Spinal Cord Neoplasms Flashcards
Primary spinal cord tumors arise from the different elements of the CNS:
- Neurons.
- Supporting glial cells.
- Meninges.
Additionally, neoplasms of the spinal cord may be classified according to …?
Compartment of origin, either INTRAMEDULLARY (inside the cord) or EXTRAMEDULLARY (outside the cord).
Met lesions cause …% of the cases of neoplastic spinal cord compression
85%.
Metastatic spinal cord compression usually follows …?
Hematogenous dissemination of malignant cells to the vertebral bodies, with subsequent expansion into the epidural space.
Spread into the epidural space may occur by means of …?
Tumor extension through the INTERVERTEBRAL FORAMINA or HEMATOGENOUS SPREAD by way of the BATSON venous plexus.
Most frequently, met seeding appears in the …?
THORACIC spine (70%).
Lumbar next (20%).
Cervical (10%).
==> Multiple spinal levels (30%).
Systemic cancer with a tendency for spinal cord metastasis:
- Breast.
- Prostate.
- Renal.
- Lung.
- Lymphoma.
- Sarcoma.
- MM.
==> GI + pelvic ==> Lumbosacral spine.
==> Lung + breast ==> Thoracic.
Intramedullary or extramedullary mets are more common?
EXTRA.
Intramedullary mets - Signs/symptoms tend to simulate those of …?
Epidural compression.
However, the associated motor weakness is more likely to be UNILATERAL.
Principles of treating intramedullary cancer are similar to those for …?
Epidural spinal cord compression.
Leptomeningeal mets spread by means of …?
Diffuse or multifocal seeding of the meninges from systemic cancer (eg lung or breast cancer, melanoma, lymphoma).
==> Consequent signs and symptoms may be referable to the spine or spinal cord.
Evidence of spinal compromise may include:
Lower extremity weakness, paresthesias, reflex asymmetry, and spinal pain.
Most primary intramedullary spinal cord tumors are:
- Astrocytomas.
2. Ependymomas.
INTRADURAL extramedullary tumors include:
- Schwannomas.
- Neurofibromas.
- Meningiomas.
==> Affect the paravertebral area may spread and compress the cord through expansion.
***An enlarged cancerous lymph node may compress the cord.
Hemangiomas:
Usually discovered incidentally + asymptomatic.
==> Symptoms emerge if pathologic vertebral fractures or epidural extension occurs.
Nerve tracts most vulnerable to mechanical pressure include:
- Corticospinal.
- Spinocerebellar.
- Posterior columns.
Neoplasms may compromise the …?
Vascular supply, causing edema or ischemia.
Less frequently, tumors may induce …?
- Cyst formation.
2. Cavitation within the spinal cord.
Frequency - USA:
0.5-2.5 /100,000.
Metastatic lesions that involve the spinal cord affect about 5-10% of pts with cancer.
Approx …% of all primary CNS lesions arise from the spinal cord.
15%.
Mortality/morbidity - Most primary spinal cord cancers …?
Do NOT disseminate widely through the CNS or body.
==> Consequent disability relates to the degree of cord impairment and anatomic level of cord.
Metastatic tumors that cause epidural cord compression and dysfunction are …?
MCC of oncologic CNS injury.
**mortality correlates with the prognosis of the primary cancer.
The severity of the spinal cord compromise 2 to a tumor spans a wide range:
Initially, symptoms may be limited to pain or minor sensory or motor disturbance.
==> As the compression progresses, neurologic abnormalities become more pronounced, advancing to disability.
==> PARTIAL cord compression, such as Brown-Sequard syndrome, may evolve.
==> In the advanced stage of compression, complete transverse sensory and motor paralysis with bowel and bladder incontinence occurs.
Best predictor of ultimate disability in pts with epidural cord compression:
The disability of the pt at the initiation of therapy serves as the best predictor of ultimate disability in pts with epidural cord compression.
==> Early detection of cord compression and early intervention is the goal.
Sex:
A SLIGHT male predominance for primary spinal cord tumors.
+
Symptomatic hemangiomas occur most frequently in the thoracic region of teenaged girls.
Age:
> 50 ==> More likely to experience back pain 2o to a metastatic tumor.
==> The incidence of primary spinal cord tumors peaks in people aged 30-50 years.
Certain CNS tumors, such as neuroblastoma, occur almost solely in …?
Pediatric patients.
Clinical syndromes produced by intramedullary tumors vary depending on the age of the individual:
In children ==> Gait disturbances prevail, with pain reported infrequently.
==> Spinal cord neoplasms may manifest as scoliosis or torticollis in younger pts.
==> Pain is the MC early complaint of adult pts with spinal cord neoplasms, followed by the insidious progression of spinal cord dysfunction.
