Cancers can occur anywhere in the spinal column, from the base of the skull down to the lower back. Cancerous cells may be found in vertebrae, as well as in nerves, muscles, tendons, and other tissues that are part of the spine or help to support it. About 10,000 men and women in the United States develop cancer of the spinal cord each year.
Physicians at Yale Medicine have been using a new radiation therapy called SBRT since 2008, and are national leaders in the field.
What are the types of spinal cord cancer?
There are two main types of cancers involving the spine.
Primary spine cancer originates within or around the spinal column.
Secondary spine cancer, which originates in another part of the body and spreads to the spine, is more common. These cancers usually develop first in the lung, prostate, breast, thyroid, or kidneys.
What are risk factors for spine cancer?
Because most cancers involving the spine are secondary and originate elsewhere in the body, cancer in any organ, usually the lung, kidney, breast, prostate or thyroid, is the biggest risk factor.
How is spine cancer diagnosed?
Doctors first perform a physical exam and then typically order imaging tests to get a closer look at a tumor’s size and location.
These imaging tests may include:
- Magnetic resonance imaging (MRI). This test uses a high-powered magnet and radio waves to create a detailed picture of the bones and nerves in and around the spinal cord.
- Computerized tomography (CT) scan. This test involves a series of powerful X-rays to get a more detailed picture of the spine.
Doctors may also perform a biopsy, whereby a tissue sample from the tumor is extracted and analyzed under a microscope to determine what type of cancer cells are present, a crucial step in developing a treatment plan. Only a biopsy can provide a definitive cancer diagnosis.
How is spinal cord cancer treated?
For patients with primary spine cancer, surgical removal of the tumor is often recommended first, as long as the patient is a suitable candidate.
For patients with secondary spine cancer, surgery is recommended when the tumor is compressing the spinal cord, when there is spinal instability, or where the vertebral body (the thick bone segment forming the front of each vertebra) has weakened or lost height.
If the tumor can be removed safely with surgery, a spine surgeon performs the operation using techniques designed to minimize damage to the spinal cord and nerves.
Most patients with spinal tumors will also be treated with radiation therapy.
Yale Medicine uses a newer radiation therapy method called stereotactic body radiation therapy (SBRT) to treat spine cancer when appropriate. A machine targets the tumor from outside the body with higher doses of radiation than conventional radiation therapy. SBRT also typically requires fewer treatments (usually one to five). Where treatment requires just one treatment session, the method is called stereotactic radiosurgery (SRS). Treatment is painless (though patients do have to lie still for an extended period) and sessions span 60 to 90 minutes (with much of the time spent positioning the machine).
“At Yale Medicine, we often treat using a single treatment, though occasionally we use three treatments. With conventional radiation, however, treatment can take five to 10 treatments,” says Zain Husain, MD, director of Yale Medicine's Spine Radiosurgery. "Long-term, evidence has shown SBRT/SRS to be more effective than conventional radiation therapy in addressing spine cancer."
What are the potential side effects of SBRT for spine cancer?
“While treatment sessions are painless, in the days or week following radiation treatment with SBRT, patients may experience pain flares at the treatment site, meaning a slight increase in pain from time to time,” says Dr. Husain. “We think this is due to inflammation caused by the high doses of radiation used.”
The pain usually resolves on its own within days, but steroids and other pain medications may be options for relief.
Another potential side effect is a sore esophagus, depending on how close the esophagus is to the treatment site.
Additionally, if the tumor had weakened the bone of the spine, then occasionally the bone may be further weakened post-treatment. To stabilize the bone and help prevent a fracture, doctors may inject the vertebrae with medical “bone cement,” a polymer that acts as a grout to fill cracks. In rarer instances, the spine may be surgically stabilized using metal plates or rods.
How is Yale Medicine’s approach to treating spine cancer unique?
At Yale Medicine, we use a multidisciplinary approach to treat spine cancer. Surgeons and radiation oncologists collaborate with other specialists to plan the best treatment. Together, the team discusses whether a patient will benefit from a form of SBRT. They consider multiple factors, including the patient’s overall health status, the tumor's type, location and size, and whether the cancer has spread.
Yale Medicine has been treating spine cancer with SBRT since 2008, making it a national leader in the field. The equipment Yale Medicine uses for SBRT treatments is among the most advanced in the world, allowing them the ability to safely treat tumors within millimeters of the spinal cord. “We’ve now used SBRT to treat hundreds of patients, often achieving very good outcomes,” says Dr. Husain.