Vertebral tumor

Overview

A vertebral tumor is a growth of cells that happens in the bones of the spine. A vertebral tumor also is called a spinal tumor. The bones of the spine are called the vertebrae. The spine is made up of many small vertebrae stacked on top of one another. The vertebrae hold the body upright. They enclose and protect the spinal cord.

Vertebral tumors can be cancerous or not cancerous. A noncancerous vertebral tumor also is called a benign vertebral tumor. Vertebral tumors that are cancerous are called malignant vertebral tumors.

Most malignant vertebral tumors are caused by cancer that starts somewhere else in the body and spreads to the spine. Cancer that spreads from an organ to another part of the body is called metastatic cancer. Cancers that affect the blood cells and bone marrow also can cause malignant vertebral tumors.

Vertebral tumors that start in the bones of the spine and haven't spread from somewhere else are rare. Another name for these tumors is primary bone tumors.

Treatment for vertebral tumors includes surgery, radiation therapy and medicines, including chemotherapy. Small and slow-growing vertebral tumors might not need treatment right away. The treatment that's best for your vertebral tumor depends on your situation. Your healthcare team considers the type of tumor you have, whether it is cancerous and its location within the spine.

Symptoms

Signs and symptoms of vertebral tumors include:

• Back pain in the area of the tumor.
• Back pain that radiates or shoots from the back to a nearby area.
• Back pain that's worse at night.
• Changes in sensation, such as numbness or a feeling of pins and needles.
• Loss of the ability to move part of the body.
• Loss of control over the bladder and bowels.
• Muscle weakness.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

Some vertebral tumor symptoms are similar to symptoms caused by other conditions. For example, back pain is very common, and most back pain isn't caused by a tumor. Sometimes it's hard to decide whether to see a healthcare professional when you have back pain.

Make an appointment if:

• The pain is constant and is getting worse.
• The pain doesn't seem to be caused by a certain activity.
• The pain is worse at night.
• You have a history of cancer and the back pain is something new.

Seek immediate medical care if you have back pain along with:

• Muscle weakness in the arms or legs.
• Loss of control of the bowel or bladder.
• Numbness or tingling in the genital area.

Causes

Most vertebral tumors are caused by cancer that starts somewhere else in the body. Cancer that spreads from an organ to somewhere else in the body is called metastatic cancer. Any cancer can spread to the spine. Most vertebral tumors are caused by cancer that spreads from the breasts, lungs or prostate. Other cancers that tend to spread to the spine include kidney cancer and thyroid cancer.

Cancers that affect the blood cells and bone marrow also can cause vertebral tumors. These cancers include multiple myeloma and lymphoma.

Vertebral tumors that start in the spine are rare. It's not clear what causes them.

Vertebral tumors that start in the spine happen when cells in the bones of the spine develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In the tumor cells, the DNA changes give different instructions. The changes tell the tumor cells to make many more cells quickly. Tumor cells can keep living when healthy cells would die. This causes too many cells.

Sometimes cells develop changes in their DNA that turn them into cancer cells. Cancer cells can invade and destroy healthy body tissue. They can break away and spread to other parts of the body.

Examples of vertebral tumors that start in the spine and aren't cancerous include:

• Hemangioma.
• Osteoid osteoma.
• Osteoblastoma.
• Aneurysmal bone cyst.
• Osteochondroma.
• Enchondroma.
• Chondroblastoma.

Examples of vertebral tumors that start in the spine and are cancerous include:

• Chondrosarcoma.
• Ewing sarcoma.
• Osteosarcoma.
• Chordoma.

Risk factors

The risk of vertebral tumors is higher in people who have cancer or have been treated for cancer. Most vertebral tumors are caused by cancer that starts somewhere else in the body and spreads to the spine. Cancer that spreads to the spine most often starts in the breasts, lungs or prostate.

Complications

Complications caused by vertebral tumors include:

• Spinal cord compression. Spinal cord compression happens when a tumor grows to press on the spinal cord or nearby nerves. It often causes back pain at first. Later it can cause weakness and numbness in the part of the body controlled by the affected nerves. There may be difficulty walking and a loss of control of the bladder and bowels.
• Spinal instability. Spinal instability can happen if a vertebral tumor weakens the bones in the spine. Bones weakened by tumors can break or go out of alignment. This can make it hard for the spine to hold the body upright. Spinal instability typically causes pain and can lead to weakness.

Treatments may help prevent or treat these complications.

Diagnosis

Diagnosis for vertebral tumors typically starts with a physical exam and questions about your symptoms. Imaging tests can show the size and location of the tumor. A sample of tissue might be removed from the tumor and tested in a lab to make the diagnosis.

Exams

Your healthcare professional might start by asking about your symptoms and your health history. If you have cancer or have been treated for cancer in the past, tell your healthcare professional. Most vertebral tumors are caused by cancer that starts somewhere else in the body and spreads to the spine. Knowing your complete health history can be helpful for understanding your symptoms.

The health professional may examine your body. This might involve checking your spine for painful spots and other symptoms that might be concerning. This assessment also might include a neurological exam. This exam tests different parts of your body to understand how your nerves are working. The health professional may check your balance, coordination, strength and reflexes.

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.

Treatment

Treatments for vertebral tumors include surgery, radiation therapy, and chemotherapy and other medicines. Other options might include minimally invasive procedures to hurt the tumor cells or stabilize the bones in the spine. Not every vertebral tumor needs treatment. Sometimes careful monitoring can watch a vertebral tumor to see if it grows.

Your healthcare team considers many factors when creating your vertebral tumor treatment plan. These factors include the type of vertebral tumor you have and its location. The team also considers your overall health and your preferences.

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.

Alternative medicine

No alternative medicine treatments have been found to cure vertebral tumors. But some treatments used along with the treatments from your healthcare team may help you cope with a vertebral tumor diagnosis.

Treatments that might help in this way include:

• Art therapy.
• Exercise.
• Meditation.
• Music therapy.
• Relaxation exercises.

Talk with your healthcare team about your options.

Coping and support

Learning that you have a vertebral tumor can be overwhelming. But you can take steps to cope after your diagnosis. Try to:

Find out all you can about your specific vertebral tumor

Write down your questions and bring them to your appointments. As your healthcare professional answers your questions, take notes. Or ask a friend or family member to come along to take notes.

The more you and your family know and understand about your care, the more confident you'll feel when it comes time to make treatment decisions.

Get support

Find someone you can share your feelings and concerns with. You may have a close friend or family member who is a good listener. Or speak with a clergy member or counselor.

Take care of yourself

Choose a healthy diet rich in fruits, vegetables and whole grains whenever possible. Check with your healthcare professional to see when you can start exercising again. Get enough sleep so that you feel rested.

Reduce stress in your life by taking time for relaxing activities, such as listening to music or writing in a journal.

Preparing for an appointment

If you have symptoms that worry you, make an appointment with a doctor or other healthcare professional. If you have a vertebral tumor, you'll likely be referred to a specialist.

Specialists who care for people with vertebral tumors include:

• Doctors who diagnose and treat brain and spinal cord conditions, called neurologists.
• Surgeons who operate on the brain and spinal cord, called neurosurgeons.
• Doctors who diagnose and treat tumors that affect the bones, called orthopedic oncologists.
• Surgeons who operate on bones and joints, called orthopedic surgeons.
• Doctors who use radiation to treat cancers and tumors, called radiation oncologists.
• Doctors who use medicine to treat cancer, called medical oncologists.

Here's some information to help you get ready for your appointment.

What you can do

• Write down any symptoms you've been experiencing and how long you've had them.
• List your key medical information, including all conditions you have and the names of any medicines you're taking. Include prescription medicines and medicines you can buy without a prescription.
• Note any family history of brain or spinal tumors, especially in a first-degree relative, such as a parent or sibling.
• Take a family member or friend along. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Questions to ask at your first appointment include:

• What may be causing my symptoms?
• Are there any other possible causes?
• What kinds of tests do I need? Do these tests require any special preparation?
• What do you recommend for next steps in determining my diagnosis and treatment?
• Should I see a specialist?

Questions to ask an oncologist or a neurologist include:

• Do I have a vertebral tumor?
• What type of tumor do I have?
• How will the tumor grow over time?
• What might be the consequences?
• What are the goals of my treatment?
• Am I a candidate for surgery? What are the risks?
• Am I a candidate for radiation? What are the risks?
• Is there a role for chemotherapy?
• What treatment approach do you recommend?
• If the first treatment isn't successful, what will we try next?
• What is the outlook for my condition?
• Do I need a second opinion?

In addition to the questions that you've prepared, don't hesitate to ask any other questions that may come up during your appointment.

What to expect from your doctor

Be prepared to answer questions about your symptoms and your health history. Questions may include:

• What are your symptoms?
• When did you first notice these symptoms?
• Have your symptoms gotten worse over time?
• If you have pain, where does the pain seem to start?
• Does the pain spread to other parts of your body?
• Have you participated in any activities that might explain the pain, such as a new exercise or a long stretch of gardening?
• Have you experienced any weakness or numbness in your legs?
• Have you had any difficulty walking?
• Have you had any problems with your bladder or bowel function?
• Have you been diagnosed with any other medical conditions?
• Are you currently taking any medicines, including prescription medicines and medicines that you can get without a prescription?
• Do you have any family history of noncancerous or cancerous tumors?