Spine-Directed Oncology Program Archive Questions

Below are Dr. Kwok’s answers to Spine-Directed Oncology Program questions
received through the Ask the Expert feature.

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Now displaying records 1 to 11 of 11.

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Q : 1 04/18/2009	At the age of 15 my son had bone tumor (CMF) at the lower spine. He was operated on to remove the tumor in 2002. It reappeared in 2009. He once again has been operated upon, but a small portion has been still left in. I shall be grateful to you for your kind advise in the matter. Any new research or treatment on the Condramyxiod Fibroma? CMF is a very rare tumor and spinal location presents a challenge. Surgery is the treatment of choice, but complete resection is often not possible due to locations such as base of skull or spine. There are reported cases of using radiation therapy [Feuvret L, Noël G, Calugaru V, et al. Chondromyxoid fibroma of the skull base: differential diagnosis and radiotherapy: two case reports and a review of the literature. Acta Oncol. 2005;44(6):545-53]. You should be able to find this article at any major medical library. Typically it is recommended not to use radiation based on a single reported case in the medical literature of a malignant transformation. One must remember that this is extremely rare and that it must be balanced against the potentially serious morbidity of repeated surgeries. There is a nice review article by Hakan et al [Hakan T, Vardar Aker F. Chondromyxoid fibroma of frontal bone: a case report and review of the literature. Turk Neurosurg. 2008 Jul;18(3):249-53]. This article will be a bit more difficult to get, but a medical library should be able to order this. Hakan recommends post-operative radiation for incompletely resected tumors since there are severe complications associated with recurrences and repeated surgeries. It is difficult for me to go into specifics of your son's case not having films, path, etc., but you should get a consultation from a good radiation oncologist. The decision to give him radiation now or later must be made in a multi-disciplinary fashion with full input from the surgeon and radiation oncologist.
Q : 2 03/29/2009	My wife has been undergoing radiation treatment (10 sessions) for breast cancer which spread to spine. She is scheduled to get monthly IV of Zometa. Is there anything else we should be looking into? She is receiving the standard course of radiation at a first rate radiation oncology department. She is getting Zometa to strengthen her bones. It appears that your wife is getting the standard of care. The next step is to see her medical oncologist to see if she qualifies for a clinical trial of chemotherapy. Good luck!
Q : 3 02/19/2009	My mother has a tumor is her lower back, I believe it is on the sacrum. Can surgery be performed on this area of the back? The tumor has already caused some bone loss. Yes, tumors of the sacrum can be removed with surgery provided they are resectable. This can be assessed by a MRI or a CT scan. More importantly, she will need to have a consultation with a surgeon who has a significant amount of experience since her function can be effected after the procedure.
Q : 4 12/11/2008	I have had a lumbar spine X-rays at my chiropractors and I now have been referred to my GP as he seems to have found something odd-looking in the breast area. Is it possible to find such a thing on a spinal X-ray? (I went in with back pain which I've had for many years). It seems this is quite a large mass and it is described as "radiolucent." Any information at this stage would be appreciated. Breast cancer diagnosis must be explored for couple of scenerios regarding spinal x-rays. First, if the spinal x-ray catches a view of a portion of the breast and there is an abnormality, then breast cancer diagnosis must be ruled out by mammogram/biopsy. Second, if the spinal x-ray demonstrates a large radiolucent mass on the spine as in this case, then a breast cancer must be ruled out because breast cancer very commonly spreads to the bones and spine. Therefore, it is crucial that your GP examines your breast and rules out a breast cancer diagnosis, particulary if you have: never had a screening mammogram; a past diagnosis of breast cancer; or a strong family history of breast cancer. Hope this helps and good luck.
Q : 5 03/09/2008	I have had some type of painful lesions that have gathered around my spine and other boney areas of my body. Some doctors find them hard to palpate. They are very tender and do not go away, but spread. Dermatologists, Rheumatologists, Endocrinologist, etc. have all turned me away. I don't know who to go to for a biopsy of these lesions. When I touch them in my lower back, the pain radiates in a straight line up to my right shoulder. They have become worse in my lower back and straight up my spine. (I do have spinal problems and have problems having bowel movements which a general surgeon suggested could be neurological). I am not sure of who to see or who to ask these questions to. Can you help me? If what you say is true, then something like an MRI of the spine may help. This may end up showing nothing and you may not need a biopsy. We typically do not biopsy unless CT or/and MRI shows a lesion that can be biopsied. I would thus start with an imaging of some sort, which would be ordered by your primary care physician if he or she deems it necessary.
Q : 6 03/02/2008	My father is 75-yrs old and has a tumor on his spine detected by MRI and CT. At the same time, a 11 mm lesion on his lung was detected. The spine is causing him a great amount of pain but so far he is not suffering paralysis, incontinence, etc. The MRI and CT was conducted 2 wks ago, then a consult with ortho, then PET scan, this coming week a radiation consult, blood work, then a lung biopsy followed by a consult with oncologist on diagnosis and treatment plan. It appears it will be 4 weeks before any kind of treatment occurs on the spinal tumor from the time it was detected on the MRI and CT. Is this a normal length of time? The pain continues to worsen for my father. It is very difficult to judge whether this is a "normal" time period or not without knowing all the details. It is clear that physicians are monitoring your father's condition. We always try to move things along in an expeditious manner; however, it is not unusual that it takes 4 weeks to get therapy started if the situation is sufficiently complicated. A simple thing like uncertainty in the biopsy can delay things. It is imperative that you contact his physicians immediately and call 911 should his neurologic symptoms worsen abruptly, such as paralysis.
Q : 7 02/27/2008	I have been diagnosed as having a small syrinx in the c6-c7 area of my spine. I tried to get referred to a neurosurgeon locally, but all I got was a reply stating that what I have cannot be treated and I will just have to live with the pain that it is causing me. Are such things as a syrinx quite common? Should I arrange to get a second opinion? I am a 33-year-old male. It is a very well known entity, especially in a major academic hospitals. It is very difficult to judge whether your syrinx is surgically amenable or not, without looking at your MRI. They can often be fixed by an experienced spine surgeon. If you have constant pain, then a second opinion is very reasonable.
Q : 8 11/05/2007	In 2006, I had a L3 vertebrectomy. I was diagnosed with renal cell carcinoma with metastases to the lumbar region. Since that time, I have had level 5+ pain. The pain subsides when I lay down, but when I walk, sit, or stand, the pain increases. I have been hospitalized twice for pain management. The only solution suggested is what they call "micro movement" of the cage that was placed in the L3 vertebrae section. There must be some way to fix this post-surgical problem. I had radiation, and I am now taking sutant for the renal cell cancer. In July, metastases was reappearing in the spine area. It is difficult to comment on the situation without knowing the MRI appearance and radiation details. The pain can come from variety of problems, including pressure from the bone, tumor, scarring and others. There are options for effective pain control, including placement of pumps or stimulators in the spine. Therefore, it is worth while getting an opinion from a pain specialist. Regarding local tumor recurrence, this has to be thoroughly discussed with the medical/surgical/radiation oncologists, as this may be the cause of pain.
Q : 9 10/01/2007	I was found to have a schwanoma in the L-4 region about nine months ago, at which time the doctor said there wasn't much to be done. As the months go on, I am in more and more pain, and the numbness in my extremities has increased, but my doctor wishes to wait three months for another MRI. Should I wait or get a second opinion? If I wait, are there any real concerns I should know about? If the problem is getting worse, then one should think about doing something. I have not seen your images; however, it can be safely assumed that it is compressing on your nerves in the spinal canal. The anatomy can be quite complex, but these things can be excised, or decompressed. Further, these things can also be treated with stereotactic radiosurgery (aka, SBRT or extra-cranial radiosurgery). Sometimes we can do surgery and radiosurgery. Since the lesion is causing problems, it is very reasonable to get a second opinion with a neurosurgeon or a radiation oncologist specializing in spinal tumors.
Q : 10 09/26/2007	My brother is 64 and was told he has cancer: Sarcoma soft tissue Pent stage 4. He was told it is rare and a tumor was removed from his spine. He is incontient and has use of one leg. They are going to start radiation for 5 days and chemo. In rehab, he was sitting all day in a wheel chair getting around. Now that he is in the hospital, he is no longer up and is always tired due to the medication. Is it normal procedure for a patient to be that medicated before radiation as not to be able to sit up or stay awake? Any other information you can give would be appreciated. It is difficult to know what is causing him to not be able to sit up or stay awake. Radiation to the spine does not cause this. More commonly, it can be from some of the medications he is getting which are causing him to feel weak. Common medications like pain medications (morphine, oxycodone, etc), anti-anxiety medications (ativan, valium, etc) can causing significant drowsiness.
Q : 11 09/18/2007	Is it ever too late to try surgery for a large lumbar tumor (spinal axis tumor) that has displaced the spine and elevated the kidney? My friend experienced back pain in 7/07 and went to her PCP for an examination. She was told she had a very large tumor (9in. x 1in.)wrapped around & displacing her backbone and it's elevating her kidney. It's thought to be benign. She was told surgery would likely cause paralysis and do more harm than good, with a wait and see mentality. She is 51 and is in good physical shape; numbness in right arm at times and now experiencing a major kidney infection said to be caused from the elevation. Otherwise she is having only mild back pain in the local region of the tumor. Recently experienced a seizure with paralysis of her face on the right side (same side as the numbness of her arm). What other avenues can she try? Waiting with no treatment options seems to be giving up, while this tumor continues to grow. She has a copy of her doctor report from the tests and MRI. I will forward this to her with any recommendations you may have. Thank you for your time and consideration concerning this matter. Without a biopsy, it is very difficult to know from this e-mail how to proceed and figure out what can be done to help your friend. There are tumors that are amenable to radiation or chemotherapy that may significantly impact her quality of life, and then there are tumors that may not be helped by these modalities. The only way to find out what may help her is to find out what we are dealing with. I think a 2nd opinion is always prudent in difficult situations.

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