Doctors use the term "malignant" to indicate that a particular tumor or a cancer often spreads to other parts of the body, can be difficult to cure or treat, and may often be deadly. This is very different from "benign" cancers, which are much less likely to spread, are easier to treat and control, and are much less deadly.
The spine and it surrounding elements have a generous blood supply, draining many of the structures of the lower abdominal cavity via a system of veins called Batson's Plexus. This venous plexus is felt to be the reason that certain intra-abdominal and pelvic tumors have a tendency to spread to the spine.
The spread or metastasis of tumors from elsewhere in the body to the spine may occur after a cancer has been growing in another part of the body for a long time. Tumors that have spread to the spine usually cause a significant amount of pain. If they are large enough, they may put pressure on the spinal cord, which causes increasing pain and loss of normal functioning in the bowel, bladder, and legs. Metastatic cancer may not be curable, but the treatment goals are usually directed at relief from pain, decompression of the neural elements (removing the pressure on the spinal cord and nerves), and preserving the patient's quality of life as much as possible. Surgery, chemotherapy, and localized radiation therapy all play a role in reducing the pain associated with cancers that have spread to the spine from other sites.
Myeloma is the most common primary malignant tumor of bone. It typically affects adults greater than 40 years of age. It tends to be generalized, involving multiple bones, but back pain and involvement of the spine is the most common presenting complaint. Treatment is palliative; meaning that disease can be controlled, but not completely cured. Chemotherapy is used to control the pain and slow the progression of the disease. Surgery may be required if pathological fractures develop or there is compression of the spinal cord.
Osteosarcoma is the second most common primary malignant tumor of bone. There are two age groups that can often develop this type of cancer. It typically affects adolescents and young adults, with a second peak of incidence in older adults. It is very rare in the spine. Modern advances in imaging, chemotherapy, and surgical treatment of osteosarcomas have significantly improved the 5-year survival to greater than 80 percent. This is an amazing accomplishment, since 20 years ago, this disease was almost always fatal.
Leukemia: Leukemia, in its many forms, may present with back pain, which can be caused by the cancer growing in the bone marrow of the vertebral body. However, the more common symptoms of leukemia, such as fevers, fatigue, easy bruiseability, excessive bleeding, and anemia are usually noticed well before back pain occurs.
Although chordoma may appear anywhere in the spinal column, it's more likely to appear at the ends of the spine at the occipital cervical junction or in the sacrococcygeal region. Chordoma is rare. Sacrococcygeal chordoma appears more often in males and usually develops during middle ages, but can develop any time.
Although imaging studies such as x-rays and MRIs may be suspicious, the diagnosis of chordoma is established by biopsy of the tumor. Treatment is surgical resection of the tumor. The overall prognosis for the tumor depends on the size, extent of skeletal involvement, and other factors.
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