1. SPINAL TUMORS

2. GROUP MEMBERS:  Carlwyn Collins  Jennifer Haynes  Satrupa Devi Singh  Vanessa Wickham

3. DEFINITION SPINAL TUMOR : A spinal tumor is an abnormal tissue growth of cells (mass) in or surrounding the spinal cord associated with cancer. The type of tumor that occur in the spine are: Leukemia Lymphoma Myeloma

4. A small number of spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other gliomas.

5. AETIOLOGY Primary Spinal Tumors are tumors that start in spinal tissue. Secondary spinal tumors are tumors that spread to the spine from some other place (metastasis). Tumors may spread to the spine from the breast, prostate, lung, and other areas. The cause of primary spinal tumors is unknown. Some primary spinal tumors occur with genetic defects.

6. Spinal tumors can occur: Inside the spinal cord (intramedullary) In the membranes (meninges) covering the spinal cord (extramedullary - intradural) Between the meninges and bones of the spine (extradural) Or, tumors may extend from other locations. Most spinal tumors are extradural.

7. As it grows, the tumor can affect the: Blood vessels Bones of the spine Meninges Nerve roots Spinal cord cells The tumor may press on the spinal cord or nerve roots, causing damage. With time, the damage may become permanent.

8. PATHOPHYSIOLOGY Spinal cord tumors can be primary or metastatic. These tumors are identified by the location of the origin of the mass: Extradural: Lesions located outside the dura mater in either the epidural space or the bones of the spinal column or paraspinal tissue. Intradural: Lesions located within or under the dura mater of the meninges. Intramedullary: Intradural lesions arising within the substance of the spinal cord, within the tracts and central gray matter. Extramedullary: Lesions arising outside of the spinal cord in the meninges, nerve roots, or vertebral bodies.

9. PATHOPHYSIOLOGY cont’d Spinal cord tumors are rare in terms of overall central nervous system tumors. Presenting symptoms depend on location of the lesion as well as the cell type. Metastatic extradural tumors causing epidural spinal cord compression are most commonly a result of lung tumors in men and breast tumors in women.

10. CLINICAL FEATURES Non-mechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumors. Pain may spread beyond the back to the hips, legs, feet or arms and may worsen over time — even when treated by conservative, nonsurgical methods that can often help alleviate back pain attributed to mechanical causes. Depending on the location and type of tumor, other signs and symptoms can develop, especially as a malignant tumor grows and compresses on the spinal cord, the nerve roots, blood vessels or bones of the spine. Impingement of the tumor on the spinal cord can be life-threatening in itself.

11. CLINICAL FEATURES cont’d Additional symptoms can include the following: Loss of sensation or muscle weakness in the legs, arms or chest Difficulty walking, which may cause falls Decreased sensitivity to pain, heat and cold Loss of bowel or bladder function Paralysis that may occur in varying degrees and in different parts of the body, depending on which nerves are compressed Scoliosis or other spinal deformity resulting from a large, but benign tumor

12. MEDICAL MANAGEMENT cont’d The goal of treatment is to reduce or prevent nerve damage from pressure on (compression of) the spinal cord. Treatment should be given quickly. The more quickly symptoms develop, the sooner treatment is needed to prevent permanent injury. Any new or unexplained back pain in a patient with cancer should be thoroughly investigated.

13. MEDICAL MANAGEMENT cont’d Treatments include: Corticosteroids (dexamethasone) may be given to reduce inflammation and swelling around the spinal cord. Surgery may be needed to relieve compression on the spinal cord. Some tumors can be completely removed. In other cases, part of the tumor may be removed to relieve pressure on the spinal cord.

14. Radiation therapy may be used with, or instead of, surgery. Chemotherapy has not been proven effective against most spinal tumors, but it may be recommended in some cases. Physical therapy may be needed to improve muscle strength and the ability to function independently. MEDICAL MANAGEMENT cont’d

15. REFERENCE American Association of Neurological Surgeons - Spinal Tumors. (n.d.). Retrieved March 16, 2015, from http://www.aans.org: http://www.aans.org/Patient%20Information/Conditions%20a nd%20Treatments/Spinal%20Tumors.aspx Medline Plus - Spinal Tumors. (n.d.). Retrieved March 16, 2015, from http://www.nlm.nih.gov: http://www.nlm.nih.gov/medlineplus/ency/article/001403.htm The Leaders in Spine & Brain Care. (n.d.). Retrieved March 16, 2015, from http://www.neurospinewi.com: http://www.neurospinewi.com/newsletters/spinalcordtumors. html