Anyone who is diagnosed with cancer feels a great deal of fear and shock. However, it is even more difficult to find out that the cancer has spread to other parts of the body while undergoing treatment. Today we are going to talk about such a situation. That is, when a cancer that is in another part of the body spreads to the spine. In medicine, we call this `Spinal Metastasis`.
Simply put, what is spinal metastasis?
Imagine someone has breast cancer, lung cancer, or any other cancer. Sometimes, some cells from that cancer break away, travel through our bloodstream, and reach the spinal cord (the part we call the spine) and start growing there. That's what we call `Spinal Metastasis` or secondary cancer in the spine.
The important thing is that this is not a new cancer that has developed in the spine. What happens in this case is that the cells from the original cancer (for example, breast cancer) have also spread to the spine. Therefore, when treating, the treatment is related to that original cancer.
This condition is a fairly common complication among cancer patients. Most often, these cancer cells spread to the vertebrae in the middle part of the spine (thoracic spine) and the lower part of the spine (lumbar spine). Sometimes, the cancer can even spread to the spinal cord in this way.
How do you recognize the symptoms of this?
The symptoms of cancer that spread to the spine can vary depending on where the cancer is located (i.e., in the spine or spinal cord). Let's take a look at the main symptoms that you may experience.
| Symptom | How does it feel and why? |
|---|---|
| Back or neck pain | This is the most common symptom. Cancer damages the bones of the spine. This can cause a dull ache or a sharp, stabbing pain. This pain can be worse at night. |
| Change in the shape of the spine | Cancer can change the natural shape of the spine, causing it to become hunched over or arched. |
| Numbness, weakness, or a tingling sensation | When the cancer presses on the spinal cord, it presses on the nerves that run to the arms and legs. This can cause numbness and a feeling of loss of consciousness in the arms and legs. Sometimes, you may even feel pins-and-needles in the chest. |
| Difficulty controlling urine and stool | The function of our bladder and bowels is also controlled by the spinal cord. So if a tumor presses on the spinal cord, you may experience urinary incontinence or fecal incontinence without even realizing it. |
| Paralysis | This is a very serious condition. If the nerves in the spinal cord are severely damaged by cancer, messages from the brain do not reach the rest of the body. This can lead to loss of sensation in the limbs and paralysis. |
Why does this happen? What cancers are most likely to spread to the spine?
As we mentioned earlier, this is when cells from the original cancer travel through the bloodstream and reach the spine. While any cancer can spread this way, it is most common with certain types of cancer. Here are the types of cancer most commonly found:
- Breast cancer
- Lung cancer
- Prostate cancer
- Kidney cancer
- Colorectal and other gastrointestinal cancers
- Thyroid cancer
How does the doctor diagnose this? (Diagnosis)
If you have cancer and you have symptoms like back pain, the first thing your doctor will do is examine you carefully. They will check your balance and how strong your arms and legs are. They will ask about the pain. That is, what kind of pain is it, when does it come on, and whether it is constant or not.
Then, they will ask about your medical history and recommend several tests to confirm this condition.
- Blood tests: When bones break down due to cancer, chemicals like calcium and alkaline phosphatase from those bones get into the blood. So tests are done to see if there are too many of these things in the blood.
- Imaging tests: An MRI scan can show the spinal cord, nerves, and spine very clearly. A CT scan can detect problems with the bones of the spine (vertebrae). Even a regular X-ray can show abnormal growths in the spine.
- Bone scan: This can detect any abnormalities in the spine, which could be where the cancer has spread.
- Fine needle aspiration / Biopsy: Sometimes, a very small sample of a tumor or bone in the spine is taken for testing. This can help determine exactly what type of cancer has spread to the spine.
What are the treatments for this?
The first thing we need to understand is that spinal metastasis is an advanced stage of cancer. This means that it is difficult to completely cure. However, the main goals of current treatments are to control pain, maintain as much spinal function as possible, and slow the growth of the cancer.
The treatment you receive will depend on several factors.
- Type of original cancer: For example, if lung cancer spreads to the spine, the spine also contains lung cancer cells. Therefore, the treatment is most effective for lung cancer.
- Your overall health: The cancer may have spread not only to your spine, but also to other parts of your body (such as your brain or liver). All of these factors will be taken into account when deciding on treatment.
- Where the cancer is: Treatment may vary depending on whether the cancer is in the bones of the spine or the spinal cord.
The main treatment methods used are:
- Chemotherapy: This involves giving the body drugs that kill cancer cells. These can be taken as pills or given as an injection into a vein. Because these drugs travel throughout the body, they can help kill cancer cells in the spine as well as cancer cells in other parts of the body.
- Radiation therapy: This uses high-energy X-rays to either destroy cancer cells or shrink tumors. This can provide great relief from pain.
- Stereotactic radiosurgery: This is not surgery. It is a very precise, targeted method of delivering radiation beams only to the cancerous tumor. This causes very little damage to the surrounding healthy tissue.
- Surgery: Surgery is usually only done if other treatments have not been successful. Sometimes, if there are compression fractures, minor surgeries like `Vertebroplasty` or `Kyphoplasty` can be performed to strengthen the bones and reduce pain.
- Palliative care: This is a very important area of treatment. The primary goal of this is not to cure the disease, but to improve the patient's quality of life. It involves controlling pain, managing the side effects of treatment, and helping them cope with the condition.
Are there any side effects to these treatments?
Yes, like any treatment, there can be side effects.
- During chemotherapy and radiation treatments, things like fatigue, hair loss, nausea, and vomiting are common.
- During stereotactic radiosurgery: You may feel mainly tired.
- During Kyphoplasty or Vertebroplasty surgeries: Infection, bleeding, increased pain, and numbness may occur very rarely.
Never be afraid to talk to your doctor about any side effects you experience. There are treatments for those too.
How can you take care of yourself?
During these difficult times, it is very important to take good care of yourself as well as seek treatment.
- Eat well: Cancer and its treatments can cause loss of appetite. But try to eat a well-balanced diet to get the energy your body needs. If you have difficulty eating, seek advice from a nutritionist.
- Consider your mental health: It's common to experience depression or anxiety with this type of situation. If you're struggling, talking to a mental health counselor can be a great relief.
- Manage stress: Things like meditation and breathing exercises can help reduce stress.
- Ask your doctor questions: Talk openly with your doctor about your condition, treatment, side effects, and pain management. Ask them about any fears or concerns you may have.
What are the situations that require urgent attention?
You should be very careful about these symptoms. If any of these symptoms appear , you should immediately go to the Emergency Department (ETU) of a hospital.
| Opportunity | What to do |
|---|---|
| If the pain cannot be controlled with the painkillers prescribed by the doctor. | Call your doctor. |
| If you experience sudden, sharp, unbearable back or neck pain (this could be a sign of a fracture). | Call your doctor. |
| Go to the Emergency Treatment Unit (ETU) immediately! | |
| If your legs and stomach feel numb. | Go to a hospital immediately. |
| If it is difficult to move your legs, if they feel lifeless. | Go to a hospital immediately. |
| If you are unable to control your urine or stool. | Go to a hospital immediately. |
| If you are unable to urinate. | Go to a hospital immediately. |
It's normal to feel overwhelmed, scared, angry, and uncertain about the future when you receive a diagnosis like this. Your medical team understands all of these feelings. So share your thoughts and concerns with them. They are always ready to help you.
Take-Home Message
- Spinal metastasis is not a new cancer, but the spread of cancer from elsewhere in the body to the spine.
- If you have cancer, never ignore unusual, severe pain in your back or neck. Tell your doctor right away.
- Although this condition cannot be completely cured, there are many very effective treatments that can help you manage pain and improve your quality of life.
- If symptoms such as leg numbness or loss of bladder/bowel control occur, it should be considered an emergency and you should immediately go to a hospital's Emergency Treatment Unit (ETU).
- It is very important to talk openly and honestly with your doctor about your condition, treatment options, and your fears.
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