Complications: Metastatic Spinal Cord Compression Flashcards
What 3 cancers account for more than 60% of spinal mets?
Prostate, breast, lung
In what percentage of patients with advanced cancer does metastatic spinal cord compression occur?
15%
In what region of the spine does MSCC most commonly occur?
Thoracic
What causes MSCC?
Collapse or compression of a vertebral body that contains metastatic disease
10% due to direct tumour extension into vertebral canal
How does MSCC present?
BACK PAIN - prolonged, usually first symptom occurring 2-3 months before others
Limb weakness
Sensory level
Bladder and anal sphincter dysfunction
Reduced performance status (feeling unsteady on feet)
What can exacerbate back pain in MSCC?
Coughing Straining Sneezing Straight leg raise Lying down
What examination findings occur?
Acute onset of flaccid paralysis Progressing over time: spasticity in limbs below level of MSCC - increased tone - hyperreflexia - clonus
Plantar reflexes going up
Sensory loss with well defined dermatomal level
Palpable bladder suggestive of retention
If a patient has back pain suggesting spinal mets, what imaging should be done within a week?
MRI
If a patient has signs of MSCC how quickly should an MRI be done?
Within 24 hours
Before definitive treatment, what medication should be given to reduce swelling in suspected MSCC?
Dexamethasone 16mg plus PPI
When would surgery be considered?
Treatment of choice if patient is fit and has a good prognosis
- good motor function
- good performance status
- limited comorbidities
- single level spinal disease
- absence of visceral mets
What is the most common treatment for MSCC?
Radiotherapy
What factors determine radiotherapy as treatment of choice?
Extensive disease
Poor physiological reserve
How does radiotherapy help to relieve symptoms in MSCC?
It causes cell death to rapidly dividing tumour cells and consequently relieves the pressure on nerve roots and spine
What is a poor prognostic sign?
Loss of sphincter function
Ambulatory at presentation
