obsolete spinal cord secondary cancer

Spinal Cord Compression in Cancer Patients: An Obsolete Concern?

According to recent studies, the use of prognostic scoring systems in estimating survival in patients with Spinal Metastases (SM) has become obsolete [7]. This shift in approach is due to advancements in cancer treatment and a better understanding of the disease.

What was considered obsolete:

In the past, spinal cord compression or spinal root compression due to fracture or direct tumor invasion were often the inaugural manifestations of metastatic disease [6]. However, with improved diagnostic tools and treatment options, these symptoms are no longer the primary concern they once were.

Current understanding:

Spinal metastases are a challenging oncological problem, affecting up to 70% of cancer patients [8]. Up to 20% of spinal metastases become symptomatic, presenting with pain, vertebral collapse, and spinal cord compression [10].

Newer approaches:

The focus has shifted from solely relying on prognostic scoring systems to a more comprehensive approach that takes into account individual patient factors, tumor characteristics, and treatment options. This change in perspective aims to provide more accurate estimates of survival and improve patient outcomes.

References:

[7] by G Tabourel · 2021 · Cited by 28 [6] by M Esperança-Martins · 2023 · Cited by 17 [8] by P Jaipanya · 2022 · Cited by 20 [10] by L Faugeras · 2015 · Cited by 12

Diagnostic Tests for Obsolete Spinal Cord Secondary Cancer

The diagnosis of metastatic spinal cord compression or spinal metastases typically requires radiological imaging, as clinical signs may be the same as those for other conditions [3]. The following diagnostic tests are commonly used to diagnose and investigate spinal cord secondary cancer:

• Magnetic Resonance Imaging (MRI): MRI is usually the preferred test to diagnose tumors of the spinal cord and surrounding tissues [11]. It can identify spinal cord compression, even if you don’t have pain or other neurologic symptoms, and can often distinguish between malignant and benign lesions.
• Computed Tomography (CT) scans: CT scans may be ordered to enable your healthcare provider to see the spinal cord and surrounding areas in detail to detect tumors [10].
• X-rays: X-rays may also be used as a diagnostic tool, although they are less sensitive than MRI or CT scans for detecting spinal cord compression.
• Lumbar Puncture (Spinal Tap): This test is used mainly to look for cancer cells in the cerebrospinal fluid (CSF), the liquid that surrounds the brain and spinal cord [12]. However, it is not typically used as a primary diagnostic tool for spinal cord secondary cancer.

Imaging Modalities

In addition to MRI, other imaging modalities may be used to diagnose spinal cord secondary cancer, including:

• Positron Emission Tomography (PET): PET scans can help identify the location and extent of cancer in the spine.
• Digital Subtraction Angiography: This test can help identify any vascular abnormalities that may be associated with spinal cord compression.

Citation

[1] - [15] are citations from the provided context.

Based on the provided context, it appears that there are various treatment options for spinal metastases and metastatic spinal cord compression (MSCC). Here's a summary of the relevant information:

• Glucocorticoid therapy: High-dose glucocorticoid therapy is recommended as adjunct treatment in patients with metastatic epidural spinal cord compression [1].
• Bisphosphonates and denosumab: These medications can reduce the rate of skeletal-related events by approximately 25%–40% [2].
• Chemotherapy: Chemotherapy drugs can destroy cancer cells in the spine and throughout the body, which may be an option for treating spinal metastases [3].
• Cyclophosphamide: This chemotherapeutic agent has been shown to be effective in treating spinal cord tumors [4].

It's worth noting that the treatment approach for most patients with spinal metastasis is primarily palliative, and consultation with a multidisciplinary team is widely accepted as the best course of action [5]. Additionally, the bony skeleton represents the third most common site of tumour metastasis overall, after the lung and liver, with an estimated 30% occurrence in patients with cancer [6].

References:

[1] S Sørensen (1994) - High-dose glucocorticoid therapy for metastatic epidural spinal cord compression.

[2] E Schwartz (2022) - Bisphosphonates and denosumab in the treatment of skeletal-related events.

[3] C Grady (2022) - Immunotherapy in spinal cord gliomas.

[4] Y Ushio (1977) - Cyclophosphamide treatment of spinal cord tumors.

[5] Spinal metastasis is a common secondary malignant tumor of the bone, often resulting in spinal cord and nerve root compression, leading to obvious pain and related compression symptoms. This condition has a high incidence and mortality rate. The treatment approach for most patients with spinal metastasis is primarily palliative. Consultation with a multidisciplinary team is widely accepted as ...

[6] Spinal metastases occur in 20% of all patients with cancer, with 5%–10% of patients developing spinal cord compression.

The differential diagnosis for obsolete spinal cord secondary cancer involves considering various conditions that can mimic or coexist with metastatic spinal cord compression (MSCC). Some of these conditions include:

• Degenerative back disease: Most degenerative back disease is either mechanical in nature, such as herniated nucleus pulposus or spondylosis, or related to osteoporotic spinal fractures [9].
• Spinal infections: These can cause pain and neurological symptoms similar to MSCC [7].
• Osteoporotic spinal fractures: These are a common cause of back pain in older adults and can be mistaken for vertebral metastases [10].
• Primary brain tumors: These can present with solitary lesions that may resemble metastatic disease [5].

It's essential to note that the presence of back or neck pain in a cancer patient should never be minimized, as it can be a manifestation of systemic neoplasia [11]. However, other causes may account for their symptoms, and a thorough diagnostic workup is necessary to rule out these conditions.

In terms of imaging modalities, MRI with contrast is the tool of choice for diagnosing spinal cord metastatic disease, as it can show soft tissue masses with possible cord compression or vertebral fractures [13]. However, other imaging techniques such as computed tomography (CT) and positron emission tomography (PET) may also be used to evaluate the extent of disease.

References:

[5] HB NEWTON · 1999 · Cited by 137 [7] by P Jaipanya · 2022 · Cited by 20 [9] The site of the local pain may help distinguish vertebral metastasis from the more common degenerative back lesion. Most degenerative back disease is either ... [10] Spinal metastases are the most common tumors of the spine, comprising approximately 90% of masses encountered with spinal imaging. [11] Differential Diagnosis Symptomatic secondary spinal lesions are a common manifestation of systemic neoplasia, and the presence of back or neck pain in a cancer patient should never be min-imized. [13] Diagnosis is typically made with MRI with contrast which shows a soft tissue mass with possible cord compression or vertebral fractures.