Sarcoma of the spine

Sarcoma of the spine is a rare malignant tumor. The disease is one of the most difficult to recognize and diagnose. This is due to physiological and anatomical features, as well as proximity to vital organs and systems.

During the diagnosis of neoplasm, an oncologist, a neurosurgeon and a surgeon participate. Let's look at the peculiarities of the spine sarcoma, the causes of the tumor, the symptoms, the methods of treatment and the prognosis of recovery - this is an oncological disease that is rare and difficult to diagnose. Let's look at the features of the spine sarcoma, the causes of the tumor, the symptoms, the methods of treatment and the prognosis of recovery.

Sarcoma of the spine is extremely rare. Pathology is difficult to diagnose and cure. This is due to the physiological and anatomical features of the disease, as well as the proximity of the sarcoma to vital organs and systems. During the diagnosis of the spine sarcoma, the oncologist has to solve several problems simultaneously. Before the doctor tasks of oncological, surgical and neurosurgical nature become.

Tumor processes of this kind differ in a wide range of clinical manifestations. It is this fact that causes errors in diagnosis and improper medical therapy. There are many kinds of sarcomas of the spine, let's consider them:

• Osteosarcoma is a malignant lesion of the spine and bone tissue.
• Ewing's sarcoma is the most common pathology in pediatric patients.
• Chondrosarcoma is a malignant tumor of cartilaginous origin.
• Metastatic spine sarcomas.
• Fibrosarcoma is a tumor in soft connective tissues, tendons, muscle fascia.
• Chordoma - malignant neoplasm, affecting the spinal cord.
• Single plasmacytoma - a tumor that afflicts the vertebrae, slowly progresses and is difficult to diagnose.

Each type of spinal sarcoma requires a separate diagnosis and specialized treatment. Only professional oncologists and surgeons can recognize the disease.

[1], [2], [3], [4]

Causes of sarcoma of the spine

The causes of sarcoma of the spine are varied. The disease can appear due to the transferred injuries and diseases or arise as a result of metastasis from organs and systems affected by oncology. That is, the exact cause of the sarcoma of the spine is very difficult to determine. There is an assumption that the disease appears due to a genetic defect, which manifests itself in the process of cell division, even during fetal development of the embryo. Another version of the cause of sarcoma of the spine is based on the fact that the human tissue and organs contain a program of tumor growth, that is, the development of atypical cells. But for their manifestation there must be certain conditions, that is, provoking factors.

Predisposing factors of the spine sarcoma:

• Work under conditions of exposure to radiation or chemical production.
• Regular eating disorders.
• Systematic prolonged exposure to open sunlight or in artificial ultraviolet.
• Long-term smoking experience (passive smoking is also a predisposing factor).
• Injuries and defects of the spine.

All of the above risk factors cause the appearance of malignant neoplasms throughout the body. Tumors develop and metastasize into the spine, causing sarcoma. This is due to the fact that the circulatory system is well developed in the spine, therefore, malignant pathologies metastasize hematogenically.

Any tumors of the spine can appear from the spinal cord, in the area of the soft meninges that cover the spinal cord. Sarcoma can occur between the soft medulla and the bones of the column of the spine. That is, there are many options for localization of the sarcoma. Many sarcomas have an extradural arrangement. As a rule, these are primary tumors that occur in the spine itself. Much less often secondary, which appear as a result of metastasis from other organs and systems (thyroid, prostate, kidneys, lungs, mammary glands). Very rarely, sarcomas are localized near the nerve endings of the spinal cord.

The exact cause of the appearance of primary tumors of the spine is unknown, but it can be genetic defects. By the way, sarcoma of the spine, like any other tumors of the spinal cord, are much less common than malignant brain lesions. As sarcoma grows, the pathological process involves the tissues and roots of the spinal cord, blood vessels and bone tissue. The disease causes tissue ischemia due to invasion of sarcoma cells or due to pressure on the vessels.

As a rule, pain in the lumbar region is not always a sign of a malignant process. Therefore, doctors carefully diagnose the patient's condition, examining the organs for the potential causes of malignant process. Regular preventive examinations, tests and radiography - allow timely detection of malignant formations in the body and prevent the development of spine sarcoma.

[5], [6], [7]

Symptoms of the spine sarcoma

Symptoms and clinical manifestations of the spine sarcoma depend on a number of factors: at what level the spine is affected, what kind of sarcoma, how quickly the tumor progresses, the degree of involvement of the spinal cord, the size of the reserve space in the spinal canal and the general health of the patient. The rate of growth of the neoplasm depends on the nature of its origin. If the tumor is metastatic, it progresses very quickly. If the neoplasm is primary, the sarcoma develops slowly, sometimes within 1-2 years.

Symptoms of the spine sarcoma are not immediately recognizable. It is because of such extensive symptoms, the disease is difficult to identify. First of all, it is worthwhile to know that the spine sarcoma is a malignant formation in the spinal cord or surrounding tissues. The most dangerous symptom of the disease is squeezing the spinal cord and nerve roots, which leads to damage to these structures.

Symptomatics and clinical manifestations of sarcoma of the spine depend on such factors:

• At what level the spine is affected, and in which element the sarcoma has arisen.
• The degree of damage to the spinal cord and its involvement in the pathological process.
• The tumor is located on the spinal cord (intramedullary) or adjacent to it (extramedullary). If the tumor is extramedullary, then to which part of the spinal cord it is attached, to the anterior, posterior or posterolateral.
• The growth rate of the spine sarcoma and the dimensions of space in the vertebral canal.
• General health of the patient, the presence of chronic diseases and pathologies.

Isolate the symptoms of the spine sarcoma, which depends on the level of damage to the spinal cord. So, the sarcoma can settle in the cervical, thoracic, lumbosacral spine or in the lower extremity of the spinal cord. The sarcomas that are within the spinal cord have extensive symptomatology, since they affect most of the trunk. Sarcomas that are outside the spinal cord have a long period of development, so their symptoms are very meager, and, as a rule, manifests as a lesion of nerve endings. The rate of increase in the sarcoma depends on the nature of its occurrence. If the tumor is secondary, that is, it appears as a result of metastasis, then it quickly progresses. But primary malignant tumors develop slowly.

Symptoms of malignant tumors of the spine are based on such kinds of disorders:

Radicular disorders

Under this concept, extramedullary tumors are meant. Sarcoma affects connective tissue membranes of the posterior roots. The patient feels severe pain, a picture of the neuralgia of the occipital or intercostal nerves. The patient suffers from lumbosacral or cervico-brachial radiculitis.

The pain is streaking, girdling or tightening. Unpleasant sensations increase when the patient is in a horizontal position and decreases in a standing position. Some patients have a burning sensation in the spine, symptoms of shingles are possible. But this is a clinical manifestation of the spine sarcoma, which is successfully masked for other diseases, which greatly complicates the process of diagnosis and treatment.

Segmental disorders

Are manifested as motor disorders that cause atrophic paralysis and vegetative-vascular disorders. This type of disorder occurs because of intramedullary spine tumors.

Conducting disorders

Characterized by motor disorders, which manifest themselves as central paralysis and paresis. The patient has motor disorders and pelvic disorders. It is possible to increase the tone of ligaments and muscles, the pathological severity of protective and tendon reflexes.

The main symptoms of spine sarcoma:

• Muscle weakness and difficulty while walking.
• Back pain (painkillers do not improve the condition), which increase in prone position.
• Fasciculation, muscle spasms, painful sensations in the lower limbs.
• Burning, itching and tingling of the skin (paresthesia), decreased vestibular function.
• Cold, sticky skin, a feeling of cold in the lower limbs.
• Paralysis, incontinence of urine and feces.

It is worth noting that the clinical picture of sarcoma of the spine has similar signs to other malignant tumors. Patients have a short history, and the disease itself can develop from several weeks to several years. The patient feels discomfort in the affected area, permanent pain, which does not stop after taking painkillers and anesthetics. Due to progressive sarcoma, the spine becomes immobile, which makes it very difficult to choose a comfortable position. Patients have symptoms of abnormalities in the pelvic region and paralysis.

The sarcoma of the spine causes severe pain, which can localize in the area of injury or give to other parts of the body. At the first stage, the sarcoma is not expressed. But with further progression causes an increase in body temperature. Very often, the disease causes spasms of the back musculature, which intensify at night. Sarcoma causes disturbances in the sensitivity of the lower extremities and motor muscles of the muscles. The patient has irregularities in his gait, walking and keeping his balance becomes difficult. If paralysis occurs, it leads to incontinence and the appearance of bruises and changes in the skin. In the region of the spine, there may be a swelling that can be palpated. The patient quickly loses weight, feels a general weakness and fatigue.

[8], [9], [10]

Ewing's sarcoma of the sacral spine

Ewing's sarcoma of the sacral spine is a malignant neoplasm that affects bone tissue. Most often this type of sarcoma is found in patients at a young and young age. The tumor affects femurs, vertebrae, collarbone, pelvic bones, ribs.

To date, doctors have no common opinion about the origin of Ewing's sarcoma of the sacral spine. Some people hold the opinion that since the spine is rich in nervous pathways and blood vessels, it increases the risk of developing the disease. The peculiarity of this type of sarcoma is that it metastasizes into other bones and into the lungs. The symptomatology of the disease is manifested as increased fatigue and general weakness, severe weight loss, anemia, fever, local tissue changes, pain, an increase in nearby lymph nodes.

Ewing's sarcoma, affecting the sacral spine, is divided into two groups:

1. For a long period of time, the sarcoma is within the same bone. At the last stages, the tumor metastasizes into regional lymph nodes and lungs. At the last stage, the sarcoma affects other bones.
2. The second group of the disease is characterized by the fact that the sarcoma quickly destroys the affected vertebra. Within a short period of time, a single focus of disease metastasizes and becomes plural. In this case, patients experience symptoms of weakness, back pain and elevated body temperature.

Diagnoses Ewing's sarcoma oncologist. Treatment depends on the stage of the tumor process. Therapy can be carried out by conservative medical methods or methods of surgical intervention.

[11], [12], [13], [14], [15], [16]

Diagnosis of the spine sarcoma

Diagnosis of the spine sarcoma is one of the important steps aimed at finding and drawing up a further treatment plan for a malignant tumor. Let's look at the basic methods used in diagnosing spinal sarcoma:

• Radiography is the main diagnostic method, which allows to reveal pathologies in the bone tissue of the spine.
• Magnetic resonance imaging and computed tomography are a feature of these methods in that they can detect the smallest metastases of the sarcoma, determine the exact dimensions of the tumor and their relation to the surrounding organs, tissues, nerves, vessels, bone marrow channel.
• Neurological tests and physiological examination - can determine the affect of the neurological system of sensory functions, reflexes, tone and muscle strength.
• Electroencephalogram (EEG) - a method of measuring electrical conductivity in the column of the spine.
• Biopsy - if the sarcoma affected the bone marrow, then this method allows you to know the type of sarcoma, its stage and the type of cancer cells.

In addition to the above methods, auxiliary methods are used to diagnose spinal sarcoma. Such methods include ultrasound, polymerase chain reaction for the detection of cancer cells in the blood, osteoscintigraphy, microscopic, molecular genetic and immunohistochemical studies.

Very often, the sarcoma of the spine is found on examination, which is carried out to establish the cause of pain in the cervical spine or vertebrae. The radiography method reveals bone changes in the spine. But to confirm the sarcoma, X-rays are few. Therefore, for a clearer visualization, computer tomography is used. In some cases, if there is a suspicion of sarcoma in the spine, the patient is scanned. But laboratory tests are used to refine the morphology of the malignant tumor and its nature. In addition, the results of the analyzes allow predicting possible complications and suggesting the outcome of the disease, that is, the survival of patients with spine sarcoma.

[17], [18], [19], [20], [21], [22], [23]

Treatment of spine sarcoma

Treatment of spine sarcoma is a complex process, the success of which depends on the diagnosis of malignant neoplasm. The choice of the treatment method and the prognosis of the patient's survival depends on the type of cancer, the degree of spinal cord injury and the localization of the sarcoma. Over the compilation of tactics for the treatment of sarcoma, a consortium of surgeons, oncologists and radiology doctors works. Modern methods of treatment significantly improve the prognosis of malignant disease and allow preserving the high quality of life of the patient.

Let's look at the main methods of treating spinal sarcoma:

• Surgical treatment - not all types of sarcoma are susceptible to chemotherapy and radiotherapy, so surgical intervention is used to treat them. The surgeon excises the tumor, the tissue around it and the nearest lymph nodes.
• Chemotherapeutic treatment - as a rule, chemotherapy is used to treat Ewing's sarcoma, osteosarcoma and rhabdomyosarcoma. Other types of sarcoma are less prone to chemotherapy. Very often oncologists combine chemotherapy and radiotherapy to achieve a better result.
• Target therapy - a method of point, that is, targeted therapy. The purpose of such treatment is to eliminate the causes of tumor growth without harming surrounding tissues and organs. This method of treatment is highly effective.
• Radiation therapy with simulated intensity - IMRT is a radiotherapy, that is, the destruction of the spine sarcoma by radioactive rays. This method is progressive and has proven to be highly effective in treating malignant tumors in patients of all ages.
• Brachytherapy - a method used for deep sarcomas of the spine. The essence of the method is that a small capsule is introduced into the lesion area, which generates rays and destroys the spine sarcoma.

Prophylaxis of spine sarcoma

Prophylaxis of the spine sarcoma is a complex of methods aimed at preventing the onset of the disease. As such, there is no way to completely protect yourself from sarcoma. But the timely access to a doctor and the passage of regular examinations, allow us to identify violations in the body. That is, the earlier the sarcoma of the spine or any other malignant neoplasm will be detected, the more chances for successful recovery and complete health preservation.

Prophylaxis of spinal sarcoma implies:

• Healthy lifestyle and nutrition.
• Limitation of contact with carcinogens.
• Refusal from smoking and alcohol.
• Complete exclusion of occupational hazards.
• Prevention of injuries.

The main prevention of spinal sarcoma is a healthy lifestyle, preventing injuries and timely treatment of diseases. There are certain risk groups that are most susceptible to malignant tumors. The risk group includes people with adverse heredity and exposed to ionizing radiation. Prophylaxis of sarcoma in such patients consists in the passage of routine examinations with the oncologist and the delivery of the necessary tests. Any pain in the spine should be treated, as this may be a symptom of a progressive tumor.

Prognosis of spine sarcoma

The prognosis of the spine sarcoma depends on a number of different factors.

• The prognosis of the disease is affected by the type of sarcoma and its appearance.
• It depends on the type of malignant neoplasm and the type of sarcoma of the spine that determines the tactics of treatment and the chances for a successful recovery.
• From the localization of the sarcoma depends the possibility of a radical operation to remove the tumor and the chances of a full recovery.
• Positive prognosis depends on the age of the patient, the presence of concomitant diseases, the absence of metastases in organs and tissues.

All this suggests that the prognosis of the spine sarcoma is individual for each patient. In addition to the main treatment, the prognosis depends on the rehabilitation process, which takes a long period of time. But even timely diagnostics and application of modern methods of treatment do not always guarantee a positive prognosis of the spine sarcoma.

Survival in sarcoma of the spine

Survival in sarcoma of the spine is due to the type of malignant formation, its localization, the chosen tactics of treatment and the characteristics of the patient's body. Thus, the prognosis of a five-year survival rate in sarcoma of the spine is about 50%. The use of modern medicines and surgical treatment do not guarantee a full recovery. If a patient has a Ewing sarcoma of the sacral spine, then the patient is waiting for a life-long dispensary observation. Regular examinations can identify possible relapses and complications of the disease and increase survival.

Sarcoma of the spine is a malignant neoplasm, which is very difficult to diagnose and cure. There are several types of sarcomas affecting the spine. The type of tumor depends on the treatment and overall prognosis for recovery. The peculiarity of the spine sarcoma is that the disease is very rare. Timely diagnosis and properly formulated therapy - increase the chances of a successful recovery.