Neurosurgeon Mark Bilsky talks about advances in the treatment of spine tumors with radiation therapy, surgery, and other procedures.
Diagnosing a spine tumor usually begins with a comprehensive medical examination to assess symptoms such as pain and neurologic function. Depending on your symptoms and whether you have been diagnosed and/or treated for another primary cancer, your doctor may also recommend one or more of the following tests to make an accurate diagnosis and determine the stage of your tumor.
Once a complete diagnostic profile is available, our multidisciplinary spine tumor team will use this information to develop a treatment plan that addresses the specific features of your disease. A framework developed at Memorial Sloan-Kettering called NOMS assessment guides this planning.
Doctors at Memorial Sloan-Kettering use advanced imaging technologies to identify the size and precise location of a spine tumor. Imaging is also used to see the impact of the tumor on your spine, as well as the health and stability of your vertebrae. Information from imaging tests can help determine the most effective treatment and reduce the risk of complications from surgery or radiation therapy.
The following are the most commonly used imaging tests to diagnose spine tumors:
Magnetic Resonance Imaging
This imaging test is the most reliable method for diagnosing spine tumors. MRI is capable of identifying spinal cord compression in patients without pain or other neurologic symptoms, and can often distinguish between malignant and benign lesions.
CT uses multiple x-rays to determine the size and location of your tumor and assess the quality of bones in the spine. This information is used to help determine the stage of a tumor and to see if it has metastasized (spread).
An x-ray may be used to identify the specific vertebra involved in spinal cord compression and to evaluate the alignment of the spine. During treatment, x-rays can also help doctors to assess the placement of rods and pedicle screws used to stabilize your spine.
Positron Emission Tomography
Before your scan begins, a small amount of radioactive sugar is injected into a vein. Because cancer cells absorb sugar more rapidly than normal cells, they are highlighted on the PET scan. PET may be used to screen for spinal metastases and can help distinguish between malignant and benign bone lesions.
A radiologist takes an x-ray of the area after injecting a dye into the spinal fluid cavity. The image reveals the outline of the tumor and can help direct radiation beams during radiation therapy. Because MRI is more effective than myelography in diagnosing spine tumors, this technique is primarily used to plan treatment prior to using a high-dose, high-precision form of radiation therapy called stereotactic radiosurgery.
During a biopsy, doctors use CT, alone or with an imaging contrast dye, to guide placement of a needle into the tumor and remove a small amount of cells, fluid, or other tissue for examination under a microscope. By studying the cells closely, a pathologist can determine whether a spine tumor originated in your spine (a primary tumor) or spread (metastasized) to the spine from another part of the body. If the tumor is primary, a biopsy can determine whether it is malignant (cancerous) or benign (noncancerous). If your tumor is metastatic, a biopsy can usually reveal where it began.
Many spine tumor biopsies are performed using a minimally invasive approach, in which a CT scan is used to guide the placement of a thin needle into the tumor or surrounding fluid.
Developing a Treatment Plan: NOMS Assessment
Neurosurgeons at Memorial Sloan-Kettering have developed a multidimensional decision framework called NOMS(1) to guide treatment planning for each patient. NOMS organizes diagnostic information into several important areas that affect a patient’s overall clinical status, including:
- Neurologic involvement – presence or extent of spinal cord or nerve root compression caused by the tumor
- Oncologic information – whether or not the tumor is likely to respond to radiation therapy
- Mechanical factors – vertebral fractures and other problems that affect the stability of the spine
- Systemic factors – your general health, including the extent of the primary cancer, which can affect your ability to tolerate surgery and radiation therapy
Most people with spine tumors are treated with a combination of therapies, depending on the stage of their disease and their NOMS assessment. Our spine tumor experts collaborate from the beginning to determine which treatments offer you the best chance to eliminate or control tumor growth as well as restore mobility and other functions.