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.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 15 of 19.

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Q : 1 05/23/2010	Is cancer in the spine from metastatic breast cancer treated the same way as other cancers in the spine? I am looking for treatment for my mother who has it from breast cancer all through her spine and in the disk areas. Your site indicates that cancer of the spine originates somewhere else in the body, but doesn't make clear the differences between treatment options. If the breast cancer spreads to only one area in the spine, there are several options including surgery and stereotactic body radiation therapy. Unfortunately, your mother has breast cancer that has spread throughout the spine, so in cases like this, typically only the symptomatic (e.g., pain) areas are treated with fractionated radiation over two to three weeks. This kind of radiation can be safely delivered at many radiation oncology centers.
Q : 2 04/12/2010	My father was recently diagnosed with a leiomiosarcoma in the mouth. According to the surgeon who operated on him, the surgery was successful and no evidence of residual disease was found on further CT scan and MRI studies. I would like to know your opinion regarding the necessity for additional chemo and/or radiotherapy. This is difficult to assess at this point since I don't know the anatomy of the tumor. Microscopic residual disease by definition cannot be seen on CT/MRI scans. The fact that these scans did not show a large tumor that is detectable by the eyes of a radiologist is great sign. This is a relatively rare tumor that can definitely behave aggressively. Chemotherapy has not been shown to be beneficial after surgical resection of sarcomas. The value of radiation therapy is a different matter. Because of the rarity, there is a controversy regarding the role of radiation therapy. Therefore, we have to extrapolate from much more common location of sarcomas, which classically occurs in soft tissues of the extremities, such as the arms or legs. Adjuvant radiation therapy after surgery in soft tissue sarcomas of the extremity is the standard of care. Thus, if it were my "mouth" (ie., oral cavity), I would want adjuvant radiation. This could come in the form of external radiation or brachytherapy in the form of catheters. A significant factor in determining whether radiation is necessary is the pathology, whether there was a big margin or how big the tumor was. Your father must be evaluated by an experienced radiation oncologist. He should ideally be evaluated by a radiation oncologist who treats head and neck cancers.
Q : 3 03/14/2010	I was wondering if there were any treatment options for someone with a very symptomatic pineal cyst? On rare occasions, pineal cyst has to be drained either stereotactically or via a craniotomy. There are cystic tumors that can occur in this location. Thus, you have to be evaluated thoroughly by an experienced neurosurgeon.
Q : 4 03/05/2010	After several months of what I though was pain in my abdomen, I had an MRI the showed I have a bone lesion on T7and T8 of my spine and some area of the rib. I had an open biopsy on the lesion that showed normal tissue. My internist wants me to go to an Orthopedic Oncology surgeon because of the ongoing pain and the fact I have had swollen lymph nodes and weight loss of 30 lbs. Given that the biopsy was normal, is bone cancer still a possibility here and what else could cause all this? This is a difficult question to answer without examining the images and pathology. Clearly, there are sampling errors to biopsies and not infrequently, multiple biopsies may be performed. The differential diagnosis is very broad here, ranging from benign to malignant causes. Given that you have swollen lymph nodes, weight loss and bony abnormalities, it is crucial that you see an experienced oncologist to rule out a malignancy. Good luck.
Q : 5 01/04/2010	Is it possible for a glioma to spread to other parts of the body? A high-grade glioma such as glioblastoma multiforme can spread to other parts of the body, but this is very rare. If an undiagnosed metastatic cancer, such as lung or breast cancer, is involving the brain, then this is very serious and needs to be evaluated by an experienced physician as soon as possible.
Q : 6 11/30/2009	My mother-in-law was diagnosed with stage 4 breast cancer 3 years ago. She underwent a mastectomy, radiation and chemo. She has recently started having symptoms of headaches, vomiting, falls and seizures. They have found cancer cells in her spinal fluid and also detected a spot on her pancreas. They are inserting a port in the scalp to administer chemo through the spinal fluid. Is there any other treatment that could be considered and should they biopsy the spot on the pancreas? Nothing has been mentioned to this point. Doing a biopsy of the pancreas, which can be risky, is not necessary. It is presumed to be breast cancer metastasis. Chemotherapy to her spinal fluid (intrathecal chemotherapy) is precisely what she should be getting. Radiation should be given only if there is a local problem being caused by a tumor.
Q : 7 09/08/2009	My wife has breast cancer witch has spread to her spine. The MRI showed about 15 to 20 small tumors and we were told that this is too many for the CyberKnife. Are there any other treatments for the spine? When there are multiple lesions in the spine, we would only treat the area of the spine that is giving active symptoms such as pain. Otherwise, the goal would be to give chemotherapy to attack all lesions at once or with radiopharmaceutical agents like Samarium which is ideal for situations where many bony areas are giving pain.
Q : 8 05/24/2009	I've recently been diagnosed with blood feeding tumors scattered throughout my T-spine. I was told they are Hemangiomas. I don't know what the treatment or prognosis for Hemangiomas is, as I've not been told. I've had tumors or polyarteritis for 6 years without a biopsy for diagnosis. Can you tell me what Hemangiomas are? My arms seem to have gained a lot of hard fatty tissue that is painful and has limited my range of motion. I also have lumps in my face, mouth and tongue. These lumps are severely painful. Hemangiomas of the bone are rare benign vascular tumors. Almost universally, observation is recommended in patients who are asymptomatic. Only when structural problems arise (such as fractures, vertebral body collapses, spinal cord compressions, etc) that cause significant problems such as what you are experiencing, is surgery or other interventions needed. From your description, you may indeed have hemangiomas in your muscles and other soft tissues. Because you have pain and range of motion difficulties in your arms, it sounds like you need a consultation from an orthopedic surgeon.
Q : 9 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 : 10 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 : 11 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 : 12 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 : 13 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 : 14 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 : 15 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.

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