Diagnosing & Staging of Spine & Spinal Cord Tumors

Printer-friendly version

Because early detection and treatment is key, it’s important that you see a doctor if you notice symptoms that could be caused by a tumor. While many of these symptoms could indicate another health issue, only an experienced doctor can make that determination through additional testing.

Tests utilized by the spine and spinal cord tumor specialists at the Florida Hospital Brain and Spinal Cancer Program include:

• Physical exam and history: The first stage is a basic physical examination. The doctor will check your overall health and look for signs of a spine or spinal cord tumor. The doctor will also ask you detailed questions about your overall health, lifestyle habits, exposure to any risk factors and family history to see if there is a reason you are experiencing these symptoms.
• Neurological Exam: Since spine or spinal cord tumors can affect a wide range of issues, from walking and standing to motor skills, your doctor may conduct a neurological exam. This includes a series of questions and tests to see how your brain, spinal cord and nerves are functioning. Tests include mental awareness, basic coordination, the ability to walk and stand, and assessments of your muscles, senses and reflexes. 
• MRI (Magnetic Resonance Imaging): To get a detailed look at the spine and spinal cord, Magnetic Resonance Imaging (MRI) may be conducted. The MRI uses magnetism and radio waves to generate computer images of the spinal cord. To get added detail of any cancers present, the radiologist may have gadolinium injected into the vein. This substance makes cancer cells appear brighter in the imaging, making it easier to confirm the presence and location of spinal tumors.
• CT Scan: To acquire additional imaging of the spine, technicians may perform a CT scan, or CAT scan as it is sometimes known. After a dye is swallowed or injected to help the region show up more clearly, three-dimensional images are created using computerized x-rays. 
• Myelogram: If an MRI or conventional CT does not yield enough data, a myelogram may be ordered. A contrast dye is first injected directly into the spinal column. This dye moves through the spinal cord and spinal nerves, appearing as white on an x-ray or CT scan. It is often effective in identifying compressed nerves.
• PET Scan (Positron Emission Tomography Scan): A PET scan is highly effective in locating malignant tumor cells in the region. To increase the accuracy of the scan, radioactive glucose is injected into a vein. Cancerous tumor cells consume more energy than noncancerous cells, so the areas show up as bright spots on the PET scanner’s imaging. 
• SPECT Scan (Single Proton Emission Computed Tomography Scan): With its special camera connected to a computer, SPECT scans can make highly detailed images in three dimensions. To enhance the imaging, a radioactive substance is added to your bloodstream. Areas with increased blood flow and more chemical reactions show where cancer could be growing.
• Angiogram: Used to find abnormalities of blood vessels supplying the spine, a spinal angiogram requires several rounds of imaging to complete, each needing multiple injections through a catheter that has been fed into the spinal arteries.

If initial tests detect an area of interest, a biopsy may be required. This is the only way to determine the type and growth rate of the spine or spinal cord tumor. Depending on the tumor’s location and the patient’s health, the biopsy will be conducted one of two ways. The preferred method is a needle biopsy that uses image guidance technology to direct the needle into the tumor area of the spine. Tumor specimens can also be obtained using open surgery, which is far more complex with associated increased risks.

Once the tissue sample is retrieved, it will be analyzed under a microscope by a highly trained pathologist who will grade the tumor based on its type and extent, or aggressiveness.

Grading Spine and Spinal Cord Tumors

The World Health Organization approved today’s generally accepted spinal tumor grading system in 1993. Tumors may be classified as low-grade (slowly growing) or high-grade (rapidly growing), change grades as they progress, or become a different type of tumor altogether.  Spine and spinal cord tumors are not “staged” as most people think of today.

Grade I -  grows slowly and generally does not spread to other parts of the brain.  It is often possible to surgically remove an entire grade I benign tumor, but this type of tumor may be monitored periodically, without further treatment.

Grade II - grows slowly, sometimes into surrounding tissue, and can become a higher-grade tumor.  Treatment varies according to tumor location and may require chemotherapy, radiation, or surgery followed by close observation.

Grade III - considered malignant and can spread quickly into other tissue.  Tumor cells will look different than those in surrounding tissue.  Aggressive treatment, often using a combination of chemotherapy, radiation, and/or surgery, is required.

Grade IV - invade nearby tissue very quickly and are difficult to treat.  The cancerous tissue will look very different from surrounding tissue.  Aggressive treatment is required.