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Metastatic Spinal Tumours

Conditions Treated

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Overview

Metastatic spinal tumours occur when cancer from another part of the body spreads to the spine. They are the most common type of spinal tumour and can affect the vertebral bodies, epidural space, or, less commonly, the spinal cord itself. Common cancers that metastasise to the spine include:

  • Lung cancer
  • Breast cancer
  • Prostate cancer
  • Kidney (renal cell) cancer
  • Thyroid cancer
  • Multiple myeloma

Symptoms

  • Back or neck pain, often the first symptom; may be progressive and severe, frequently worse at night.
  • Pain that does not improve with rest or common analgesics.
  • Weakness or paralysis in the arms or legs, depending on the level of spinal involvement.
  • Numbness or loss of sensation in the trunk or limbs.
  • Bowel or bladder dysfunction, including incontinence or retention.
  • Unintentional weight loss, fatigue or other systemic symptoms related to the primary cancer.
  • Symptoms may develop gradually or, if the tumour causes vertebral collapse or haemorrhage, may occur rapidly.

Diagnosis

  • MRI with contrast: Primary imaging modality; identifies tumour location, extent of spinal cord or nerve compression, and soft tissue involvement.
  • CT: Evaluates bone destruction, vertebral instability and is used for surgical planning.
  • PET-CT or bone scan: Assesses for additional skeletal metastases and extent of systemic disease.
  • Biopsy: May be required to confirm the primary cancer type, particularly when the diagnosis is unknown. Often performed percutaneously under CT guidance.
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Treatment

Treatment of metastatic spinal tumours is guided by the primary cancer type, extent of spinal involvement, neurological status and overall prognosis.

  • Radiation therapy (including stereotactic radiosurgery): Often used to control tumour growth, relieve pain and preserve neurological function.
  • Surgery: Considered for spinal cord or nerve compression, mechanical instability, or when tissue is required for diagnosis. May involve decompression, stabilisation or vertebrectomy.
  • Chemotherapy and targeted therapy: Systemic treatment depending on the primary cancer type.
  • Steroids: Used to reduce spinal cord oedema and improve neurological symptoms acutely.
  • Pain management: Including opioid analgesia, nerve blocks or palliative radiotherapy.
  • Supportive care and rehabilitation: Physiotherapy, mobility aids and symptom management to optimise quality of life.