Getting an accurate diagnosis for a spinal tumor is important for determining an effective treatment plan. This process typically involves taking the patient’s history, performing a physical exam, medical imaging, and possibly a biopsy if a suspected tumor is found.
Taking the patient’s history is an important first step when new back pain has developed. Some basic info is gathered, including current symptoms, pre-existing conditions, past illnesses, injuries, medications, diet and lifestyle, and family history.
For patients with a current or previous history of cancer in another region of the body, it typically raises the risk of developing a spinal tumor. Depending on the stage or severity of the cancer, the treatments may vary.
A doctor will palpate along the back (or neck) and observe for any lesion, bump, instability, or other abnormalities. Clinical tests may also be performed to test the arms and/or legs for:
Any abnormal neurological functioning could indicate inflammation or compression of the spinal cord and/or a spinal nerve, and may need further investigation.
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When back pain is suspected to be caused by a spinal tumor, various medical imaging technologies may be considered.
- Computed tomography (CT) scan. CT scans are increasingly being used as first-line imaging for suspected spinal problems because, compared to x-rays, they give an enhanced view of the bones. A CT scan uses x-rays and a computer to create a series of cross-section images for greater detail.
- Magnetic resonance imaging (MRI) scan. MRI scans are the best at viewing soft tissues and can be particularly helpful in distinguishing tumors from other neurovascular structures. A gadolinium contrast-enhanced MRI can help identify whether a tumor is outside the spinal cord or inside the spinal cord.
- Positron emission tomography (PET) scan. PET scans can be useful in confirming whether an abnormality that has shown up on other imaging is a tumor. The patient is injected with a small amount of a radioactive tracer, typically a type of sugar, which flows through the bloodstream. A special camera is then used to identify areas of the body where the radioactive tracers have collected, which are more likely to be in tumor cells.
- Bone scan. This scan involves injection of a radioactive substance (tracer) that flows through the bloodstream and is absorbed by bones. Then a special camera is used to clearly see the bones and any areas of abnormal changes in the them, called hot spots.
In cases when MRI is not an option, a CT scan with myelography (a contrast dye) may be performed to visualize the soft tissues, such as tumors, in addition to the bones.
When a spinal tumor is suspected based on imaging, a biopsy may be requested for verification and/or to learn more about the tumor. Two general types of biopsies for spinal tumors include:
- Percutaneous needle biopsy. A needle is inserted through the skin and into the tumor using x-ray guidance. Percutaneous needle biopsy is the most common type when trying to diagnose a spinal tumor.
- Open biopsy. This biopsy is considered open surgery and usually occurs when another surgery is already planned. Open biopsy may be incisional (remove part of the tumor) or excisional (remove all of the tumor).
Sometimes biopsy is not requested for spinal tumors, such as in cases when an advanced cancer has already spread to the spine from another part of the body.
Blood tests may also be part of the diagnostic process for spinal tumors to help screen for cancer. It is also possible for a blood test to help confirm where a metastatic (secondary) tumor in the spine originally came from, such as the breast or prostate.1,2