Early diagnosis and treatment of spinal cancer is essential to care. To better understand what spinal cancer is, who is at risk, and how spinal cancer is diagnosed and treated, SpineUniverse spoke with Ali A. Baaj, MD, Spinal Neurosurgeon and Assistant Professor of Neurological Surgery at Weill Cornell Medical College, Cornell University, in New York, NY. Dr. Baaj also serves on the SpineUniverse Editorial Board.

Q: What types of spinal cancer are there?
Dr. Baaj: There are two main types of spinal cancer: 1) primary tumors of the spinal vertebra (bones of the spine), nerve sheath (the protective lining that covers the nerves), or spinal cord; and 2) metastatic tumors in the spine that spread from another part of the body (primary location) like lung or breast cancer. There also is a third type of spinal cancer that is related to disorders of the blood and bone marrow (example: multiple myeloma).

Metastatic tumors are by far the most common type of spinal cancer, with lung, breast, and prostate cancer being the primary sources of cancer in most cases. In metastatic tumors, cancer cells travel from the original site through the blood or lymph system and form new tumors in another part of the body.

Metastatic cancers are more serious than primary cancers due to the aggressive nature of spread throughout the body. Cancer can develop in any part of the spine from the cervical (neck) spine all the way down to the sacrum (triangular bone at the bottom of your spine) and ilium (hip bones). Tumors may develop within the bone of the spine but also within the spinal canal.

Q: What are the risk factors for spinal cancer?
Dr. Baaj: Smoking is the main culprit that leads to lung cancer and eventually metastatic cancer to the spine. In addition, there is a genetic predisposition to some cancers, like breast cancer, that may spread to the spine. 

Metastatic cancer to the spine is often due to delayed detection or lack of treatment of the primary source. Thus, screening for detectible types of cancer—like breast and prostate cancer—is essential for early detection and treatment.

Q: Can spinal cancer cause deformity?
Dr. Baaj: Definitely. Cancer cells weaken the bone and structural integrity of the spine.  This causes pathological fractures, or collapse of the vertebrae, leading to pain and deformity. Deformity can happen at one or multiple contiguous vertebrae levels.

Q: What are the primary symptoms of spinal cancer?
Dr. Baaj: Back pain is the primary symptom of spinal cancer, especially when a person has back pain at rest. Other warning signs of spinal cancer may include back pain spreading to the arms or legs, difficulty walking, loss of bowel or bladder control, numbness or weakness in the arms or legs, spinal deformities or constant new spinal pain in a patient with known history of cancer. 

Q: One of your areas of specialization is spinal oncology. Is that a subset of spinal surgery?
Dr. Baaj: Spinal oncology surgery is a subspeciality within spinal surgery. It focuses on the surgical treatment of primary and metastatic spine tumors. Spinal surgery, in turn, is a specialty within neurosurgery and orthopaedic surgery. 

Q: How do spine surgeons help patients with cancer of the spine?
Dr. Baaj: Patients with cancer of the spine present with tumors either within the bones of the spine (the vertebrae), within the dura (thick membrane) that covers the spinal cord, or in between these spaces. Spine surgeons have the expertise to safely remove tumors and stabilize the spine when necessary.

Q: What can patients with spinal cancer expect during a first visit with an oncologist?
Dr. Baaj: An oncologist typically makes the diagnosis of spinal cancer using physical exam, blood tests, and imaging (such as an MRI and CT scans). A biopsy (small sample of cells taken from the tumor) may be necessary to confirm the diagnosis.

After cancer is diagnosed, an oncologist performs a number of examinations (called a workup). The main parts of the workup include identifying the tumor type, tumor staging (how big the tumor is, whether cancer cells have spread in the body, and where it has spread), and if the patient has any neurological or physical deficits.

The next step is to devise a treatment plan, which may involve surgical and nonsurgical treatments. The treatment may include chemotherapy, radiation, surgery, or any combination of these three. Treatment decisions are driven by the type of cancer the patient has and what treatment that type of cancer typically respond to best.

Patients with acute or progressive neurological deficits such as weakness in the arms or legs may need more urgent treatment or referral to a spine specialist. In addition, surgery may be needed sooner if a tumor does not respond to chemotherapy or radiation therapy.

Q: What should a patient expect when visiting a spinal oncologist?
The spinal oncology surgeon should be able to discuss the diagnosis, surgical plan, and prognosis with the patient. This is often done in collaboration with a multidisciplinary team from medical and radiation oncology services. 

Q:  What advice do you have for patients with spinal cancer?
Dr. Baaj: Cancers of the spine are typically aggressive, even if they are benign. I favor prompt evaluation by an oncology specialist so treatment can be initiated as soon as possible. Some primary tumors can be cured with complete and total surgical resection (removal of the tumor) and others can be contained (grow slowly and not spread) for many years. The important thing is to tackle these conditions head on and ensure there is a good support system to help the patient during the treatment phase.

To learn about Dr. Baaj’s practice, click here.