Tumours of the spine can arise from local tissues (primary tumour) or from tumours that have spread to the spine (metastatic tumours). Another common form of tumour that is found in the spine are the blood cell (myeloid) tumours that include multiple myeloma, lymphoma and leukaemia.
Benign or Malignant?
Tumours are classified into benign or malignant tumours.
If a tumour does not have the ability to spread outside the tissue in which it arises it is benign.
If the tumour is aggressive and has the potential for spread to other areas or has already spread (metastasized) then it is malignant.
Primary Tumours in the spine
Any cell type can form tumours. In the spine the most common tumours arise from the bone, cartilage or nerve tissue or nerve lining cells.
Haemangioma – is a benign tumour arising from blood vessels in the bone. It is very common (5% of the population) and is not commonly a cause of symptoms unless very large in which case they can weaken the bone and lead to fracture.
Schwannoma – is a primary tumour of the nerve sheath. It is benign but sometimes can cause symptoms if the nerve sheath swells enough to compresss the nerve. In this case it presents as a radiculopathy (eg Sciatica).
Osteoid Osteoma – is a primary bone tumour and is benign but can be quite painful. It usually presents in children and young adults.
Osteochondroma – is a primary tumour arising from bone and can grow to form a lump in the back.
Meningioma – is a primary tumour of the lining of the brain and spinal cord and may grow to put pressure on the spinal cord in the spine. It is benign and can be removed safely in most cases.
Osteosarcoma – is a malignant primary tumour and is very uncommon in the spine. It can arise in bone previously affected by Paget’s disease.
Chondrosarcoma – is also a malignant primary tumour arising from the cartilage in the spine and is also uncommon. It usually presents in later life.
Chordoma – is a malignant primary bone tumour that affects the most upper and lower segments of the spine most commonly. It is a rare tumour that despite being slow growing can reach a very large size before it is diagnosed and this makes resection difficult.
Myeloma – is a malignant tumour of plasma cells which live in bone and normally make the antibodies of the immune system. It usually affects older adults and is quite a common tumour to present in the spine. It can be very aggressive because of its ability to cause bone destruction and fractures.
Lymphoma – is a malignant tumour of lymphocytes, which are also part of the immune system. It is quite a common tumour even in young adults but for most types there is a good response to chemotherapy regimes.
Metastatic Tumours of the spine
These tumours arise else where in the body and have spread to the spine, most commonly via the blood stream. These are the most common tumours to present in the spine.
The common types of tumours to spread to the spine are Breast, Prostate, Bowel, Kidney, Thyroid, Lung and Melanoma.
Metastatic tumours in the spine are often painful and can lead to fractures or put pressure on the spinal cord or nerves of the cauda equina.
Treatment depends on the type of tumour, the location and size of the tumour and the extent of spread.
Commonly radiotherapy is the first line of treatment unless the stability of the spine is at risk or the tumour is not responsive to radiation.
Surgery can have specific roles to decompress the nerves and provide stability where necessary. Sometimes surgery is required for a diagnosis as tissue samples from needle biopsy are not always adequate.