Spinal Tumor Diagnosis and Spinal Cancer Stages and Grades

January 12, 2026

This page was reviewed under our medical and editorial policy by Yvette Theodore, N.P., Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte.

Doctors usually recommend testing for spinal tumors and cancer only if an adult or child has symptoms, such as back pain, numbness, weakness or difficulty walking. The diagnostic process is generally similar for both adults and children and may include a physical exam, imaging tests and sometimes a biopsy to inspect the tumor under a microscope.

The main difference when testing for pediatric patients is that children may need extra support during testing to help them stay comfortable and still, especially for scans.

How to Test for Spinal Tumors

If a spinal tumor is suspected, the care team may order imaging tests. Typically, this includes magnetic resonance imaging (MRI) or computed tomography (CT) scans. These imaging tests are used most often to look for spine diseases by taking detailed pictures of the brain and spinal cord. These scans usually show whether a tumor is present and may give doctors ideas about tumor type and location.

X-Ray

X-rays are sometimes used when checking for spinal problems, but they aren’t the main tool for diagnosing spinal tumors. An X-ray can show changes in the bones of the spine, such as damage caused by a tumor. However, tumors themselves don’t always show up clearly on an X-ray, especially if they’re small or in the soft tissues around the spine.

That’s why doctors usually rely on advanced imaging, like MRI or CT scans, which provide significantly more detail. These tests can show both the bones and the soft tissues, helping the care team see the tumor’s exact size, location and impact on the spinal cord.

MRI Scan

An MRI scan is the most common test used to look for spinal tumors. The care team may use it when symptoms suggest a tumor. That’s because an MRI shows detailed pictures — more detailed than those from CT scans — of both the spinal cord and the tissues around it.

On an MRI, a spinal tumor often appears as a spot or mass that looks different from the normal tissue. The scan can show the size, shape and precise location of the tumor, and whether it’s pressing on the spinal cord or nerves — detail that helps the care team personalize a spinal tumor treatment plan.

CT Scan

A CT scan uses X-rays and a computer to create detailed cross-sectional pictures of the spine. Doctors may use this imaging test if they need a closer look at the bones of the spine, since it shows bone changes more clearly than an MRI.

Sometimes a CT scan is used together with an MRI to give a more complete picture of the tumor and its effects. CT may also be used if a patient can’t have an MRI, for example, if they have excess body weight or certain types of metal implants.

PET Scan

A positron emission tomography (PET) scan is sometimes used when doctors need to learn more about a spinal tumor or to see if cancer has spread to the spine from another part of the body. A small amount of a safe radioactive substance is administered, which highlights areas of high activity in the body — such as tumor cells — on the scan.

With spinal tumors, PET scans aren’t usually the first test. They’re most helpful when doctors need information that MRI or CT scans can’t provide, such as whether a tumor is active, aggressive or spreading.

How Is Spinal Cancer Diagnosed?

If a spinal tumor is discovered, the care team will perform more tests to learn what kind of tumor it is and whether it’s cancerous. The most critical test is usually a biopsy, where a small sample of tumor tissue is removed and analyzed under a microscope.

Biopsy

A biopsy is the only way to know for sure whether a spinal tumor is cancerous.

The main types are:

• Stereotactic (needle) biopsy: During this less invasive procedure, a thin needle is guided (often with CT or X-ray) into the tumor to remove a small sample.
• Surgical or open biopsy: If surgery is a good option, a neurosurgeon may perform this procedure to remove either the whole tumor or as much of it as safely possible (debulking).

Biopsy Testing

When a biopsy is done on a spinal tumor, pathologists don’t just check if it’s cancerous — they also look at certain genetic features of the tumor to help guide treatment and determine outlook. These include gene mutations (changes) and chromosomes, including:

• IDH1 or IDH2 gene mutations
• 1p19q chromosomal co-deletions
• MGMT promoter methylation

In some cases, doctors also test for other gene changes, such as ATRX, TERT, H3F3A, BRAF or HELA.

Stages of Spinal Cancer

Spinal tumors, whether cancerous or benign, aren’t staged the same way as many other cancers. That’s because spinal tumors rarely spread outside the central nervous system. Instead of a stage, doctors assign a grade (1 to 4) to the tumor based on how the tumor cells look under a microscope.

Grade 1 Spinal Tumor

Grade 1 spinal tumors are lower grade, meaning they tend to grow more slowly and are less likely to invade nearby tissues.

Grade 2 Spinal Tumor

Grade 2 spinal tumors grow slowly and may invade nearby tissues.

Grade 3 Spinal Tumor

Grade 3 spinal tumors tend to grow faster and are more likely to penetrate nearby tissues. Because of this, they often need more intensive treatment.

Grade 4 Spinal Tumor

Grade 4 spinal tumors grow the most quickly of all grades. They may spread to other parts of the spine or other structures, and may come back after treatment.