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Spine Tumors

Our Approach
Being diagnosed with a spine tumor is frightening. But as a patient at City of Hope, you have a highly experienced and dedicated team to treat your tumor. City of Hope is Southern California’s busiest spine tumor program, and our doctors have the experience to help you even when others cannot. Our mission is to treat your spine tumor so that you can continue with the highest quality of life.
 
Our Spine Tumor Team, including surgeons, medical oncologists, radiation oncologists and pain management specialists, creates treatment plans tailored to each patient. Whenever possible, our surgeons use minimally invasive surgical techniques. And our radiation oncologists use state-of-the-art radiation therapy techniques, including Helical TomoTherapy , to deliver highly localized doses of radiation to primary tumors and metastases while sparing as much normal tissue as possible. 
 
Our team is led by two neurosurgeons, Mike Chen , M.D., Ph.D., and Jandial, Rahul M.D., Ph.D. , M.D., Ph.D., who are leading experts in less-invasive spine tumor surgery. These experts, whose writings are featured in books and leading neurosurgical journals, also teach their innovative techniques to other surgeons. You can have added peace of mind knowing that Chen and Jandial will be in the operating room working together to make your surgery safer, faster and better.

City of Hope researchers are conducting clinical trials of innovative therapies to find more effective treatments for patients with spine tumors. We believe the future of tumor treatment involves the merger of science and technology, and we are developing advanced, creative methods that aim to give the upper hand to patients battling spine tumors.

We aim to bring scientific findings into clinical practice as quickly as possible. With our extensive program of clinical trials, patients at City of Hope have access to new treatments that are not yet available elsewhere. 
 
Please look through these tabs and feel free to contact us should you have any additional questions.
 

About Spine Tumors

The spine consists of a bony canal (the back bones) that encloses the spinal cord. Surrounded by protective membranes, the spinal cord is a thick white bundle of nerve tissue that travels from the base of the skull down the back. The spinal cord and the brain make up the central nervous system.
 
Along the length of the spinal cord, 31 pairs of spinal nerves extend through spaces between the vertebrae. They connect with nerves throughout the body, acting as conduits for critical messages between the brain and the entire body.
 
The spine can be affected by many different kinds of tumors. Malignant (cancerous) tumors can arise within the spine itself. Secondary tumors, which are actually much more common, begin as cancers in another part of the body, such as the breast and prostate, and then spread (metastasize) to the spine.

Not all growths are cancerous. But because the spinal cord is enclosed within the rigid, bony spinal column, any abnormal growth can cause problems by compressing the spinal cord and nerves, or compromising the structural integrity of the spine.

Types of Spine Tumors
 
Benign Tumors
Benign (nonmalignant, non-cancerous) spine tumors include:
 
  • Meningiomais a tumor that arises in the meninges, the layers of tissue that cover and protect the brain and spinal cord. Meningiomas compress the nerve tissues near them. Although these are typically slow-growing benign tumors, they can also be malignant and more aggressive. Meningiomas in the spinal cord can cause problems with neurologic function. Meningiomas make up about 25 percent of all spine tumors. 
  • Osteochondromais a slow-growing tumor of the cartilage that typically occurs in the roof of the spine. It usually affects adolescents.
  • Osteoidosteomais a small bone tumor that causes night pain, and can lead to deformation of the spine. It usually affects adolescents.
  • Osteoblastomais a tumor that can be large, aggressive and painful, sometimes causing spine deformity and paralysis. It primarily occurs in children and adolescents.
  • Aneurysmal bone cystscan be large and typically cause pain and swelling. They mainly affect children and adolescents.
  • Giant cell tumoris commonly located at the base of the spine (sacrum). It often arises in children and young adults.
  • Hemangiomais a vascular mass that most often does not cause symptoms and requires no treatment. On rare occasions, hemangiomas can damage the vertebra and cause paralysis (paraparesis). It occurs most often in adults, arising within the vertebral body in the mid to upper (thoracic) spine.
  • Eosinophilic granulomais a tumor in the vertebrae of children and adolescents. In some cases, these are known to heal spontaneously.
  • Lipomais a benign tumor composed of normal fatty tissue located within an otherwise normal spinal cord. It arises most commonly within the thoracic spinal cord, and can cause neurological symptoms by compressing the nerves.
  • Hemangioblastomais a tumor that is usually benign but occasionally malignant. These tumors originate from tissues that make up the blood vessels. Although relatively rare in childhood, hemangioblastomas can occur at any age. In approxmiately 25 percent of cases, these tumors are associated with Von Hippel-Lindau syndrome, an inherited genetic condition. They can also be associated with a cyst in the spinal cord.
 
Malignant Spine Tumors
 
Some of the more common types of malignant spine tumors include:

Glioma
A glioma is a primary brain or spinal cord tumor that arises from glial cells, which are the most common cells in the brain and spinal cord. Their main function is to support and protect the nerve cells (neurons).

Glial cells have three main types: astrocytes, oligodendrocytes and ependymal.
 
While neurons cannot multiply, glial cells have the power to divide and reproduce. Sometimes this process goes out of control, resulting in a tumor called a glioma.

Each type of glial cell creates its own type of glioma. Most gliomas come from abnormal astrocytes, and are called astrocytomas. The other types of gliomas include oligodendrogliomas and ependymomas. Sometimes, a tumor will have a combination of cell types.

Astrocytomas
Astrocytomas are tumors that occur mainly in the neck and upper back areas of the spinal cord. They can range in severity from benign (noncancerous) to malignant (cancerous). These tumors arise from star-shaped cells called astrocytes, a type of glial cell. The glial cells are the most common cells in the brain and spinal cord. Their main function is to support and protect the nerve cells (neurons).
 
Astrocytomas are most common among children and, in fact, are the most common pediatric spinal cord tumor that originates from supporting cells.

Chordoma
Chordomas are rare, slow-growing malignant tumors that typically arise in the spine and the base of the skull. Although chordomas can affect children and adolescents, they most often occur between 40 and 70 years of age. They may spread to other organs, including the lungs.
 
Chordomas develop from tissue that originally gave rise to the spine in the early stages of fetal development. Although this tissue is normally replaced by the spine, small areas can remain which can lead to chordomas.

Ependymoma
Ependymomas are a rare type of glioma that develop from the ependymal cells found within the central canal of the spinal cord. They account for the majority of adult spine tumors and may occur in any part of the spine, and also in the brain.
 
Ependymomas can spread from the brain to the spinal cord via the cerebrospinal fluid that surrounds and protects the brain and spinal cord. About 40 percent of spine canal ependymomas arise within the filum terminale, a neurologically non-functioning structure at the tail end of the spinal cord.

People of all ages can develop these tumors.
 
Nerve sheath tumors
Nerve sheath tumors arise from the cells that surround nerves. They are generally categorized as either schwannomas or neurofibromas.

Nerve sheath tumors account for about 25 percent of intradural spinal cord tumors (located within the membrane surrounding the cord) in adults. Most are single schwannomas that can arise anywhere within the spine canal. With neurofibromas, these are typically associated with a genetic condition called neurofibromatosis, characterized by multiple tumors.
 
Only a small percentage of these intradural spine nerve sheath tumors are malignant.

Metastatic spine tumors
A metastatic or “secondary” spinal cord tumor arises when cancer cells break away from a primary tumor elsewhere in the body and spread to the spinal cord. Metastatic spine tumors are usually extradural in that that they grow outside the dura mater, a tough membranous layer that surrounds the spinal cord. These tumors can create pressure that affects the spinal cord and spine nerves.
 
Spine metastases occur most commonly in people with breast cancer, prostate cancer and multiple myeloma.
 

Symptoms / Diagnosis

Spine Tumor Symptoms
 
Symptoms of a spine tumor may vary depending on which part of the spine is affected. Common symptoms may include:
  • Neck or back pain
  • Numbness or weakness in the limbs
  • Muscle atrophy
  • Spasticity
  • Loss or bowel or bladder function
 

Diagnosing Spine Tumors
 
Several tests may be used to diagnose spine tumors, including:
  • Physical exam and history
  • CT or CAT (computerized axial tomography) scan:  This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • Angiography:  This procedure allows doctors to get a clearer image of the blood vessels by injecting them with a dye that makes the blood vessels stand out on X-ray film.
  • MRI (magnetic resonance imaging):  MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
  • Biopsy:  Tissue samples are examined under the microscope to determine what types of cells are present.
  • Lumbar puncture (spinal tap):  This procedure is used to look for cancer cells in the cerebrospinal fluid. An area in the lower part of the back is numbed and some of the fluid is withdrawn using a needle.
 

Spine Tumor Treatment Options

Treatment of spine tumors at City of Hope is individualized to the patient. Important factors in developing a treatment strategy include the tumor type, location and the patient’s overall health. These determine which options – surgery, radiation, chemotherapy and other experimental therapeutic agents – would be the most beneficial.

Minimally Invasive Surgery
Surgery is commonly used to treat patients with spine tumors. When applicable, our specialists utilize minimally invasive surgery with advanced technologies such as laparoscopy and the da Vinci S Surgical System with robotic capabilities that allows for greater precision. These surgeries feature small incisions. The result is less discomfort and blood loss with faster recovery and fewer complications.
 
One of the following surgical procedures may be used:
 
  • Endoscopic surgery:  Certain brain and spine surgeries may be performed through an endoscope — a thin, lighted tube that requires a small opening and accommodates tiny surgical tools. Smaller openings minimize post-operative discomfort and risk of infection. City of Hope researchers are working to develop a miniaturized surgical system that will allow these surgeries to be even less invasive, with an even lower risk of complications.
  • Spinal cord monitoring:  Used when performing surgery for tumors within the spinal cord, nerve transmission monitoring provides important data that helps doctors preserve important nerve function and sensation.
  • Advanced spine instrumentation:  Spine instrumentation is a method of straightening and stabilizing the spine after spinal fusion surgery by attaching structural elements so that stresses on the bones can be better distributed, keeping them in proper alignment. City of Hope is advancing the field of spine instrumentation by grafting bone matrix materials infused with stems cells topromote natural bone regrowth.
 
Radiation
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells. OurDivision of Radiation Oncologywas the first in the western United States to offer theHelical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to integrate radiation therapy and tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.
 
The TomoTherapy system integrates two types of technology – spiral CT scan ning and intensity modulated radiation therapy, or IMRT, that produces hundreds of pencil beams of radiation (each varying in intensity) that rotate spirally around a tumor. The high-dose region of radiation can be shaped or sculpted to fit the exact shape of each patient’s tumor, resulting in more effective and potentially curative doses to the cancer. This, in turn, reduces damage to normal tissues and offers fewer complications.

TomoTherapy is particularly useful in treating children with certain spine tumors. Because it operates with absolute precision, normal tissue is protected, reducing the risk of long-term cognitive problems.
 
Chemotherapy
Chemotherapy – the use of anticancer medicines – is another strategy used to combat spine tumors. Drugs may be given alone or in combination with surgery and radiation therapy.

Chemotherapy is often given in situations where cancers in other areas of the body have metastasized to the spine. In these cases of secondary cancer, the kind of drugs given are the same that are used to treat the original (primary) tumor.
 
Generally, tumors of the central nervous system are more difficult to treat with drugs than other cancers. This is because they cannot cross the blood-brain barrier, a natural barrier that prevents toxic chemicals from reaching nerve cells. However, new drugs are being developed that can either cross the barrier or be delivered directly to the spinal cord.
 

Spine Tumor Resources

All of our patients have access to the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs.

Additional Resources

National Brain Tumor Foundation
National Comprehensive Cancer Network
American Brain Tumor Association
Pituitary Network Association
The Brain Tumor Society
Acoustic Neuroma Association
The Society for Neuro-oncology
Brain Tumor Foundation for Children
Children's Brain Tumor Foundation
Clinical Trials and Noteworthy Treatment for Brain Tumors
Pediatric Brain Tumor Foundation of the United States

Spine Tumor Research and Clinical Trials

City of Hope has long been a leader in cancer research, driven to bring the latest scientific findings into clinical practice as quickly as possible. With our extensive program of clinical trials, patients here have access to new treatments that are not yet available elsewhere.

New strategies
Unlike drugs that act by chemically destroying cancer cells or halting their growth, new strategies in development at City of Hope are using alternatives such as immunotherapy. This uses the body’s own immune system to attack cancer tissue from within.
 
In one strategy, T cell s, the body’s primary defense against infection, cancer and other diseases, are genetically reprogrammed to fight cancer, grown in large numbers and infused into the body, where they seek out cancer cells and attack them. City of Hope researchers are also testing ways to add cancer-fighting substances to immune T cells, making them even more powerful. Other methods being developed include loading immune cells with microscopic “nanotubes” filled with anticancer substances. As they seek out cancer cells to destroy, the cells deliver their drug therapies directly to the tumor site.

To learn more about our clinical trials program and specifically about trials for spine tumors,  click here .

 

 

Spine Tumor Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Kimberly Wah
Director
Phone: 213-241-7275
Email: kwah@coh.org

 
 
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Led by multidisciplinary teams of volunteers and professionals, the Sheri & Les Biller Patient and Family Resource Center offers an integrated array of cancer support services.
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Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
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