Neoplasms: Spinal Tumors

Question 1

Three types of spinal tumors

Answer 1

Intradural/Intramedullary

Intradural/Extramedullary

Extradural/Extramedullary

Question 2

Intradural/Intramedullary tumors

Location
Arise from
Most common in
Symptoms

Answer 2

Usually within the cord itself

Usually astrocytoma or ependymoma

Most common in children, least common in adults

Causes neurologic sx by invasion and compression

Question 3

Intradural/Extramedullary tumors

are made from

Answer 3

Most common site of intraspinal tumor in adults

Primarily Schwannoma or Meningioma

Question 4

Most common site of intraspinal tumor in adults

Answer 4

Intradural/Extramedullary

Question 5

Extradural/Extramedullary tumors
Severity
Can lead to
Treatment

Answer 5

Most common spinal tumor, often metastatic

Can often lead to bone destruction and vertebral collapse causing secondary sx

Easiest to access but since it is by the bone it can potentially lead to vertebral collapse

Question 6

What is the most common sx for a intraspinal tumor

Answer 6

Spontaneous pain due to nerve root irritation

Then motor sx usually follow sensory sx

Question 7

What are the two types of pain caused by intraspinal tumors and how would you differentiate them

Answer 7

Intramedullary pain is poorly localized and deeply burning (diffuse pain)

Extramedullary pain is radicular and radiating (dermatomal pattern - spinal nerve)

Question 8

Intramedullary pain is

Answer 8

When pain is poorly localized and deeply burning (diffuse pain)

Pain is more diffuse it is because multiple pathways could potentially be affected

Question 9

Extra-medullary pain is

Answer 9

Radicular and radiating (dermatomal pattern - spinal nerve)

Pain follows dermatomal pattern because compression is by spinal root

Question 10

Treatment of spinal tumors

Answer 10

Radiation therapy is the tx of choice, as surgical decompression has been found to have a 30% rate of neurologic improvement

Radiation may cause myelopathy subacutely

Prognosis is based on degree of loss prior to radiation therapy

Question 11

Metastatic Tumors

Account for and how does cancer reach the CNS

Answer 11

The ↑ in survivability from other cancers has allowed metastases to other body parts to occur

Metastases to the CNS account for 20% of all intracranial lesions, & 55% of all intraspinal lesions

Metastases reach the brain via arterial blood system; lung cancer is most common 1° site

Question 12

Initial sx of metastatic tumors

Answer 12

Initial sx may be the same as in intracranial tumors, but the progression is much more rapid due to the significant edema that accompanies metastasis

Question 13

Prognosis of metastatic tumors

Answer 13

The prognosis for metastatic brain tumors is poor as it indicates that the 1° has already escaped control