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A - MSRA Cancer Care [1] > [23] Spinal Cord Compression > Flashcards

[23] Spinal Cord Compression Flashcards

1
Q

Is spinal cord compression a medical emergency?

A

Yes

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2
Q

What is required with spinal cord emergency?

A

Swift diagnosis and treatment

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3
Q

Why is it important that spinal cord compression receives swift diagnosis and treatment?

A

To prevent long-term disability due to irreversible spinal cord injury

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4
Q

What is metastatic spinal cord compression?

A

Compression by direct pressure and/or induction of vertebral collapse or instability by metastatic spread or direct extension of malignancy that threatens to cause neurological disability

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5
Q

What might cause malignant spinal cord compression?

A
  • Extradural spread from vertebral body metastasis
  • Direct metastasis
  • Vertebral crush fracture
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6
Q

What cancers most often metastasise to bone and cause spinal cord compression?

A
  • Breast
  • Kidney
  • Thyroid
  • Prostate
  • Lung
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7
Q

When are most spinal metastases diagnosed?

A

Most are diagnosed following the diagnosis of the primary cancer

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8
Q

In what % of cases are spinal metastases the first manifestation of an unknown tumour?

A

10%

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9
Q

How can early detection of spinal cord compression be achieved?

A

You should inform patients at high risk of metastases of the symptoms of spinal cord compression, and advise them of what to do should they develop these symptoms

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10
Q

What symptoms suggest possible spinal metastases?

A
  • Pain in thoracic or cervical spine
  • Severe unremitting or progressive lumbar spine pain
  • Spinal pain aggravated by straining
  • Noctural spinal pain preventing sleep
  • Localised spinal tenderness
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11
Q

What symptoms suggest spinal cord compression?

A
  • Radicular pain
  • Limb weakness
  • Difficulty in walking
  • Sensory loss, or bladder and bowel dysfunction
  • Neurological signs of spinal cord or cauda equina compression
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12
Q

What investigation is done in spinal cord compression?

A

MRI imaging of whole spine

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13
Q

What is the purpose of MRI imaging of the whole spine in spinal cord compression?

A

So definitive treatment can be planned

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14
Q

How soon should MRI imaging of the whole spine be performed if clinical features suggest spinal metastasis?

A

Within 1 week

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15
Q

How soon should MRI imaging of the whole spine be performed if clinical features suggest spinal cord compression?

A

Within 24 hours, or sooner (including out of hours) if emergency treatment is needed

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16
Q

When should management be started for spinal cord compression?

A

As soon as possible after diagnosis

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17
Q

What is the aim of starting treatment as soon as possible after diagnosis in spinal cord compression?

A
  • Minimising permanent damage to the spinal cord

- Reduce pain

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18
Q

Why might treatment for spinal cord compression reduce pain?

A

If the treatment shrinks the tumour and therefore relieves the pressure on the nerves and spinal cord

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19
Q

What factors will the treatment for spinal cord compression depend on?

A
  • Type of cancer
  • Area of spine affected
  • General fitness
20
Q

What are the treatment options for spinal cord compression?

A
  • Steroids
  • Radiotherapy
  • Chemotherapy
  • Surgery
  • Hormonal therapy
  • Drugs that strengthen bones
21
Q

How do steroids work in spinal cord compression?

A

They help reduce pressure and swelling around the spinal cord

22
Q

Who should be given steroids in spinal cord compression?

A

All patients with spinal cord compression unless contraindicated

23
Q

Give an example of a contraindication to steroids in spinal cord compression

A

Significant suspicion of lymphoma

24
Q

What steroid is given in spinal cord compression?

A

Dexamethasone

25
Q

What dose of dexamethasone should be given in spinal cord compression?

A

16mg loading dose, followed by short course of 16mg daily while treatment is being planned

26
Q

When should the loading dose of dexamethasone be given in spinal cord compression?

A

As soon as possible after assessment

27
Q

What should happen to the dose of steroids after surgery or the start of radiotherapy in spinal cord compression?

A

It should be gradually reduced over 5-7 days and stopped

28
Q

What should be done to the dose of steroids if the neurological function deteriorates at any time in spinal cord compression?

A

Reconsider the dose

29
Q

What is the most common treatment for spinal cord compression?

A

Radiotherapy

30
Q

Is radiotherapy used on its own or in conjunction with other treatments in spinal cord compression?

A

Can be used on its own, or alongside other treatments such as surgery

31
Q

What kind of radiotherapy is used for spinal cord compression?

A

External radiotherapy

32
Q

What course of radiotherapy is given in spinal cord compression?

A

Usually given as a short course of treatment, ranging from 1 single treatment to one treatment a day for 1-3 weeks, or longer for some types of cancer

33
Q

When should radiotherapy for spinal cord compression be started?

A

As soon as possible after diagnosis

34
Q

is surgery available for everyone with spinal cord compression?

A

No, it is only available for a small number of people

35
Q

What does the availability of surgery in spinal cord compression depend on?

A
  • Type of cancer
  • Area of spine affected
  • How stable the spine is
36
Q

What is the aim of surgery in spinal cord compression?

A

Remove as much of the tumour as possible, and relieve pressure on the spinal cord and nerves
May also involve removing several parts of the vertebrae

37
Q

What care needs to be taken with surgery for spinal cord compression?

A

Not to weaken the spine

38
Q

What types of surgery are used in the management of spinal cord compression?

A
  • Stabilisation and debulking of the tumour

- Decompression laminectomy

39
Q

What is a decompression laminectomy?

A

Where a section of bone is removed from one of the vertebrae

40
Q

How can the spine be further stabilised in spinal cord compression?

A

Using metal rods, screws, or bone grafts

41
Q

When might adjuvant radiotherapy be given in spinal cord compression?

A

If the tumour cannot be completely removed, or if there is recurrence

42
Q

When is chemotherapy used to treat spinal cord compression?

A

When it is caused by tumours that are very sensitive to chemotherapy, e.g. lymphoma, testicular cancer

43
Q

What is hormonal therapy often used in combination with in spinal cord compression?

A

Chemotherapy

44
Q

When is hormonal therapy used in spinal cord compression?

A

For certain cancers such as breast cancer and prostate cancer

45
Q

Give two examples of drugs that strengthen the bones

A
  • Bisphosphonates

- Denosumab

A - MSRA Cancer Care [1] (47 decks)

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