Overview

Malignant spinal cord compression (MSCC) occurs when cancer cells grow in, or near to the spine, and press on the spinal cord and nerves. MSCC only occurs in a small number of people

This results in swelling and a reduction in the blood supply to the spinal cord and nerve roots. The symptoms of spinal cord compression are caused by the increasing pressure (compression) on the spinal cord and nerves.

Any type of cancer can spread to the bones of the spine, which can lead to spinal cord compression. It’s more commonly seen in people with cancers of the breast, lung, or prostate, and people who have lymphoma or myeloma.

Symptoms of MSCC

If your doctor has told you that you’re at risk of MSCC, or you think you might be, let your doctor know immediately if you have any of these symptoms:

• Back pain (the first symptom is usually any unexplained back pain, which may be mild to begin with, and which lasts for more than 2 weeks). The pain might feel like a 'band' around the chest or tummy (abdomen), and can sometimes stretch over the lower back, into the buttocks or legs.
• Numbness or 'pins and needles' in toes and fingers, or over the buttocks.
• Feeling unsteady on your feet, having difficulty with walking, or your legs giving way.
• Problems peeing (including difficulty controlling your bladder, peeing very little, and not peeing at all).
• Constipation or problems controlling your bowels.

These symptoms can also be caused by other conditions. It’s very important to let your doctor know if you have any of these symptoms so that they can be investigated.

The treatment is more likely to be effective if  MSCC is diagnosed early.

How MSCC is diagnosed

Tests will be needed before a diagnosis of spinal cord compression can be made. These may include the following.

MRI scan

This type of imaging uses magnetism to build up a detailed picture of areas of your body. During the scan you’ll be asked to lie very still on a couch inside a long tube for about 30 minutes. It’s painless but can be uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you will be given earplugs or headphones.

Some people are given an injection of contrast dye into a vein in their arm to help the doctors see the bones better, but this usually does not cause any discomfort.

CT scan

A CT scan takes a series of X-rays to build up a 3D picture of the inside of your body. The scan is painless and takes 10 to 30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you, and will not harm anyone you come into contact with. You’ll be asked to not eat or drink for at least 4 hours before the scan. A CT scan might be done to find exactly where the tumour is, or to check if the cancer has spread.

Most people who have a CT scan are given a drink or injection to allow areas to be seen more clearly. This may make you feel hot all over. Before having the injection or drink, it’s important to tell the person doing this test if you are allergic to iodine or have asthma.

Bone scan

This scan does not diagnose MSCC but might be done to check if there are any abnormal areas inside the bone.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what the treatment involves and agree to have it.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Treatment

Treatment should be started as soon as possible after diagnosis. This is to prevent permanent damage to the spinal cord, which can result in paralysis (not being able to move some or all of your body).

The choice of treatment depends on several factors, including the type of cancer, the area of the spine affected, and your general health. The most common treatment is radiotherapy, although surgery and chemotherapy are also sometimes used.

The aim of treatment is to shrink the tumour and to relieve pressure on your nerves. You can choose to not have the treatment, and the staff will explain what might happen if you do this. You do not have to give a reason for not wanting the treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Treatment usually involves a combination of the following therapies.

Bedrest

Your doctor will usually advise complete bedrest, and at first you might need to lie flat on your back. This is to prevent any further damage to your spinal cord being caused by unnecessary movement. During, and after treatment, you’ll have frequent physical examinations by your doctor. This involves a detailed check of your nervous system (examining your range of movement, reflexes and sensation to touch). This helps the doctor to see any improvement in your symptoms, as well as to decide when it’s safe for you to start getting up.

Steroids

High doses of a steroid called dexamethasone are usually started immediately if spinal cord compression is suspected. The steroids help to reduce pressure and swelling around the spinal cord, and can quickly relieve symptoms, such as pain. They’re gradually reduced over time, depending on the improvement of your symptoms, and after starting other treatments, such as radiotherapy and surgery.

Radiotherapy

Radiotherapy is the use of high-energy rays of radiation to destroy the cancer cells, and is the most common way to treat spinal cord compression. It’s usually used on its own, or sometimes with other treatments, such as surgery. It’s given by directing radiotherapy at the tumour from outside the body. This is known as external radiotherapy. Radiotherapy is given as a short course of treatment, usually between 1 and 7  days. It might be given for up to 4 weeks for myeloma and lymphoma. Radiotherapy will be started as soon as possible after MSCC is diagnosed.

Surgery

Only a small number of people will need to have an operation to treat their spinal cord compression. This will depend upon several factors, including the type of tumour, where it’s situated, and how unstable the spine is.

The aim of surgery is to remove as much of the tumour as possible and relieve pressure within the spinal canal.

Surgery might involve removing several parts of the bones that make up the spine (vertebrae), and as much of the tumour as possible, without weakening the spine. The common surgeries for this are anterior stabilisation and debulking of tumour, and decompression laminectomy. This surgery may also involve making the spine more stable by using metal rods or bone grafts. Your doctor or nurse will explain the surgery if it’s appropriate for you.

Radiotherapy is sometimes given after surgery to treat any remaining tumour that cannot be removed surgically, or if the tumour comes back after treatment.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) medicine to destroy cancer cells. It’s occasionally used to treat spinal cord compression. It may be used for tumours that are sensitive to chemotherapy, such as lymphoma or small-cell lung cancer.

Chemotherapy and hormone therapy can also be used after radiotherapy or surgery for certain cancers, such as breast and prostate.

Managing your symptoms

Pain control

If you are in pain, your doctor or nurse will discuss with you ways of controlling this. You might be given different medicines to help, and these will be assessed regularly to make sure they are effective.

Bladder symptoms

Your doctor and nurse will monitor how well your bladder’s working. If you’re having problems peeing, a thin flexible tube (catheter) might be used to help drain your bladder.

Bowel symptoms

You might be given medicine to help with constipation, or if you're having difficulty controlling your bowels.

After treatment has finished

Spinal cord compression affects everyone differently. The care you need after treatment will depend on the result of treatment, and your ability to walk with or without help.

Some people who have lost the ability to walk, or lost movement before treatment, may not get this back. If this happens, treatment would usually be followed by a period of rehabilitation and care.

This will involve a rehabilitation team of healthcare professionals, including a doctor, nurse, physiotherapist, occupational therapist and social worker. They’ll work closely with you and your family to organise a plan of care and rehabilitation to suit your needs.

Your further care might be at your cancer centre or your local hospital. The rehabilitation team will monitor your progress and help you to become as independent as possible.

Before you leave hospital, the staff should organise any care you will need while at home. This might include nursing care and physiotherapy. Adaptations to your home, to make things easier for you, such as ramps or wider door frames to allow wheelchair access, can also often be arranged. Any equipment you may need, such as wheelchairs, special mattresses or lifting aids, will also be supplied.

Support and more information

Macmillan Cancer Support have a freephone helpline, phone 0808 808 000, Monday to Sunday, 8am to 8pm. The number is free from these mobile phone networks: 3, O2, Orange, T-Mobile, Virgin and Vodafone when calls are made from the UK. Online chat options, and a lot of information can also be found at www.macmillan.org.uk