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Causes
By Mayo Clinic staff
Although scientists are learning more about the genetic and environmental factors involved in the development of many kinds of tumors, spinal tumors are still a relatively unknown quantity. Spinal tumor cells often contain a number of abnormal genes, but in many cases, researchers don't know what causes these genetic alterations. They do know that in some cases, spinal cord tumors run in families and are associated with familial cancer syndromes such as:
- Neurofibromatosis 2. In this hereditary disorder, noncancerous tumors develop on or near the nerves related to hearing, leading to progressive hearing loss in one or both ears. Some people with neurofibromatosis 2 also develop tumors in the arachnoid layer of the spinal cord or in the supporting glial cells.
- Von Hippel-Lindau disease. This rare, multisystem disorder is associated with noncancerous blood vessel tumors (hemangioblastomas) in the brain, retina and spinal cord and with other types of tumors in the kidneys or adrenal glands.
It's also known that spinal cord lymphomas — cancers that affect lymphocytes, a type of immune cell — are more common in people whose immune systems are compromised by medications or disease.
Overview of the spine
Your spine provides structural support for your body while at the same time allowing flexible movement. It comprises a complex network of bones, muscles, cartilage, ligaments, joints and nerves. Of these, the vertebrae and spinal cord are the most important for an understanding of spinal tumors:
- Vertebrae. Your spine is made up of 24 small bones (vertebrae), stacked on top of one another, that enclose and protect the spinal cord and its nerve roots. The sacrum, containing five fused vertebrae, sits below the lower back. The last three tiny vertebrae, also fused together, are called the tailbone (coccyx).
- Spinal cord. Your spinal cord is a double-layered, long column of nerve fibers that carries messages to and from your brain. The inner layer of your spine contains nerve cells, blood vessels and glial cells, which are cells that support the brain. The outer layer contains nerve fibers (axons) that relay sensory information and conduct motor impulses. Wrapped around the entire spinal cord are three protective membranes (meninges). The inner membrane is called the pia mater, the middle is called the arachnoid, and the tough, outer membrane, to which the spinal nerves attach, is called the dura mater.
Types of spinal tumors
Spinal tumors are classified according to their location in the spine.
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Extradural (vertebral) tumors. Most tumors that affect the vertebrae have spread (metastasized) to the spine from another site in the body — often the prostate, breast, lung or kidney. Although the original (primary) cancer is usually diagnosed before back problems develop, back pain may be the first symptom of disease in people with metastatic spinal tumors.
Cancerous tumors that begin in the bones of the spine are far less common. Among these are osteosarcomas (osteogenic sarcomas), the most common type of bone cancer in children, and Ewing's sarcoma, a particularly aggressive tumor that affects young adults. Multiple myeloma is a cancerous disease of the bone marrow — the spongy inner part of the bone that makes blood cells — most commonly seen in older adults.
Noncancerous tumors, such as osteoid osteomas, osteoblastomas and hemangiomas, also can develop in the bones of the spine where they may cause long-standing pain, spinal curvature (scoliosis) and neurological problems.
- Intradural-extramedullary tumors. These tumors develop in the spinal cord's arachnoid membrane (meningiomas), in the nerve roots that extend out from the spinal cord (schwannomas and neurofibromas) or at the spinal cord base (filum terminale ependymomas). Meningiomas occur most often in middle-aged women. Although almost always noncancerous, meningiomas can be difficult to remove and may sometimes recur. Nerve root tumors also are generally noncancerous, although neurofibromas can become cancerous over time. Ependymomas at the end of the spinal cord are often large, and their treatment may be complicated by the extensive system of nerves in that area.
- Intramedullary tumors. These tumors begin in the supporting cells within the spinal cord. Most are either astrocytomas, which mainly affect children and adolescents, or ependymomas — the most common type of spinal cord tumor in adults. Intramedullary tumors can be either noncancerous or cancerous and, depending on their location, may cause numbness, loss of feeling, or changes in bowel and bladder function. In rare cases, tumors from other parts of the body can metastasize to the spinal cord itself.
- Brain and spinal tumors: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/brainandspinaltumors/detail_brainandspinaltumors.htm#43233060. Accessed July 25, 2009.
- Welch WC, et al. Spinal cord tumors. http://www.uptodate.com/home/index.html. Accessed July 25, 2009.
- Donthineni R. Diagnosis and staging of spine tumors. Orthopedic Clinics of North America. 2009;40:1.
- Schiff D. Clinical features and diagnosis of epidural spinal cord compression, including cauda equina syndrome. http://www.uptodate.com/home/index.html. Accessed July 25, 2009.
- Detailed guide: Brain / CNS tumors in adults. American Cancer Society. http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=3. Accessed July 25, 2009.
- DeAngelis LM. Tumors of the central nervous system and intracranial hypertension and hypotension. In: Goldman L, et al., eds. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/151491959-3/0/1492/741.html?tocnode=54620820&fromURL=741.html#4-u1.0-B978-1-4160-2805-5..50204-4--cesec51_9020. Accessed July 25, 2009.
- Cole JS, et al. Metastatic epidural spinal cord compression. Lancet Neurology. 2008;7:459.
- Moynihan TJ (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 2, 2009.
