Spinal Tumors

Stock photo of hands holding a tablet that is displaying a spine X-ray image

At the OHSU Brain Institute, we provide complete care for people with spinal cord tumors. We work with you to create a treatment plan that is right for you. We offer:

  • Expertise in treating spine and spinal cord tumors, which are rare.
  • A team approach, combining the expertise of many specialists. Our team meets weekly to discuss next steps in your care.
  • Patient-centered care, with experts who take time to get to know you and your loved ones. We work with you to plan treatment that meets your needs, wishes and values.

Understanding spinal tumors

What are spinal tumors?

Anatomy of the spinal cord. Medical Illustration Copyright © 2020 Nucleus Medical Media. All rights reserved.
Medical Illustration Copyright © 2020 Nucleus Medical Media. All rights reserved.

The spinal cord and brain make up the central nervous system, responsible for thinking, movement and sensation. A tumor happens when cells grow out of control, and form a mass on the spine or spinal cord. Tumors can form on any part of the spine, from the neck to the lower back.

Benign versus malignant: A spinal tumor can be benign (not cancer) or malignant (cancer). Both need treatment to avoid nerve damage.

Primary versus secondary or metastatic: A primary tumor starts on the spine. A secondary, or metastatic, tumor spreads from cancer elsewhere in the body. Metastatic spinal tumors most often spread from cancer in the lungs, breasts, prostate, kidneys or thyroid.

Who gets spinal tumors?

Primary spinal tumors are rare, and doctors usually do not know what causes them. According to the American Association of Neurological Surgeons, about 10,000 Americans develop a spinal tumor each year. Only about 30% are primary tumors.

  • Meningiomas, tumors in the tissue covering the spinal cord, and benign tumors called neurofibromas are the most common primary spinal tumors.
  • Meningiomas most often occur in women ages 40 to 70.

The few risk factors linked to primary spinal tumors include:

  • Radiation exposure: Most often, a patient had radiation therapy for a different condition.
  • Family history: People with neurofibromatosis type 2 or Von Hippel-Lindau syndrome may have higher risk.
  • Age: Spinal tumors can affect anyone, but they are more common in young and middle-aged adults.

Survival rates

Survival rates vary widely depending on the tumor type and your age. For example, 87% of patients ages 20 to 44 live at least five years after a meningioma diagnosis. The rate is 71% for patients ages 55 to 64.

Survival rates are averages, and can’t predict the outcome for any one person.

Symptoms of spinal cord tumors

Symptoms are similar to those of many other conditions. A team that specializes in spinal tumors can make an accurate diagnosis. Symptoms may differ from person to person but can include:

  • Neck pain
  • Worsening back pain, even with treatment, especially in the lower back
  • Muscle weakness or loss of feeling in the legs, arms or chest
  • Loss of bladder or bowel control
  • Paralysis
  • Scoliosis (curved spine)
  • Difficulty walking
  • Muscle contractions or twitches

Diagnosing spinal tumors

Most of our patients already have a diagnosis. Our team will do more tests, including surgery in some cases, to verify the diagnosis.

Tests may include:

  • Lumbar puncture: We use this test, also called a spinal tap, to look for cancer cells. If they are found, it means cancer spread from elsewhere in your body. To do the test, we numb your lower spine. We insert a needle between your spine bones and remove some of your cerebrospinal fluid. This is the clear liquid that cushions your brain and spinal cord.
  • Myelogram: This spinal X-ray uses a special injected dye to create detailed pictures of your spine bones and the spaces between them.
  • A spine CT or MRI: These tests create high-resolution images of your spinal cord so we can look for problems.
  • Needle biopsy: We use an operative microscope and advanced spinal cord monitoring to remove a small piece of tumor so we can analyze it. This helps us identify the tumor type and the best treatment plan.

Types of spinal tumors

There are two categories of primary spinal tumors, intramedullary and extramedullary.

Intramedullary tumors

These begin in the spine, usually in the neck. Types include:

  • Gliomas: These start in glial cells, which surround and support neurons. Neurons are the nerve cells that send signals throughout the body. Types of gliomas include:
    • Astrocytomas start in the cells that control movement, posture and balance.
    • Ependymomas develop in the cells that line the brain’s fluid-filled cavities and the center of the spinal cord.

Extramedullary tumors

These grow in the cells that surround the spinal cord or in the nerve roots that grow from the spinal cord. Types include:

  • Meningiomas: These begin in the meninges, tissues that cover the brain and spinal cord.
  • Nerve sheath tumors: These grow on nerves throughout the body. The nerve sheath is made up of myelin, which protects nerve fibers and helps them send signals. The cells that create myelin can grow rapidly and form a tumor. Common types are:
    • Schwannomas, which are usually benign. Types include vestibular schwannomas and acoustic neuromas, which form on the nerve that helps with hearing and balance.
    • Neurofibromas, associated with an inherited condition called neurofibromatosis type 1, or NF1.

Staging

Spinal tumors typically do not spread outside the central nervous system, so doctors don’t use the traditional cancer staging system. Other factors help guide treatment, such as: 

  • Age: Younger people often have better outcomes than older adults.
  • Impact: How much your daily functions are affected.
  • Tumor features: Your team considers the tumor type, location and size.
  • Genetic factors: The tumor’s genetic traits may offer treatment options.
  • Localization: Some tumors are in one site, while others have spread.

Grading

Doctors grade spinal tumors on a scale of one to four. The lower the grade, the less aggressive the tumor and the easier it is to treat. Tumors graded I or II are often benign. Tumors graded III and IV are often malignant. Here’s how the World Health Organization defines grades:

  • Grade I: Slow-growing. Cells look almost normal. Associated with long-term survival. Rare in adults.
  • Grade II: Relatively slow-growing. Cells look slightly abnormal. Can spread to nearby normal tissue and recur, sometimes returning as a higher-grade tumor.
  • Grade III: Cells look abnormal and are reproducing. They can grow into nearby normal tissue and are prone to recurring, often as a grade IV tumor.
  • Grade IV: Cells look highly abnormal and rapidly reproduce. Tumors form new blood vessels to support growth. They have dead cells in their centers. They can easily invade nearby normal tissue.

Treatment of spinal tumors

Radiation therapy is the main treatment for spinal tumors. We use one of the most advanced radiation therapy systems available. Targeted radiation therapy uses high doses of radiation to destroy the tumor. Our neuro-oncologists work closely with radiation oncologists to provide this advanced treatment.

Your care team may also include neuropathologists, experts in diagnosing brain and spinal diseases, and radiologists who specialize in brain and spinal tumors. We may work with orthopedic specialists to plan your recovery.

Radiation therapy

Radiation sessions, also called fractions, usually happen once a day, Monday through Friday, for several weeks. Each session lasts about 30 minutes. We take care to target your tumor while protecting healthy tissue.

Types include:

  • Stereotactic radiosurgery delivers a precise dose to the tumor in a single session or a few sessions.
  • 3-D conformal radiation therapy (3D-CRT) uses several high-dose radiation beams, aimed from different directions and shaped to match the tumor.
  • Intensity-modulated radiation therapy (IMRT) is a type of 3D-CRT. We use a machine that changes your position during treatment. We can adjust beam strength while protecting healthy tissue.

Surgery

Surgery may be used to remove a tumor or to relieve symptoms.

Our neurosurgeons and orthopedic surgeons offer vast experience and the latest techniques. They are fellowship trained, meaning they completed advanced, hands-on work after their residency.

Clinical trials

At OHSU, we offer access to a wide range of clinical trials. Find a clinical trial.

Additional services

As part of our partnership with the OHSU Knight Cancer Institute, our patients have access to a full range of support services, including:

Learn more

For patients

  • Referral: To become a patient, please ask your doctor for a referral.
  • Questions: For questions or follow-up appointments, call 503-494-5626.

Location

Parking is free for patients and their visitors.

OHSU Neuro-Oncology Clinic, Marquam Hill
3270 SW Pavilion Loop, 2nd floor
Portland, OR 97239
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