A Tumour In The Spine

-Chhatra Karki

A spinal tumour is a cancerous (malignant) or noncancerous (benign) growth within or near the spinal cord. A tumour in these locations can compress nerve roots in the spinal cord and therefore even a noncancerous growth can become incurable unless treated timely. Spinal tumour, although it affects people of all ages, is most common in young and middle aged adults. Secondary or metastatic spinal tumours are seen among elderly. A special credit goes to Sir Victor Horsely from London, who first operated on a spinal tumour (Spinal Meningioma) in 1887.

There is no exact data available regarding known incidences of spinal tumour in Nepal. The Department of Neurosurgery at Bir Hospital, Kathmandu, sees about 300-350 cases per year, out of which about 80-100 need surgery. However the actual number of patients in the country could run in several thousands.

Cause
According to Senior Neurosurgeon at Bir hospital Dr. Rajiv Jha, the cause of most primary tumours is unknown. However, given the higher incidence of primary spinal tumours in certain familial groups, a genetic predisposition is likely. In a small number of people, primary tumours may result from a specific genetic disease (e.g., neurofibromatosis) or from exposure to cancer-causing agents.

Symptoms
Dr. Jha says that the symptoms depend on the location and type of tumour and general health of the patient. The most common presentation is persistent backache which gets worse with time despite pain medications. This is the first warning sign and “One needs to see a neurosurgeon immediately, so that proper investigations and diagnosis can be done, “opines Dr Jha. If it is not done, patient will gradually develop sensory changes, weakness of the limbs, muscle weakness and spasms, loss of muscle functions urine and stool incontinence. If the tumour is located in the higher cervical spine, patient might develop difficulty in breathing.”

Diagnosis
Timely attention of a neurosurgeon and diagnosis of spinal tumour is crucial for better treatment outcomes. It was very difficult to diagnose a spinal tumour before MRI (magnetic resonance imaging) technique and trained neurosurgeons were available. Unfortunately, even in the present times, not all countries in the SAARC region provide good neurosurgical services. These services in Nepal, though comparable to those available in Pakistan and Bangladesh, are not as good as of India which provides advanced neurosurgical services.

Treatment
Ideally, the goal of treatment is to eliminate the tumour completely, but this goal may be complicated by the risk of permanent damage to the surrounding nerves. Newer techniques and instruments allow neurosurgeons to reach tumours that were once considered inaccessible. The high-powered microscopes used in microsurgery make it easier to distinguish tumour from healthy tissue. Doctors also can test different nerves during surgery with electrodes, thus minimizing nerve damage. In some instances, they may use sound waves to break up tumours and remove the fragments. However, even with advances in treatment, not all tumours can be removed completely.

In such cases surgery may have to be combined with chemotherapy or radiation therapy. Dr Jha says that, ”Standard radiation therapy may be used following an operation to eliminate the remnants of tumours that cannot be completely removed or to treat inoperable tumours. It also may be the first line therapy for metastatic tumours. Radiation may also be used to relieve pain or when surgery poses too great a risk.”

Stereotactic radiosurgery (SRS) is a new technique capable of delivering high doses of precisely targeted radiations. In SRS, doctors use computers to focus radiation beams on tumours with pinpoint accuracy and from multiple angles. Chemotherapy, which is a standard treatment for many types of cancer, might be beneficial for the patient, either alone or in combination with radiation therapy.

As surgery and radiation therapy, as well as tumours themselves, can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce the swelling, either post-surgery or during radiation treatments. ”Although corticosteroids reduce inflammation, they are usually used only for short periods to avoid such serious side effects as osteoporosis, high blood pressure, diabetes and an increased susceptibility to infection” opines Dr. Jha