Spinal Metastasis: Symptoms, Causes, Treatment

What are the symptoms of spinal metastasis?

The symptoms of spinal metastasis can vary depending on the location of the tumor, its size, and the extent of spinal cord or nerve involvement. Common symptoms include:

Back Pain: This is the most common symptom and may start as localized pain at the site of the metastasis. The pain may worsen at night or with movement and can become more constant over time.
Nerve Pain: Pain can radiate from the spine to other parts of the body, such as the arms, legs, or chest, depending on the location of the metastasis.
Weakness: Muscle weakness, particularly in the arms or legs, may occur as the tumor presses on the spinal cord or nerves.
Numbness or Tingling: Loss of sensation, tingling, or “pins and needles” sensations can occur, typically in the hands, arms, legs, or feet.
Difficulty Walking: Progressive weakness, numbness, or coordination problems may cause difficulty walking or lead to falls.
Bowel Dysfunction or Bladder Dysfunction: Loss of control over bowel or bladder functions may occur if the tumor compresses nerves that control these functions.
Paralysis: In severe cases, spinal metastasis can cause partial or complete paralysis, depending on the extent of spinal cord compression.

Early detection and treatment are essential to managing spinal metastasis and preventing serious complications like permanent nerve damage or paralysis. If any of these symptoms are present, especially in someone with a known history of cancer, prompt medical evaluation is crucial.

What are the causes of spinal metastasis?

Spinal metastasis occurs when cancer cells spread from their original site to the spine. The primary causes include the following:

Cancer Spread (Metastasis): Cancer cells can break away from the primary tumor, travel through the bloodstream or lymphatic system, and lodge in the spine. The most common cancers that spread to the spine include breast cancer, lung cancer, prostate cancer, kidney cancer, and thyroid cancer.
Advanced Stage of Cancer: Spinal metastasis often occurs in the later stages of cancer when the disease has progressed beyond its original location.
High Blood Flow to the Spine: The spine has a rich blood supply, which makes it a common site for metastatic cancer cells to settle and grow.
Hematogenous Spread: Cancer cells typically reach the spine through blood vessels, especially via the Batson venous plexus, a network of veins that connects to the spine and provides a route for cancer cells to spread.

Spinal metastasis is not a primary condition but a result of the spread of cancer from other organs, making it more likely in patients with advanced or recurrent cancers.

How is the diagnosis of spinal metastasis made?

Diagnosing spinal metastasis involves several steps and a combination of diagnostic methods. Initially, the doctor will review the patient’s medical history and perform a physical examination to assess symptoms such as pain, weakness, or sensory changes. Imaging studies play a crucial role: X-rays may reveal abnormalities, but MRI is typically the primary tool used due to its detailed images of the spine and surrounding tissues, which help identify tumors and assess their extent. CT scans, often with contrast, can also be used to visualize the spine and detect metastases. A bone scan might be performed to detect areas of abnormal bone activity, which can indicate metastatic disease.

If imaging suggests metastases, a biopsy may be necessary to confirm the presence of cancer cells and determine their origin. This can be done through various methods, including percutaneous biopsy (with a needle) or surgical biopsy. Blood tests can help assess overall health, detect tumor markers, or evaluate organ function affected by cancer spread. Additional tests, such as PET scans or further imaging studies, may be conducted to further evaluate the extent of metastasis and identify the primary cancer source. These diagnostic approaches help confirm spinal metastasis, determine its extent, and guide treatment planning.

What is the treatment for spinal metastasis?

Treatment for spinal metastasis aims to manage symptoms, slow the progression of cancer, and improve quality of life. The approach depends on the type of primary cancer, the extent of spinal involvement, and overall patient health. Key treatment options include:

Medications: Pain relief is often managed with analgesics, anti-inflammatory drugs, or opioids. Corticosteroids may be used to reduce inflammation and swelling around the spinal cord. Targeted therapies or hormone therapies might be employed based on the primary cancer type.
Radiation Therapy: This is commonly used to treat localized metastases, reduce pain, and improve neurological function by shrinking tumors that are pressing on the spinal cord or nerves.
Surgery: Surgical intervention may be necessary to stabilize the spine, decompress the spinal cord, or remove a tumor, especially if it causes significant symptoms or is at risk of spinal instability.
Chemotherapy: This may be used if the primary cancer is responsive to chemotherapy or if there is widespread disease that affects multiple areas, including the spine.
Bisphosphonates or Denosumab: These drugs help strengthen bones and reduce the risk of fractures, which is important if the metastasis has caused bone damage.
Supportive Care: This includes physical therapy to help maintain mobility and function, and occupational therapy to assist with daily activities.

Treatment plans are often multidisciplinary, involving oncologists, radiation therapists, surgeons, and other specialists to provide comprehensive care tailored to the individual’s needs.

What is the survival rate for spinal metastasis?

The survival rate for spinal metastasis varies widely based on several factors, including the type of primary cancer, the extent of metastasis, the location and number of spinal lesions, the overall health of the patient, and how well the disease responds to treatment.

Here are some general considerations:

Type of Primary Cancer: Survival rates can differ depending on the primary cancer. For instance, spinal metastases from breast cancer or prostate cancer may have different prognoses compared to those from lung cancer or melanoma.
Extent of Disease: The presence of metastases in other organs and the degree of spinal involvement (e.g., solitary lesion versus multiple lesions) significantly impact survival.
Treatment Response: How well the cancer responds to treatments like chemotherapy, radiation, or targeted therapies can affect survival.
Overall Health: The patient’s overall health, age, and response to treatment play critical roles.

General Statistics:

Median Survival: Studies suggest that the median survival for patients with spinal metastases can range from several months to a few years. For example, the median survival might be about 6-12 months for those with more advanced or aggressive cancers, while patients with cancers that are better controlled or respond well to treatment might live longer.
Five-Year Survival Rates: These rates vary significantly and are often reported in the context of the primary cancer type. For some cancers, the five-year survival rate for patients with spinal metastases can be relatively low, reflecting the advanced nature of the disease.

It’s important to discuss prognosis with a healthcare provider, who can provide information tailored to the specific details of an individual’s case.