The spine can be affected by many different kinds of tumors.
Malignant (cancerous) tumors can arise within the spine itself.
Secondary tumors, which are actually much more common, begin as cancers in another part of the body, such as the breast and prostate, and then spread (metastasize) to the spine.
Because the spinal cord is enclosed within the rigid, bony spinal column, any abnormal growth can cause problems by compressing the spinal cord and nerves, or compromising the structural integrity of the spine.
Mike Chen, M.D., Ph.D is here to discuss spinal tumors and it's diagnoses and how City of Hope is leading the way in less-invasive spine tumor surgery.
Selected Podcast
The Facts About Spine Tumors
Featured Speaker:
Mike Chen, M.D., Ph.D.
Mike Y. Chen, M.D., Ph.D., is a surgeon/scientist at City of Hope specializing in complex operations for the removal of brain and spine tumors. Dr. Chen has an active lab focused on developing next generation therapies for the treatment of cancers that have metastasized to the central nervous system. Transcription:
The Facts About Spine Tumors
Melanie Cole (Host): Being diagnosed with a spine tumor can be frightening, but as a patient at City of Hope, you have a highly experienced and dedicated team to treat your tumor. City of Hope is Southern California’s busiest spine tumor program, and our doctors have the experience to help you when even others cannot. My guest today is Dr. Mike Chen. He is a surgeon/scientist at City of Hope specializing in complex operation for the removal of brain and spinal tumors. Welcome to the show, Dr. Chen. Tell us a little bit about what is spine cancer and what are the types of spinal tumors.
Dr. Mike Chen (Guest): Well, good morning, Melanie. Thank you for having me on. There are two types of spine cancer. The most common spine cancer that we see is when you have cancer, say, of the breast, of the lungs, and the cancer then metastasizes or travels through the bloodstream to reach the spine. This is a very common occurrence, and spine cancer will occur in approximately 50 percent of patients who have metastatic cancer. So it’s quite a common problem. Not all the time does it require surgical treatment. Often, it can be watched, but it can lead too serious consequences if not properly addressed.
Melanie: Is it just its own cancer really very often at all, or is it mostly from a cancer that has spread from somewhere else?
Dr. Chen: Ninety-five percent of the time, spine cancer is spread from somewhere else.
Melanie: How do you find out where it has spread from?
Dr. Chen: Well, the most common presentation of spine cancer is pain. When you have pain, eventually this gets worked up. And in a patient who has cancer, we would attribute the etiology of the cancer to be the primary source.
Melanie: Then someone experiences what kind of symptoms? Now, you’ve mentioned pain, but what else might let somebody know that this is something just a little bit different and you better go see a doctor about it?
Dr. Chen: Well, a lot of it is really common sense. If you have back pain and you have no history of trauma and the back pain doesn’t go away, then that’s the time that you demand that your doctor work up this new back pain that doesn’t have an obvious cause. Other symptoms that can occur include neurological symptoms such as weakness, numbness, loss of control of bowel and bladder function.
Melanie: Is there a relationship between spinal tumors and brain cancer or brain tumors at all?
Dr. Chen: Well, certain cancers do have a propensity to metastasize to the nervous system or to surrounding structures of the nervous system. For example, with breast cancer, we know that breast cancer that many women will have spinal metastasis as well as brain metastasis.
Melanie: Okay. So if this is something that is diagnosed, then how really scary, I think, that it would be. What do you tell people to give them some hope? And then what treatment options are available, Dr. Chen?
Dr. Chen: First of all, I think we have to recognize that it is not that. Although it can lead to catastrophic consequences, the vast majority of time, the spinal tumor is something that doesn’t need even need treatment. It would get treated because the detection systems are so good now that we can find these early that the chemotherapy or hormonal therapy will often kill the spine tumors along with the rest of the tumors or cancer that’s in the body. Should it progress beyond that and become symptomatic but not threatening to the health of the spinal cord, then radiation is an excellent option as an additive treatment. In very rare cases, when the structure of the spine becomes compromised or if the spinal cord itself is under pressure from a tumor growing into the spinal canal, in those circumstances, then surgery is a good option.
Melanie: What’s the surgery like, Dr. Chen? Because people think, “Oh, my gosh! It’s on my spine. Am I gonna be paralyzed?” Is there going to be weakness and numbness? What is spinal tumor surgery like?
Dr. Chen: Spinal tumor surgery is extremely rewarding for the patient and the surgeon. The modern techniques that are being developed – that we have helped develop, in fact – they are much less invasive than the previous generation of techniques. Everybody cares only really about one thing: am I going to be paralyzed? The answer is 99 percent of the time, you’re going to be absolutely fine, which is about as good odds as you can ask for.
Melanie: It really is, and I’m surprised and happy to hear you say that. What is the aftereffect? If it is from a metastasis and it’s on your spine and you have decided that their quality of life is not great, so you remove this. Is it likely to come back? Is this something that when you remove a tumor like that, it’s pretty well gone?
Dr. Chen: It is unlikely to come back. We remove the vast majority of the tumor. There’s always microscopic disease left behind. That microscopic disease is attached to critical structures, so we can’t, say, remove the spinal cord along with it. Obviously, that would not be optimal. With the combination of radiation after surgery and chemotherapy or hormonal therapy, whatever other drugs that are given after surgery, the chances of that tumor coming back at that spot are very low.
Melanie: Now, what’s going on in the world of research for spinal tumors and tumors and cancers that have metastasized to the spine?
Dr. Chen: Well, there is clinical research and there is laboratory research. From a clinical standpoint, number one, we are trying to understand what is it that causes these tumors to have a propensity to metastasize to the spine, and can we stop that from occurring. Once it’s there, what do we do about it? From a surgeon’s perspective, the main thrust of the research has been to figure out whether the new modern techniques for spinal surgery are superior to the traditional techniques. The traditional techniques, they are very invasive. They often involve two incisions, one in the back to reach the roof of the spinal canal, and then the second either in the abdomen or through the chest to reach the front of the spine. With more modern techniques, we use a single-incision approach and have an oblique trajectory to the front of the spine. We are able to take out the tumor completely and to reconstruct the spine all through a single incision. These techniques have only been made possible by the advances in modern spinal instrumentation over the last couple of years. The data that we are collecting is still not there to demonstrate superiority. Another thing that we’re working on at City of Hope is a dual surgeon approach, where these cases are traditionally considered to be very challenging. But luckily, my partner, Dr. Jandial and myself, we’re both fully trained surgeons. We tackle these cases together and we’ve significantly been able to reduce op time and patient complications. As far as basic research goes, as I said, we’re looking to see what causes the spine tumors to grow in the spine in the first place. The bone marrow is a very fertile environment, and the spine contains the most amount of bone marrow in adults. There are many stem cells in the spine, and we theorize that there may be interactions between these stem cells and the spine and the metastatic tumor. They may in fact be symbiotic. There’s also a tremendous amount of interest in seeing whether these new molecularly targeted drugs can prevent spine tumors from occurring.
Melanie: In just the last 30 seconds or so, Dr. Chen, give the listeners some hope if they are newly diagnosed with a spine tumor and tell them why they should come to City of Hope for their care.
Dr. Chen: Well, we have the most experience. We operate on many inoperable tumors. We do it through a less invasive approach. The patient outcomes are excellent. You’ll have a highly experienced team taking care of you at a fantastic institution.
Melanie: Thank you so much. That’s really great information. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
The Facts About Spine Tumors
Melanie Cole (Host): Being diagnosed with a spine tumor can be frightening, but as a patient at City of Hope, you have a highly experienced and dedicated team to treat your tumor. City of Hope is Southern California’s busiest spine tumor program, and our doctors have the experience to help you when even others cannot. My guest today is Dr. Mike Chen. He is a surgeon/scientist at City of Hope specializing in complex operation for the removal of brain and spinal tumors. Welcome to the show, Dr. Chen. Tell us a little bit about what is spine cancer and what are the types of spinal tumors.
Dr. Mike Chen (Guest): Well, good morning, Melanie. Thank you for having me on. There are two types of spine cancer. The most common spine cancer that we see is when you have cancer, say, of the breast, of the lungs, and the cancer then metastasizes or travels through the bloodstream to reach the spine. This is a very common occurrence, and spine cancer will occur in approximately 50 percent of patients who have metastatic cancer. So it’s quite a common problem. Not all the time does it require surgical treatment. Often, it can be watched, but it can lead too serious consequences if not properly addressed.
Melanie: Is it just its own cancer really very often at all, or is it mostly from a cancer that has spread from somewhere else?
Dr. Chen: Ninety-five percent of the time, spine cancer is spread from somewhere else.
Melanie: How do you find out where it has spread from?
Dr. Chen: Well, the most common presentation of spine cancer is pain. When you have pain, eventually this gets worked up. And in a patient who has cancer, we would attribute the etiology of the cancer to be the primary source.
Melanie: Then someone experiences what kind of symptoms? Now, you’ve mentioned pain, but what else might let somebody know that this is something just a little bit different and you better go see a doctor about it?
Dr. Chen: Well, a lot of it is really common sense. If you have back pain and you have no history of trauma and the back pain doesn’t go away, then that’s the time that you demand that your doctor work up this new back pain that doesn’t have an obvious cause. Other symptoms that can occur include neurological symptoms such as weakness, numbness, loss of control of bowel and bladder function.
Melanie: Is there a relationship between spinal tumors and brain cancer or brain tumors at all?
Dr. Chen: Well, certain cancers do have a propensity to metastasize to the nervous system or to surrounding structures of the nervous system. For example, with breast cancer, we know that breast cancer that many women will have spinal metastasis as well as brain metastasis.
Melanie: Okay. So if this is something that is diagnosed, then how really scary, I think, that it would be. What do you tell people to give them some hope? And then what treatment options are available, Dr. Chen?
Dr. Chen: First of all, I think we have to recognize that it is not that. Although it can lead to catastrophic consequences, the vast majority of time, the spinal tumor is something that doesn’t need even need treatment. It would get treated because the detection systems are so good now that we can find these early that the chemotherapy or hormonal therapy will often kill the spine tumors along with the rest of the tumors or cancer that’s in the body. Should it progress beyond that and become symptomatic but not threatening to the health of the spinal cord, then radiation is an excellent option as an additive treatment. In very rare cases, when the structure of the spine becomes compromised or if the spinal cord itself is under pressure from a tumor growing into the spinal canal, in those circumstances, then surgery is a good option.
Melanie: What’s the surgery like, Dr. Chen? Because people think, “Oh, my gosh! It’s on my spine. Am I gonna be paralyzed?” Is there going to be weakness and numbness? What is spinal tumor surgery like?
Dr. Chen: Spinal tumor surgery is extremely rewarding for the patient and the surgeon. The modern techniques that are being developed – that we have helped develop, in fact – they are much less invasive than the previous generation of techniques. Everybody cares only really about one thing: am I going to be paralyzed? The answer is 99 percent of the time, you’re going to be absolutely fine, which is about as good odds as you can ask for.
Melanie: It really is, and I’m surprised and happy to hear you say that. What is the aftereffect? If it is from a metastasis and it’s on your spine and you have decided that their quality of life is not great, so you remove this. Is it likely to come back? Is this something that when you remove a tumor like that, it’s pretty well gone?
Dr. Chen: It is unlikely to come back. We remove the vast majority of the tumor. There’s always microscopic disease left behind. That microscopic disease is attached to critical structures, so we can’t, say, remove the spinal cord along with it. Obviously, that would not be optimal. With the combination of radiation after surgery and chemotherapy or hormonal therapy, whatever other drugs that are given after surgery, the chances of that tumor coming back at that spot are very low.
Melanie: Now, what’s going on in the world of research for spinal tumors and tumors and cancers that have metastasized to the spine?
Dr. Chen: Well, there is clinical research and there is laboratory research. From a clinical standpoint, number one, we are trying to understand what is it that causes these tumors to have a propensity to metastasize to the spine, and can we stop that from occurring. Once it’s there, what do we do about it? From a surgeon’s perspective, the main thrust of the research has been to figure out whether the new modern techniques for spinal surgery are superior to the traditional techniques. The traditional techniques, they are very invasive. They often involve two incisions, one in the back to reach the roof of the spinal canal, and then the second either in the abdomen or through the chest to reach the front of the spine. With more modern techniques, we use a single-incision approach and have an oblique trajectory to the front of the spine. We are able to take out the tumor completely and to reconstruct the spine all through a single incision. These techniques have only been made possible by the advances in modern spinal instrumentation over the last couple of years. The data that we are collecting is still not there to demonstrate superiority. Another thing that we’re working on at City of Hope is a dual surgeon approach, where these cases are traditionally considered to be very challenging. But luckily, my partner, Dr. Jandial and myself, we’re both fully trained surgeons. We tackle these cases together and we’ve significantly been able to reduce op time and patient complications. As far as basic research goes, as I said, we’re looking to see what causes the spine tumors to grow in the spine in the first place. The bone marrow is a very fertile environment, and the spine contains the most amount of bone marrow in adults. There are many stem cells in the spine, and we theorize that there may be interactions between these stem cells and the spine and the metastatic tumor. They may in fact be symbiotic. There’s also a tremendous amount of interest in seeing whether these new molecularly targeted drugs can prevent spine tumors from occurring.
Melanie: In just the last 30 seconds or so, Dr. Chen, give the listeners some hope if they are newly diagnosed with a spine tumor and tell them why they should come to City of Hope for their care.
Dr. Chen: Well, we have the most experience. We operate on many inoperable tumors. We do it through a less invasive approach. The patient outcomes are excellent. You’ll have a highly experienced team taking care of you at a fantastic institution.
Melanie: Thank you so much. That’s really great information. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.