、脑和脊髓疾病(神经科医生、神经外科医生或脊柱外科医生)或骨骼疾病(骨科医生)方面接受过训练的医生。

以下信息可以帮助您做好就诊准备,并了解医生可能会做什么。

您可以做什么

  • 记下您经历过的任何症状以及持续时间。
  • 列出关键的医疗信息,包括您患的所有疾病,您使用的所有处方药和非处方药的名称。
  • 注意脑或脊柱肿瘤家族史,尤其是一级亲属(例如父母或兄弟姐妹)。
  • 请家人或朋友陪同就诊。有时很难记住就诊时提供给您的所有信息。陪同者可能会记住您所遗漏或忘记的一些事项。
  • 写下要向医生咨询的问题

首次就诊时需要向医生咨询的问题包括:

  • 什么原因引起我的症状?
  • 还有其他可能的原因吗?
  • 我需要做哪些检查?这些检查需要任何特殊准备吗?
  • 您对下一步的诊断和治疗有什么建议?
  • 我应该去看专科医生吗?

向肿瘤科或神经内科医生询问的问题包括:

  • 我是否患有脊柱肿瘤?
  • 我患有哪种类型的肿瘤?
  • 接下来肿瘤会怎样生长?
  • 后果可能是什么?
  • 我的治疗目标是什么?
  • 我适合手术吗?有哪些风险?
  • 我适合放疗吗?有哪些风险?
  • 化疗有用吗?
  • 您建议哪种治疗方法?
  • 如果第一次治疗不成功,下一步我们该怎么做?
  • 我的病症预后如何?
  • 我是否需要第二诊疗意见?

除了您准备咨询医生的问题外,约诊期间还可以随时提出其他问题。

医生可能做些什么

医生可能会问一些问题。提前准备好答案有助于您充分利用就诊时间。为您检查脊柱肿瘤的医生可能会问:

  • 您有哪些症状?
  • 您第一次注意到这些症状是什么时候?
  • 您的症状是否随时间加重?
  • 如果您出现疼痛,疼痛始于哪里?
  • 疼痛是否扩散至身体其他部位?
  • 您是否参与了可能引发疼痛的活动?例如,新的运动或较长时间的园艺活动?
  • 您既往是否出现过腿部无力或麻木?
  • 您行走是否有任何困难?
  • 您是否有膀胱或肠道功能问题?
  • 您是否曾被诊断出任何其他医疗状况?
  • 您目前是否正在服用非处方药或处方药?
  • 您有非癌或癌性肿瘤家族史吗?
Nov. 14, 2020
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