Clinic Provides Comprehensive Spine Tumor Care
Spine tumors, while relatively rare, present unique challenges to the physicians providing treatment. Which is what prompted UW Health spine surgeon Paul A. Anderson, MD, and colleagues to begin a spine tumor clinic.
"I felt a need for a comprehensive program to aid medical oncologists and radiation oncologists in managing these patients," Anderson explained.
In coordination with the UW Carbone Cancer Center, the Spine Tumor Clinic provides coordinated multidisciplinary care for patients with spine tumors. Spine surgeons, medical oncologists, radiation oncologists and other practitioners develop individualized treatment plans for the patients in their care.
The clinic is relatively unique in that it brings together the expertise of a spine surgeon with oncologists to treat patients with spine tumors and related conditions, including those with degenerative spine conditions.
Spine Tumors and Degenerative Conditions
Dr. Anderson explained that there are two main types of spine tumors:
- Primary, which grow out of bone, soft tissues, or nerves around or within the spine. These types of tumors are rare. They need very complex treatments and oftentimes are only treatable by surgery. "If malignant primary spine tumors are not treated properly the first time," commented Dr. Anderson, "then it is unlikely a cure will be achieved."
- Secondary, or metastatic tumors, are those that develop from another area of the body, such as breast, prostrate, lung, thyroid or kidney. These are the types of tumors most often treated at the clinic. The spine is the most common location for metastatic tumors. Roughly 40 percent of all cancer patients will have metastatic spinal tumors.
Metastatic tumors of the spine tend to occur in older individuals who have degenerative spine disorders, such as osteoarthritis or osteoporosis, that occur independent of their tumor. So, in addition to treating the cancer, it is also critical to address any underlying degenerative conditions.
"Interestingly, an oncologist will refer patients because they are having pain that turns out to have nothing to do with their cancer. It is strictly the result of a degenerative condition, but to treat that properly, it is necessary to take into account the patient's cancer," said Dr. Anderson.
Metastatic tumors can significantly impair patients' quality-of-life and even their longevity. The main issues that Dr. Anderson and his colleagues are treating when caring for patients with metastatic tumors include: pain, loss of function, spine instability and neurologic involvement. Spinal instability means the spine is no longer able to support the weight of the trunk or head, which can lead to progressive deformity or excessive motion that can injure the spinal cord or nerve roots.
"The most disastrous problems will involve neurologic complications because a tumor can grow into the spinal canal and pinch the spinal cord or the nerve roots. This can result in neurologic deterioration - that is paraplegia, quadriplegia, or loss of bladder or bowel function. And these neurological complications are often combined with spinal instability," explained Dr. Anderson. He added, "That is why it is important that these tumors be managed in a comprehensive manner."
Goals of Treatment
There is no standard course of treatment for spine tumors. Rather, the treatment is individualized depending upon the patient's condition including any underlying degenerative conditions and the patient's desires and expectations. The primary types of treatment include chemotherapy, hormonal therapy, radiation therapy or surgery.
The four main goals of treatment at the Spine Tumor Clinic include:
- Prevention of neurological deterioration
- Reduction of pain
- Correction and/or prevention of deformity
- When warranted, surgical removal of all or part of the tumor
In determining the types of treatment that are appropriate, Dr. Anderson and his colleagues are faced with similar questions: Should a patient be treated surgically before other treatments such as radiotherapy? Should a patient be treated with a brace? When is surgery indicated for a tumor that is not responding to other treatment? And what should be done if the tumor is at risk for progressive destruction to the spine that could result in neurological problems?
Dr. Anderson commented that a complication he wants to avoid is when the disease has progressed to the point it is causing severe neurological deficits - that is a decrease in the function of the brain, spinal cord, muscles, or nerves - because by then, treatment options become extremely limited.
"It is better if patients are referred to us earlier in the course of their disease, before they reach the stage of paralysis, because it's much harder to reverse that. And many times surgery isn't an option at that stage," he explained.
When Surgery is Necessary
Surgery is warranted only in a minority of cases. When it is indicated, the surgeons at the Spine Tumor Clinic can perform those surgeries. According to Dr. Anderson, common indications for surgery include primary tumors such as sarcomas which aren't amendable to radiation or chemotherapy, and consequently are best treated with a radical surgical resection.
For secondary (metastatic) tumors, surgery is indicated if there is progressive or pending neurological loss of function, intractable pain, a pathologic fracture (meaning the tumor is destroying the bone which will result in significant instability of the spine), and occasionally for diagnostic purposes.
The goals of surgery are: to reduce pain caused by the spinal tumor, to restore or preserve neurological function and to provide spinal stability. Regardless of what treatment options are needed, the most important goal is helping patients maintain their quality-of-life as much as possible.
"Up until now, most of the time when I've been consulted the patient is in a crisis situation in the hospital, such as severe pain or significant neurological deterioration," concluded Dr. Anderson. "That's what we are trying to avoid. We hope that by seeing patients earlier, as out-patients, that we can avoid these crises and help them maintain their quality of life to a greater degree."