Info
A. Characteristics
- Fairly common oncologic emergency
- Most often seen with metastatic disease
- Tumors that metastasize to bone
- Lymphomas may impinge through foramen in spinal column
- Occurrence in adults
- Lung
- Breast
- Prostate
- Ovarian
- Colon
- Lymphoma
- Occurrence in children
- Sarcoma
- Neuroblastoma
- Lymphoma
- Other causes of SCC
- Infection
- Hematoma
- Traumatic myelopathy: disk herniation, ligament rupture, hematoma
- Occurs in about 1 in 13,000 US cancer patients annually
B. Symptoms
- Pain: 85-95% on presentation; >95% on diagnosis (almost always back pain)
- Weakness: 5% on presentation; 75% on diagnosis
- Sensory Abnormalities
- Rare on presentation
- Following diagnosis, ~50% of cases show sensory abnormalities
- Autonomic Dysfunction
- Almost never on presentation; 57% on diagnosis
- Urinary and/or Fecal Incontinence
C. Diagnosis [2]
- SCC is a neurologic / oncologic emergency
- Magnetic resonance imaging (MRI)
- Best tool for evaluation of suspected SCC
- For nontraumatic cases, entire spinal cord should be visualized without contrast
- Contrast enhanced MRI scanning should be carried out if no lesion is found initially
- if clinical concern is high, then glucocorticoids should be given prior to MRI evaluation
- For traumatic cases, computerized tomographic (CT) scan should also be done
D. Treatment [3]
- High dose Glucocorticoid Therapy
- Initial therapy of choice in progressive cases
- Dexamethasone 10-100mg IV followed by 6-24 mg orally qid
- Taper over 10 days
- Usually for patients with impaired spinal cord function or high grade radiologic lesions
- Higher doses are probably preferred to maintain spinal function
- However, higher doses are not well tolerated
- if clinical concern is high, then glucocorticoids should be given prior to MRI evaluation
- Surgical Decompression
- Advocated for all radioresistant cancers
- Surgery with postoperative radiation was superior to radiation alone for all-comers with spinal cord compression [4]
- Therefore, combination surgery+postoperative radiation should be considered in all cases
- Radiation Therapy
- Indicated for prostate or breast cancers, myeloma or lymphoma
- Other tumors may be radioresistant
- Pain Management is critical, along with initial glucocorticoids
- Supportive Care
- Rehabilition improves both impaired function and associated depression
- Patients often depressed, and this should also be treated aggressively
References
- Abrahm JL, Banffy MB, Harris MB. 2008. 299(8):937
- Quint DJ. 2000. JAMA. 283(7):853
- Abrahm JL et al. 1999. Ann Intern Med. 131(1):37
- Patchell RA, Tibbs PA, Regine WF, et al. 2005. 366(9486):643