Transcript Indicated if

Case One
MALIGNANT SPINAL CORD
COMPRESSION
What is it?
• compression of the spinal
cord by cancer tumour
• extra-dural compression
is most common (90%),
but can also be intradural
Which part of the spinal cord is
affected?
• cervical cord
10%
• thoracic cord
70%
• lumbo-sacral cord
20%
• Can also occur at more than one site/level
Which cancers?
• approx 5% of cancer patients develop SCC
• associated more commonly with:
- breast cancer
27%
- prostate cancer
27%
- lung cancer
20%
- myeloma
- kidney cancer
Clinical presentation –
• symptoms may be very subtle
• main problem is the failure to diagnose early resulting
in delay in Rx
Clinical presentation –
• localised back pain
• nerve root pain
• progressive numbness/tingling
• sensory loss (objective)
• weakness ('gone off their feet')
• loss of bladder/bowel control
What should make you suspect
diagnosis of SCC?
• primary tumour is breast, prostate, lung, myeloma
or kidney
• evidence/knowledge of multiple bone metastases,
especially in vertebrae
• back pain – night pain, progressive
• bilateral sensory symptoms, weakness
What should you do if you suspect it?
• arrange urgent admission to oncologist/radiotherapist
(easier said than done!)
• start dexamethasone 16mg od straight away if any delay
in admission (PPI cover)
What happens to the patient in
hospital?
• they should start dexamethasone 16mg od if not
already on it
• urgent MRI scan of spine
• if proven, urgent radiotherapy to cord compression area
Why is it important to diagnose and
treat SCC early?
• the outcome in SCC is critically dependent on the
speed of diagnosis and treatment
• it is possible to reverse neurological damage if treated
within 24-48 hrs of onset
• speed affects the difference between patient being
paralysed for the remainder of their illness or remaining
ambulant/walking
Success rates of SCC treatment with
Radio Rx
• depends on level of neurological function at presentation
to radiotherapist
• if patient is ambulatory – 70% retain ability to walk
• if patient is paraparetic – 35% retain ability to walk
• if patient is paraplegic – 5% retain ability to walk
The role of surgery
Indicated if:
• previous Radio Rx/ no response
• to RadioRx
• life expectancy > three months
• single site
• unstable spine
Take home messages
• SCC is a palliative care emergency
• prompt diagnosis and Rx can prevent paralysis
admit ASAP if suspicion of SCC (as long as
patient agrees and is not moribund)
• start steroids if any delay in admission