Metastatic spinal cord compression as the first sign of malignancy

Abstract

Background and purposeMetastatic spinal cord compression (MSCC) as the initial manifestation of malignancy (IMM) limits the time for diagnostic workup; most often, treatment is required before the final primary tumor diagnosis. We evaluated neurological outcome, complications, survival, and the manner of diagnosing the primary tumor in patients who were operated for MSCC as the IMM.Patients and methodsRecords of 69 consecutive patients (51 men) who underwent surgery for MSCC as the IMM were reviewed. The patients had no history of cancer when they presented with pain (n = 2) and/or neurological symptoms (n = 67).ResultsThe primary tumor was identified in 59 patients. In 10 patients, no specific diagnosis could be established, and they were therefore defined as having cancer of unknown primary tumor (CUP). At the end of the study, 16 patients were still alive (median follow-up 2.5 years). The overall survival time was 20 months. Patients with CUP had the shortest survival (3.5 months) whereas patients with prostate cancer (6 years) and myeloma (5 years) had the longest survival. 20 of the 39 patients who were non-ambulatory preoperatively regained walking ability, and 29 of the 30 ambulatory patients preoperatively retained their walking ability 1 month postoperatively. 15 of the 69 patients suffered from a total of 20 complications within 1 month postoperatively.InterpretationPostoperative survival with MSCC as the IMM depends on the type of primary tumor. Surgery in these patients maintains and improves ambulatory function.

Nursing considerations for supporting cancer patients with metastatic spinal cord compression: a literature review

“…Whilst spinal cord compression may be non-malignant in origin and present in people with or without cancer, MSCC can be the first presentation of an undiagnosed primary cancer which has progressed, or may reflect secondary disease (Wanman et al, 2017). Any cancer has the potential to metastasise to the spine, but MSCC most commonly presents in breast, lung and prostate cancer, lymphoma and myeloma.…”

Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature

“…Wang et al [ 14 ] in 2012 reported a prospective cohort study of 448 patients with spinal metastases and found that the median duration of survival in the UPT group was 11.4 mo, which was much better than that in the lung cancer group (3.0 mo), but worse than that in the breast cancer group (21.5 mo). In contrast, two independent studies in 2017 both mentioned that patients with UPTs had the shortest survival (3.5 mo and 4.6 mo, respectively) among all patients with metastatic spinal disease[ 15 , 16 ].…”

“…For instance, in the study published in 2014 by Quraishi et al [ 20 ], 10 of the 17 unidentified metastatic tumors were confirmed to be adenocarcinoma postoperatively, with 6 derived from pulmonary cancer and 4 from gastrointestinal cancer. However, most of the time, even though intraoperative bone biopsy confirmed the pathological features of metastatic lesions, up to the endpoint of the study their original sites might still not have been ascertained[ 15 ]. Similarly, in our case, although the thoracic vertebral lesion had undergone both preoperative and postoperative pathological analyses, due to the rapid deterioration of the disease and the absence of either pulmonary mass biopsy or autopsy, the relationship between the metastatic tumor and the pulmonary lesion remains dubious.…”

ESTRO ACROP guidelines for external beam radiotherapy of patients with complicated bone metastases

“…MSCC predominantly affects the thoracic vertebrae (65) followed by the lumbosacral (25) and cervical region (10) [2]. 20-35 of patients have multiple sites of MSCC on imaging [1]…”