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68 Cards in this Set
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These tumors can travel to the spinal bones (vertebrae), causing pain and, on occasion, collapse of the vertebrae. These tumors can also affect the soft tissues and spaces surrounding the spine (the epidural space) and compress the spinal cord or the spinal nerves, resulting in pain, paralysis, sensory loss, and/or loss of bowel or bladder control.
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All of these areas of tumor spread are termed “metastatic disease of the spine” or “spinal metastases.”
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Metastatic tumors of the spine are far more common than primary tumors of the spine.
T or F |
True
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the most common location of metastatic disease
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The spine
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What percent of all cancer patients will have symptoms from their spinal metastases during their lifetime, with the rest having cancer in their spine but not having major problems from it. ?
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about 10% will have symptoms from their spinal metastases during their lifetime
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In which way does Spinal metastases most commonly migrate into the spine and other parts of the body.
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through the bloodstream
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What do Most patients who develop symptoms from their metastatic tumors to the spine first experience
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pain
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The pain may be mild at first and often mistaken for arthritis or a mild back strain. It may be treatable initially with acetaminophen or ibuprofen but will generally progress in severity over days or weeks, becoming more constant and severe. Other patients will have only minimal pain and then one day experience a rapid increase in symptoms often with little or no provocation. Some patients will experience pain wrapping around their chest, while others may experience pain running down their leg. Some patients will experience only pain, while others may also suffer from weakness in their arms or legs. The weakness may be mild or may progress to paralysis in a relatively short period of time. What are these sympoms of?
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patients who develop symptoms from their metastatic tumors to the spine
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Spine Metastases/ Symptoms
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Most patients who develop symptoms from their metastatic tumors to the spine first experience
#1pain. Back pain Spine deformity Spinal cord and nerve compression Neurologic dysfunction |
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What are the three major reasons why cancer involving the spine may cause pain for the patient.
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Pain may be caused by a tumor replacing the bone marrow in the bodies of the spine.
The second reason for pain is when the tumor destroys enough of the vertebra to cause either a mild or a severe break in the bone. The other cause of pain (and in some cases weakness or paralysis) is when the cancer grows out of the bone and puts pressure on the spinal cord. |
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Modality of choice for Spine Metastases
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Magnetic resonance imaging (MRI) with contrast is the most reliable method of diagnosing spinal metastasis. It is capable of identifying tumors involving the spinal bones, spinal cord and nerves, and other organ systems.
Other useful tests include spinal x-rays, bone scans, CT Scans, myelograms with spinal fluid testing, and other diagnostic examinations. A biopsy or excision of the tumor may be performed to establish the tissue type of the tumor and allow the formulation of a specific treatment plan for that type of tumor. |
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Glioblastoma Multiforme / Glioma /
Oligodendroglioma are all AKA: ? |
Spinal Cord Astrocytoma
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a rare class of tumor that develops from (neuroepithelial or support) cells.
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Gliomas
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Astrocytes, ependymal, and oligodendroglial cells are all examples of 1.____ cells that compose the supportive tissue of 2.___ _____ .
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1. glial
2. the brain |
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These comprise nearly one-half of primary brain tumors and one-fifth of all primary spinal cord tumors.
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Gliomas
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1 __________ are tumors of the spinal cord that develop within spinal cord cells called 2.________ .
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1.Astrocytomas
2. astrocytes |
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These tumors generally appear in the upper spinal cord, near the neck and top of the chest.
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Astrocytomas
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The modality of choice with spinal cord tumours is ...?
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MRI scanning (with or without contrast) which is able to produce highly detailed images of the spinal cord.
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Spinal Cord Astrocytoma/ Treatment
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Surgery is the spinal cord tumor treatment of choice and should be considered where possible, especially for patients with lower-grade astrocytomas,
another option may include observation (Periodic MRI scans monitor tumor growth to ensure the tumor doesn't become too large), |
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Spinal Cord Astrocytoma/ Treatment for patients that do NOT have lower grade astrocytomas are ;??
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chemotherapy, radiation (may be useful for highly aggressive tumors, inoperable tumors, remaining tumors following surgery and in cases of recurrence) or drug treatment.
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What are some of the Factors considered in developing a treatment plan for Spinal Cord Astrocytoma ?
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Some of the factors include the location, type and size of the tumor and whether or not it is metastatic (that is, cancer that originated somewhere else on the body and spread to the spine).
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a tumor that arises from the ependyma, a tissue of the central nervous system. Usually, in children the location is intracranial, while in adults it is spinal
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Ependymoma
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The common location of intracranial ependymoma is 1.___ _____ ______. Rarely, ependymoma can occur in 2.___ ______ ______ .
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1. the fourth ventricle
2. the pelvic cavity |
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the most frequent spinal cord tumors in adult patients.
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Ependymomas
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Although magnetic resonance imaging can be a highly accurate diagnostic tool, it does not always provide accurate differentiation between ________ and_____.
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ependymomas and astrocytomas.
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The symptoms of an ependymoma in the spinal cord will depend on which part of the spine is affected. Symptoms include ;??
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neck or back pain, and sometimes numbness or weakness in the limbs and loss of bladder control.
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What are some of the Spinal Cord Ependymoma Tests and investigations ?
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Neurological examination (nerve tests )
CT (computerised tomography) scan MRI (magnetic resonance imaging) scan Biopsy / Lumbar puncture |
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Spinal Cord Ependymoma Treatment involves what?
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Surgery
Radiotherapy Chemotherapy |
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a type of tumor that develops from the membrane that surrounds the brain and spinal cord.
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A meningioma.
It develops from the meninges, the membrane that surrounds the brain and spinal cord. |
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meningiomas (__%) are categorized as benign tumors, with the remaining __ % being atypical or malignant.
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1.90% are categorized as benign.
2.10% being atypical or malignant. |
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Tumors occurring predominantly in the thoracic spine that can be either intradural (within or enclosed within the dura mater), or extramedullary, (outside or unrelated to any medulla)
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Spinal meningiomas
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These may cause seizures, headaches, and focal neurological defects, such as arm or leg weakness, or vision loss.
They can cause back pain, or pain in the limbs from compression of the nerves where they run into the spinal cord. Sometimes memory loss, carelessness, and unsteadiness are the only symptoms. |
Spinal Meningioma
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Spinal Meningioma
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Spinal Meningioma Diagnosis is made by; ?
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a contrast enhanced CT and/or MRI (magnetic resonance imaging) scan.
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Spinal Meningioma
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Spinal Meningioma/ Treatment
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If a meningioma is small and does not cause symptoms, it may be observed over time rather than treated immediately. In cases in which treatment is necessary, the first line of treatment for these tumors usually is surgery. Because the tumors are benign, and rarely invade the surrounding spinal cord tissue, complete resection often results in a cure. Some tumors, however, may be difficult to remove completely. In addition, meningiomas have a tendency to recur even in cases of complete resection.
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Spinal Meningioma
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a primary, benign vascular tumor most common in the thoracic and lumbar spine.This type of tumor typically affects the vertebral body, but also can affect muscles. The tumor has few symptoms, and is often found on examination for another condition.
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Spinal Hemangioma
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Spinal Hemangioma
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the most common benign spinal neoplasms, often located in the thoracic and lumbar spine.
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Spinal Hemangioma
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Spinal Hemangioma
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patients are closely watched for signs of compression fractures, neurologic dysfunction or the development of a soft tissue mass as a result of a?
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Spinal Hemangioma
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Spinal Hemangioma
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Spinal Hemangioma Treatment
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Treatment depends on the size and location of the hemangioma. A combination of embolization (i.e. closing the blood flow), excision (surgical removal of the tumor) and radiation therapy is typical.
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Spinal Hemangioma
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a common, benign, fluid-containing lesion
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The simple bone cyst
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Bone or spinal cyst
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a fluid-filled sac that develop as a result of degeneration in the facet joint in the lumbar spine. It is typically a process that only happens in the lumbar spine, and it almost always develops at the L4-L5 level (rarely at L3-L4).
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Synovial cysts
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Synovial cysts
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The pain probably comes from the venous blood around the nerves not being able to drain and this leads to pain and irritation of the nerves. Sitting down allows the blood to drain and relieves the pressure. Name the pathology likely involved.
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Synovial cysts
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Synovial cysts
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There are three main treatment choices for synovial cysts in the lumbar spine:
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Observation and activity modifications
Injections Surgery |
synovial cysts in the lumbar spine:
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spinal arachnoid cysts can be broadly characterized as either
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extradural or intradural.
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spinal arachnoid cysts
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extradural outpouchings of arachnoid that are contiguous with the spinal subarachnoid space via a small dural defect. They typically occur in the thoracic spine dorsal to the spinal cord, although they may be found elsewhere.
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Extradural arachnoid cysts
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Extradural arachnoid cysts
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outpouchings of arachnoid that, regardless of size, lie entirely within the dural space.
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Intradural arachnoid cysts
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Intradural arachnoid cysts
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Which are more common?Intradural arachnoid cysts or extradural cysts.
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Intradural arachnoid cysts are more common than extradural cysts.
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arachnoid cysts
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1.______ is the most sensitive and specific study for detecting a spinal arachnoid cyst.
2._________ _________ ___ can help differentiate an epidermoid cyst from an arachnoid cyst. It may also help differentiate a cyst from an abscess or tumor. |
1. MRI
2. Diffusion-weighted MRI |
arachnoid cyst
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spinal arachnoid cysts .treatments
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For incidentally discovered spinal arachnoid cysts that cause no symptoms— most of them—surgery is not recommended.
Complete resection is ideal treatment. Drain cysts that cannot be resected. Yearly imaging should be done to detect any new abnormality and determine whether the cyst is truly benign. |
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They are dilations of the nerve root sheaths and are abnormal sacs filled with cerebrospinal fluid (CSF) that can cause a progressively painful radiculopathy (nerve pain).
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Tarlov cysts (TCs) are also known as perineural/perineurial, or sacral nerve root cysts.
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Tarlov cysts (TCs) are also known as perineural/perineurial, or sacral nerve root cysts.
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These are located most prevalently at the S2, S3 level of the sacrum.
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Tarlov cysts (TCs) are also known as perineural/perineurial, or sacral nerve root cysts.
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Tarlov cysts (TCs) are also known as perineural/perineurial, or sacral nerve root cysts.
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appear on MRI to be dilated or ballooned areas of the sheaths that cover nerve roots exiting from the sacral region of the spinal column.
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Tarlov cysts (TCs) are also known as perineural/perineurial, or sacral nerve root cysts.
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Tarlov cysts (TCs) are also known as perineural/perineurial, or sacral nerve root cysts.
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When radiation passes through the body to kill damaged or cancerous cells, it can also damage healthy cells by destroying the chemical compound. Ionizing radiation (IR) can tear atoms and molecules apart causing what we call
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radiation injury
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radiation injury
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Any person can be exposed to IR by
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stepping outside in the sunlight,
by X-ray machines and, less commonly, by radioactive elements. |
radiation injury
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will usually present with skin reaction, digestive tract reaction and/or bone marrow depression. White blood cells and platelets decrease rapidly. Red blood cells also can decrease. These symptoms go away in a matter of weeks.
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Acute radiation damage from abdominal or pelvic irradiation
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postradiation injury; Acute radiation damage from abdominal or pelvic irradiation
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damage to the endothelial wall of the blood vessel
damage directly to the chromosomes of the affected cells |
Late Effects of Radiation: Permanent Radiation Damage.
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postradiation injury; Late Effects of Radiation: Permanent Radiation Damage.
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hardening of a blood vessel from a build up of plaque. Plaque is made of fatty deposits, cholesterol, and calcium. It build on the inside lining of arteries. This causes the artery to narrow and harden. It affects large and medium-sized arteries.
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Atherosclerosis
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Atherosclerosis
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a stroke either within the spinal cord or the arteries that supply it. It is caused by arteriosclerosis or a thickening or closing of the major arteries to the spinal cord.
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Spinal Infarction
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Spinal Infarction
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Frequently spinal cord infarction is caused by a specific form of arteriosclerosis called
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atheromatosis
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atheromatosis
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a deposit
or accumulation of lipid-containing matter forms within the arteries. |
atheromatosis
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atheromatosis
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Symptoms, which generally appear within minutes or a few hours , may include intermittent sharp or burning back pain, aching pain down through the legs, weakness in the legs, paralysis, loss of deep tendon reflexes, loss of pain and temperature sensation, and incontinence.
It is uncommon and usually presents with sudden onset of paralysis and sensory disturbances. |
Spinal cord infarction
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Spinal cord infarction
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clusters of abnormal blood vessels found in the brain, spinal cord, and, rarely, in other areas of the body.
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Cavernous angioma
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Cavernous angioma
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looks somewhat like a raspberry.
It is made of multiple little bubbles of various sizes, filled with blood and lined by a special layer of cells (endothelium). These cells are similar to those that line normal blood vessels, but the bubble-like structures of one of these are leaky and lack the other layers of normal blood vessel walls. |
A typical cavernoma
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A typical cavernoma
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Cavernous angioma are also know as;
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cavernoma
cavernous hemangioma cerebral cavernous malformation (CCM) |
cavernoma
cavernous angioma cavernous hemangioma cerebral cavernous malformation (CCM) |
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A __________ can cause seizures, stroke symptoms, hemorrhages (The higher the number, the greater the chance of one or more haemorrhages occurring), and headache.
and also can cause neurological deficits such as weaknesses in arms or legs, vision problems, balance problems, or memory and attention problems. Symptoms may come and go as the _______ changes in size with bleeding and re-absorption of blood. |
cavernoma
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cavernoma
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Cavernous angioma; what is the best means of diagnosing this illness?
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An MRI scan, with and without contrast and with gradient echo sequences, read by an experienced physician remains the best means of diagnosing this illness. The MRI scan may need to be repeated to assess change in the size of a cavernoma, recent bleeding, or the appearance of new lesions.
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Cavernous angioma
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a controversial treatment that has been used on cavernomas too dangerous to reach through traditional surgery.
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Radiosurgery, by gamma knife, linear accelerator or new shaped beam techniques
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Cavernous angioma
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a disorder in which a cyst forms within the spinal cord. This cyst, called a syrinx, expands and elongates over time, destroying a portion of the spinal cord from its center and expanding outward. As a syrinx widens it compresses and injures nerve fibers that carry information from the brain to the extremities.
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Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder in which a cyst forms within the spinal cord
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Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder in which a cyst forms within the spinal cord
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Tis diorder may cause; Damage to the spinal cord often leads to progressive weakness in the arms and legs, stiffness in the back, shoulders, arms, or legs, and chronic, severe pain. Other symptoms may include headaches, a loss of the ability to feel extremes of hot or cold (especially in the hands), and loss of bladder and other functions.
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Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder in which a cyst forms within the spinal cord.
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Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder in which a cyst forms within the spinal cord.
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Syringomyelia (sear-IN-go-my-EEL-ya) is a disorder in which a cyst forms within the spinal cord. This cyst, called
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a syrinx
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a syrinx
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