Fix my Spine – The “C” that must not be named

With Iona Collins MBBS, BMedSci(Hons), MRCS, FRC(Orth) Consultant Spinal Surgeon and founder of the website fixmyspine.co.uk

Young man is signalling hush with his finger on his lips

We avoid talking about “C”. Just like Harry Potter’s Nemesis, Lord Voldemort, or “he who must not be named”, cancer is a scary, emotional word which many still equate with imminent death. But, while this may have been true forty years ago, we are now on average living twice as long with this condition compared with people who were given the diagnosis of cancer back then.

fix-graphThe charity Cancer Research UK published that, on average, 50% of everyone with the diagnosis of cancer can expect to live at least a further ten years. They also reported that the commoner cancers which are detected early tend to offer us the best chance of survival. But, while we can have realistic hope if we’re diagnosed early, we need to accept that we may now have a chronic condition, which needs keeping an eye on.

Self-Maintenance

Mechanic using laptop while repairing car in garage

We can treat our bodies a little bit like we treat cars, in thata car which is treated carefully and regularly serviced is more likely to last longer. If a problem is ignored, then when the car eventually breaks down, the chances are, the problem is now a big and expensive one to deal with – it may even be unfixable.

So, when we spot problems with ourselves at an early stage, we are far more likely to have successful treatment for whatever the problem tends to be, compared with waiting until problems are too big to ignore any longer.

The spine is no exception, when it’s one of the commonest parts of the body affected by cancer which spreads (secondary, or metastatic cancer). A study in 1958 demonstrated that cancer can be detected in the spines of 70% of people with secondary cancer, although the spinal deposits, or spinal metastases, may not necessarily grow or cause problems. This means that while we are likely to have spinal metastases when we have advanced cancer, we are unlikely to have problems from them, so there’s no point in treating them – unless they start causing problems.

HERE IS A CHECKLIST OF SYMPTOMS WHICH OUGHT TO BE CHECKED OUT PROMPTLY IF YOU HAVE CANCER.

Problems that can be caused by spinal metastases:

Back pain

Back pain is a common symptom experienced by around 80% of the whole population during their lifetime. Since cancer is so common in the general population, then it can be very tricky to spot the difference between back pain due to wear and tear in the spine and back pain due to spinal cancer/ spinal metastases. The National Institute of Clinical Excellence said that if health professionals feel that the back pain might be due to spinal cancer, then an MRI should be organised, preferably within one week. On the other hand, if the health professional felt that the back pain was not due to spinal cancer, then a close eye should be kept on the person to make sure that the back pain doesn’t get worse- if the pain worsens, then it’s very difficult to rule out the possibility of spinal cancer without getting a prompt MRI.

Jelly legs

This is a description that I’ve heard so many times from people who develop weakness in their legs due to spinal cancer. Sometimes, jelly legs can mean that the spinal cancer is affecting the spinal cord, so the legs feel slightly uncontrolled, or uncoordinated, when moving around. This is a symptom which needs to be investigated with MRI as soon as possible, in order to stop the development of weakness in the legs, which can sometimes happen quickly.

Sciatica

A spinal cancer can interfere with a nerve in the back and cause leg pain like sciatica. Sciatica in people with known cancer should have a prompt MRI to see whether the cancer is causing the sciatica, in which case, further treatment can be discussed.

Arm weakness and/or pain

If a spinal cancer is in the neck, it can cause problems with the arms, which require a prompt MRI to find out what is causing the arm problem and what can be done to help.

Neck pain

Increasingly severe neck pain should be investigated with a prompt MRI if you know that you have cancer already, as the cancer can cause spinal cancer in the neck, which can cause pain.

Pain in the middle of the back, spreading like a band to the front of the body

This symptom can sometimes represent a spinal cancer in the thoracic spine (the part of the spine where the ribs come from). If the spinal cancer also involves a nerve in this region, the pain tends to follow the path of a rib and can feel like a band of pain.

Bladder and bowel change of habit

This is a very non-specific problem, but if we get this symptom along with a known diagnosis of cancer, it’s worth discussing this with a doctor urgently, to see whether this may reflect a spinal cancer causing problems (cauda equina syndrome).

This list is not exhaustive and other conditions can cause these symptoms too, but this list covers the more common problems that spinal cancer can cause.

The main message is that we are likely to either experience cancer ourselves, or know someone close to us with this condition. The spine is a common part of the body that cancer spreads to, so if we develop back problems, leg problems, arm problems or toilet problems, especially if we know that our cancer has spread, then we need to flag this up straight away with our doctors, so that we can have an MRI, which will either reassure us, or hopefully make sure that we can have effective treatment such as radiotherapy if we’ve caught the problematic spinal cancer at an early stage.

FURTHER READING:

The charity Cancer Research UK has lots of statistics about different types of cancers in the UK. Here’s their website: www.cancerresearchuk.org/health-professional/cancer-statistics/risk/lifetime-risk

The National Institute of Clinical Excellence (NICE) published guidance on the diagnosis and treatment of spinal cancer which causes spinal cord compression in 2008. You can read the full guideline here: www.nice.org.uk/guidance/cg75/evidence/full-guideline-242052589

Roy Patchell’s landmark paper in the Lancet, 2005, proved that spinal surgery and radiotherapy together stopped morepeople from becoming permanently paralysed compared with radiotherapy alone. His paper his online is here: www.thelancet.com/pdfs/journals/lancet/PIIS0140673605669541.pdf

The American College of Radiologists last updated their collective evidence-based opinion in relation to radiotherapyand surgery in 2012. The document can be found here: https://acsearch.acr.org/docs/71097/Narrative/

 

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