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Spinal Tumors

Overview

I don’t think I can ever express how thankful we are to doctors Jandial and Chen and what they have done for my family. They gave us another chance. They did the impossible." Joel Torres, Spinal surgery patient

Cancer patients frequently develop tumors that spread to the spine, yet few specialists know how to navigate this complex region of the body. City of Hope neurosurgeons regularly treat difficult spinal cases and use their expertise to design innovative, less invasive surgical approaches — including using fewer incisions to remove most of the tumor tissue to preserve patient functioning and quality of life.

Neurosurgeons Mike Chen, M.D., Ph.D. and Rahul Jandial, M.D., Ph.D. lead the spine tumor program. This team invented a technique designed to reduce the number of incisions needed to perform complex spine surgery, resulting in a safer procedure with fewer complications, less bleeding and faster healing.

According to the California Office of Statewide Health Planning and Development, City of Hope is possibly the busiest spine surgery center in Southern California.

As a comprehensive cancer center, City of Hope offers integrated cancer care by a multidisciplinary team of medical oncologists, radiation oncologists and pain management specialists, who together create treatment plans tailored to each patient.

Program Highlights

  • Less invasive techniques. Doctors Jandial and Chen have extensive experience using less invasive techniques for spine tumor surgery, including incisions about half the length typically used, resulting in faster and better recoveries.
  • Dual surgeon approach. Spine tumor surgeries are highly technical and usually time consuming. Doctors Chen and Jandial perform them by working together to improve outcomes and shorten the duration of the operation.
  • A rare skill. According to the California Office of Statewide Health Planning and Development, City of Hope is one of the busiest spine surgery centers in Southern California. When removing spinal tumors is of benefit to our patients, City of Hope has demonstrated success in performing operations that are not possible at other major medical institutions.

Nationally recognized leader

City of Hope is a nationally recognized leader in the research and treatment of spinal tumors. We are one of the few facilities designated a comprehensive cancer center by the National Cancer Institute, and for over a decade, U.S. News & World Report has named City of Hope one of the top cancer hospitals in America.

If you have been diagnosed with a spinal tumor or are looking for a second opinion consultation about your treatment, request and appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.

NEWS & BREAKTHROUGHS

"There is an immense gratification to be able to use all of your skills to remove a complex tumor and in the process help a fellow human being." Mike Chen, M.D.,Ph.D., neurosurgeon and scientist

Cancers that begin in the spine are exceedingly rare and are diagnosed either as primary tumors — starting in the spine and surrounding structures — or metastatic tumors, which travel to brain tissue from other organs. In 2016, around 78,000 people in the United Stated will be diagnosed with a primary brain or spinal tumor — most of which will be benign (noncancerous). Some common types of cancer that develop as primary spinal tumors include:

  • Lymphoma
  • Myeloma
  • Leukemia

Spinal cord tumors are a common childhood cancer

Brain and spinal tumors occur in both children and adults, although treatment for each group tends to be different. Although they are rare, brain and spinal cord tumors are the third most common type of childhood cancer.

How spinal cancer develops

Spinal cancer develops when abnormal cells in the spinal cord grow and divide in an uncontrolled way, interfering with normal functioning. There are more than 120 types of brain and central nervous system tumors and they are classified based on the origin of the cells and how aggressively they behave. In both children and adults, spinal tumors are most often benign.

Types of spinal cancer

  • Meningeal tumors are most often benign. They sprout not from brain tissue itself but from thin, protective layers of the spinal cord called the meninges. Meningeal tumors tend to grow slowly and can become quite large before causing symptoms. Approximately one-third of brain tumors are meningiomas.
  • Nerve sheath tumors, also called neurofibrosarcomas, grow in the cells that surround the peripheral nerves and are commonly caused by neurofibromatosis type 1.
  • Ependymal tumors grow from ependymal cells, which are found in the ventricles. Since this type of brain tumor affects the ventricles, it can block the flow of cerebrospinal fluid and cause a condition called hydrocephalus.
  • Astrocytic tumors develop from star-shaped brain cells called astrocytes. Astrocytomas tend to spread tentacle-like through tissue, making them difficult to remove surgically. Astrocytomas are rated based on how fast they grow — from high grade (fast-growing) to low grade (slow-growing).
  • Oligodendrocytomas develop from cells called oligodendrocytes. They are more likely to grow slowly but can become more aggressive over time. Like astrocytomas, oligodendrocytomas tend to infiltrate normal tissue, making this type of tumor difficult to remove surgically.
  • Mixed gliomas are tumors made up of two or more types of glioma cells, including astrocytomas, oligodendrocytomas and ependymomas. Mixed gliomas usually are treated based on the behavior of the most aggressive cells in the tumor.
  • Medulloblastomas are malignant tumors, that occurs in infants and children, that start in the region at the base of the skull called the posterior fossa.
  • Pineal parenchymal tumors are rare cancers that primarily occur in pediatric patients and originate in pineal cells, which are responsible for producing melatonin.
  • Germ cell tumors begin in cells of the reproductive organs (sperm or egg) and are most common among teenage girls and young women.
  • Craniopharyngiomas are benign tumors that develop near the pituitary gland, which is located near the base of the brain. These tumors types are most common in children but older adults may also develop them.

What increases your risk of spinal tumors?

Things that put you at higher risk for getting brain and spinal cancer are called risk factors. There are very few known causes of primary tumors, although certain genetic syndromes may increase risk including:

  • Neurofibromatosis type 1 and 2 are nerve tumors of the skin, brain or spinal cord. Problems with the NF1 gene are much more likely to be implicated as a cause of brain tumors than changes to NF2.
  • Tuberous sclerosis increases the risk of certain low-grade astrocytomas and benign tumors of the brain, heart, skin and other organs.
  • Von Hippel-Lindau syndrome increases the risk of developing benign or malignant tumors in different parts of the brain and spinal cord; and other parts of the body including the pancreas, kidney, adrenal gland and inner ear.
  • Li Fraumeni cancer syndrome is caused by changes to a gene called TP53 and is associated with a higher risk of developing gliomas and other types of cancer including sarcomas, leukemia and breast cancer.
  • Other rare syndromes that increase the risk of brain and spinal tumors include Turcot syndrome and Nevoid basal cell carcinoma syndrome.

Infections such as Epstein-Barr virus and AIDS may increase risk of brain and spinal tumors, and receiving an organ transplant also increases the risk of certain central nervous system-related cancers.

Spinal tumor symptoms

Symptoms of adult spinal cord tumors are not the same in every person and depend on the stage, location and size of the tumor. Some common symptoms include:

  • Back pain
    • Nagging
    • Unrelated to specific activities
    • Worsens during rest
    • Worsens over time
    • Occurs at night
  • Spinal deformity
  • Neurological problems such as weakness or numbness in areas like the leg, knee or ankle
  • Urinary, fecal incontinence
  • Muscle spasms, twitches, weakness or function loss
  • In later stages, weight loss, fever and fatigue

Other medical conditions share these symptoms. If you have any of these conditions, you may need further consultation to rule out spinal cancer.

Brain and spinal tumors are highly complex, requiring an expert and deeply experienced team that can accurately diagnose your tumor type — so that you get the best and most effective treatment. City of Hope’s team of highly trained, nationally recognized experts use their clinical expertise, honed by seeing many different tumor types, to provide you with the most accurate diagnosis.

Diagnosing brain and spinal tumors

  • A neurologic exam is a test to find out if there are neurological problems, including motor and sensory issues.
  • An MRI (magnetic resonance imaging) uses magnets and radio waves to create a series of pictures of the brain and nearby structures.
  • CT (computed tomography) scan uses X-rays to provide detailed images of the brain and spinal structures, revealed as thin cross-sections.
  • PET (positron emission tomography) scan uses a radioactive tracer to locate cancer cells and measure their activity.

Biopsy

A biopsy (a thin sliver of tissue taken from the tumor) may occur after initial imaging and neurologic testing, or it may occur at the earliest stage of diagnosis.

There are two main ways to perform biopsy for brain and spinal cancers, including:

  • Stereotactic biopsy involves guiding a needle to the tumor site in order to extract a small sample of the tumor tissue. Needle biopsy is most often used when the tumor is in an especially risky or sensitive area of the brain.
  • Surgical biopsy is done when imaging reveals a tumor that may benefit from being removed surgically. This type of biopsy usually involves taking out most or all of the tumor.

If it is suspected that cancer has spread through the cerebrospinal fluid, a spinal tap may be performed. A spinal tap is more commonly used when certain tumor types are suspected to have spread there, such as a lymphomas or ependymomas.

 

 

Think of the dual surgeon approach as having two pilots. By having the combined experience of two neurosurgeons, you dramatically reduce blood loss and operative times, and more important, redefine what is considered ‘inoperable.'" Rahul Jandial, M.D.,Ph.D., neurosurgeon and scientist

One of the most feared complications of cancer is when it involves the spine. A complex network of bones, nerves and arteries may be affected and, in severe cases, spinal cord compression may lead to paralysis. For these reasons, treatment options for spinal tumors are not always black and white. It takes a deeply experienced team, accustomed to treating complicated cases, to weigh the best — and most individualized — options available to you.

Our physicians are nationally recognized neurosurgery and neuro-oncology experts who use advanced technologies and therapies, and are on the leading-edge of research and discovery.

Advanced techniques

Spinal tumor treatment options depend on a few factors including:

  • Tumor biology
  • Tumor location
  • Extent of the lesion

Treatment options we offer for spinal tumors include:

  • Surgery, including minimally invasive techniques such as endoscopic surgery, spinal cord monitoring and advanced spine instrumentation
  • A unique and less invasive approach when perfomorming complex procedures such as vertebrectomy, resulting in less blood loss and faster healing
  • Individually customized chemotherapy regimes
  • Highly precise radiation therapy

Your care continues long after treatment is completed, and we are committed to helping you and your loved ones manage your recovery.

City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat cancer— coupled with an enduring belief in providing compassionate care. Call 800-826-HOPE or go online to request an appointment.

Diagnostic Radiology

Bihong (Beth) Chen, M.D., Ph.D.

Clinical Specialties

  • Diagnostic Radiology
John J. Park, M.D., Ph.D.

Clinical Specialties

  • Diagnostic Radiology
Julie Ann Ressler, M.D.

Clinical Specialties

  • Diagnostic Radiology

Interventional Pain Management

Christine Chang, M.D.

Clinical Specialties

  • Interventional Pain Management

Neurosurgery

Mike Y. Chen, M.D., Ph.D.

Clinical Specialties

  • Neurosurgery
Rahul Jandial, M.D., Ph.D.

Clinical Specialties

  • Neurosurgery

Radiation Oncology

Savita Dandapani, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

Research

Clinical trials – research studies that involve volunteer patients – are a crucial component to developing new, more effective treatments that save lives. Many of today’s standard therapies are based on the results of previous trials, some of which were initiated at City of Hope.

Getting treated for spinal tumors at City of Hope means you are steps away from labs where new treatments for cancer are being developed every day. That proximity means you benefit from something unique in cancer care — bench to bedside treatment. “Bench to bedside” means innovative research we are conducting in our labs is moved quickly to the bedside to treat our patients. We offer drug, surgical and other clinical trials aimed at improving survival rates and enhancing quality of life.

Numerous clinical trials

City of Hope is a recognized leader in spinal tumor research. We offer access to numerous clinical trials and new therapies that are not readily available elsewhere. Our latest research includes developing more precise surgical and radiation techniques for better tumor removal, identifying better drugs that help prevent relapses and finding chemotherapy agents that are more effective against the cancer or less toxic for the patient.

Neurosurgeon innovators

All City of Hope neurosurgeons have active research laboratories — with projects ranging from defining the behavior of metastatic brain tumors, to inventing smaller, nimbler tools for hard to reach tumors.

When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your cancer journey — and help improve you quality of life both during and after treatment for your spinal tumor. That support includes everything from talk therapy to meditation to being paired up with a patient navigator and includes support for:

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

Support the Spine Tumors Program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts over 100 years ago. Their efforts — and those of our supporters today  have built the foundation for the care we provide and the research we conduct.

For more information on supporting the Spine Tumors Program, please contact Julie Hara. Or, you can make a gift to support all the research at City of Hope by  donating online.