Prompt diagnosis is crucial in treating a spine tumor. Determining whether the tumor is malignant or benign, identifying its source, and finding the total number of lesions will play a part in prognosis.
Patients with no history of cancer will receive a thorough physical exam, usually from their primary care doctor, to investigate the cause of their symptoms (see Symptoms of a Spinal Tumor). The primary care physician will often refer a patient for imaging studies to help identify the source of the pain. Patients with a history of cancer, or in current treatment for cancer, will likely be diagnosed by their oncologists, also after imaging tests.
In addition to X-rays, the most common tests used to identify and diagnose a spinal tumor include:
Magnetic resonance imaging (MRI): An MRI uses magnetic fields and radio-frequency waves to create an image of the spine, and can reveal fine details of the spine, including tumor growth. An MRI scan can show details in the spine that can’t normally be seen on an X-ray. MRIs, which can show the softer tissues, can detect disease tumor earlier than X-rays and CT scans. Sometimes a contrast agent is injected into a vein in the hand or arm during the test, which highlights certain tissues and structures to make tumor identification clearer.
Computerized tomography (CT): This test uses a narrow beam of radiation to produce detailed images of your spine. Like the MRI, sometimes a contrast agent is injected into a vein in the hand or arm during the test, which highlights certain tissues and structures to make tumor identification clearer.
Myelogram: This test uses a dye that is injected directly into the spinal column, and is used in conjunction with an X-ray, MRI, or CT scan.
Biopsy: Once the tumor is located, a biopsy will be taken to determine if the cells are cancerous or benign. A doctor will insert a long, thin needle into the growth to withdraw a few cells, or sometimes the cells are taken during the actual surgery to remove the tumor. The cells are then studied under a microscope and identified as either malignant or benign. If the cells are cancerous, the tumor will be graded 1-4 for its aggressiveness, and the medical team will develop and recommend a treatment plan.
The course of treatment depends on the type and location of the tumor, and should be discussed in detail with your care team. Some treatment options include:
Monitoring: If the tumor has been deemed non-cancerous, and is not growing or spreading, then monitoring may be all that is needed.
Chemotherapy or Radiation Therapy: Chemotherapy is most often used when the cancer occurs in other areas in the body in addition to the spine. Radiation is often used following spine surgery, to ensure that all the cancer cells are eliminated that may not have been possible during surgery. Sometimes radiation is used in place of surgery.
Stereotactic Radiosurgery (SRS): Neurological surgeons can use stereotactic radiosurgery (highly targeted radiation beams from multiple angles) to treat spinal tumors. This technique is a highly effective and minimally invasive treatment. Side effects are usually moderate and limited and the procedure carries a very low risk of infection or other complications that can occur after open surgery. This is a rapidly developing technique, requiring the most highly trained surgeons utilizing the most sophisticated equipment – such as the Gamma Knife, CyberKnife, proton beams, and linear accelerators – and is usually only available in major medical centers (see Doctors Who Treat Spinal Tumors).
Surgery: Removal of the mass via surgery may be the best option to not only remove the growth but also relieve the pressure it’s putting on the spine and nerves. Surgery often occurs in conjunction with radiation therapy. (Read more about Surgery for Spinal Tumors.)
Newest Techniques: Neurosurgeons at the Weill Cornell Brain and Spine Center are pioneering new methods of radiation combined with surgery called brachytherapy with P32 plaques.
Spine tumors are serious and complex lesions, and they should be evaluated by experienced spine surgeons and spinal oncologists at a major medical center. At Weill Cornell, our Spinal Tumor Program provides expert multidisciplinary care for patients with both primary and metastatic spine tumors, as well as access to advanced stereotactic radiosurgery options and new clinical trials.
Reviewed by: Rohan Ramakrishna, M.D.
Last reviewed/last updated: August 2023