What To Do If You Have Symptoms
Contact your hospital team straight away if you have any symptoms of spinal cord compression. You should have an emergency number to call.
They might ask you to go to your nearest hospital straight away. This might not be your usual hospital. Its important to follow their instructions so you are seen quickly.
If you can’t get through to your hospital team, contact your GP or go to your nearest accident and emergency department .
Who Is At Risk
Around 3 to 5 in 100 people with cancer develop spinal cord compression. Almost any type of cancer can spread to the spine.
Youre at higher risk of developing spinal cord compression if you have cancer that:
- has already spread to your bones
- is at high risk of spreading to your bones, such as prostate, breast, lung or myeloma
- started in your spine
Medical Treatments For Pc
The standard medical therapy for mHNPC was androgen deprivation therapy. No patients received cytotoxic agents or new androgen receptor-targeted therapy for mHNPC. After failed to CRPC, bisphosphonates or denosumab, new androgen receptor-targeted therapy, radium-223, or cytotoxic agents were used if these agents were approved in Japan when the physician decided to use them. The treatment sequence for mCRPC was at the physicians discretion.
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General Treatments For The Metastatic Cancer
General treatments for metastatic cancer are often used, but many of these do not reduce the size of the metastases rapidly enough to prevent further damage. For men who have prostate cancer and who have not had androgen deprivation therapy , this is usually combined with radiation therapy and/or surgery.
Chemotherapy drugs may be useful along with radiation and/or surgery, especially with cancers such as non-Hodgkin’s lymphoma and small cell lung cancer. Targeted therapies and immunotherapy may also be used, as well as hormone therapy in women with breast cancer.
Dealing With Prostate Cancer
Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.
Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.
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What Happens After Treatment
MSCC can affect men in different ways. Getting treatment early can reduce the risk of long-term problems, but for some men it can take weeks or months to recover. Sometimes the effects can last longer or are permanent. Your doctor or nurse at the hospital will make sure you get the support you need.
If MSCC means that youre less able to walk and move around, a physiotherapist can show you exercises that can help. An occupational therapist can make sure you have the right equipment in your house so that youre comfortable and can move about more easily. Your doctor will also look at the treatments you are having for your prostate cancer, to see if they need changing.
Read about treatments that can help control the growth of prostate cancer or ways to manage symptoms of advanced prostate cancer.
If You Have Symptoms Of Mscc
If you have symptoms of MSCC, you should get medical advice immediately.
You should contact the hospital team where you usually go for cancer treatment and follow-up appointments. If you are unable to get in touch with anyone, go to the nearest Emergency Department or contact your GP.
When you speak to a health professional:
- tell them you have cancer and are worried you may have spinal cord compression
- describe your symptoms
- tell them that you need to be seen straight away.
Do not wait for further symptoms to develop. The sooner MSCC is diagnosed, the sooner treatment can begin. If left untreated, MSCC can cause permanent problems.
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How Do You Know If Prostate Cancer Has Spread
Prostate cancer that has spread to the liver, intestines, or bones of the abdomen and pelvis can usually be found with a CT scan. Cancer which has spread to the lymph nodes can sometimes be detected if the lymph nodes have become enlarged.
What is the prognosis for prostate cancer that has spread to the bones?
There is currently no cure for advanced prostate cancer, but advances in treatments are extending life expectancy and improving quality of life. The ACS state that the 5-year relative survival rate for individuals with prostate cancer that has spread to distant lymph nodes, organs, or the bones is 29 percent.
Observation Versus Screening Spinal Mri And Pre
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UKUrology Unit, Royal Marsden NHS Foundation Trust, London, UK
- Alec MinersAffiliations
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UKUrology Unit, Royal Marsden NHS Foundation Trust, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UKUrology Unit, Royal Marsden NHS Foundation Trust, London, UK
- Emma HallCorrespondenceCorrespondence to: Prof Emma Hall, Clinical Trials and Statistics Unit, The Institute of Cancer Research, London SM2 5NG, UK
- Contributed equally
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How Is Mscc Treated
If you are diagnosed with MSCC, you should start treatment as soon as possible ideally within 24 hours. Your doctor will explain the different treatment options to help you decide whats right for you. They will consider your wishes as far as possible. They will also support you and your family after treatment to help you recover from MSCC.
There are two main treatments available you may be offered one of these, or your doctor may suggest having both.
-
Radiotherapy.
This aims to shrink the cancer cells that are pressing on your spinal cord. It can also help to relieve the pain. High-energy X-ray beams are directed at the affected area from outside the body. This is known as external beam radiotherapy. You may have one or more treatment sessions your medical team will discuss this with you. Read more about radiotherapy for advanced prostate cancer.
-
Surgery.
Surgery is sometimes used to treat MSCC. Your doctor will discuss this with you if its suitable for you. It usually aims to reduce the pressure on your spinal cord and makes your spine more stable. Surgery is sometimes done at a specialist spinal unit. You might be given radiotherapy once youve recovered from surgery, to shrink any areas of cancer that might be left in the spine.
Injecting Bone Cement Into The Spine
You might have this treatment if painkillers arent controlling your pain. Or you might have it if the bones of the spine have collapsed.
Vertebroplasty or kyphoplasty are two ways of injecting special medical cement into the spine.
With a vertebroplasty your doctor injects the medical cement into the area where the swelling is pressing on the spinal cord.
Kyphoplasty is similar, but your doctor uses a balloon through a needle to help create the normal shape of the bone.
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Metastatic Spinal Cord Compression
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Bone Metastases In Patients With Metastatic Crpc
In approximately 80% of PCa patients bone metastases represent the initial and main metastatic site and are an important prognostic factor . About half of PCa patients with untreated bone metastases will experience at least one SRE over the period of 2 years .
The knowledge of the mechanisms underlying the development of bone metastases and the correlation between bone and cancer cells is of special importance with regard to the different therapeutic options for the management and prevention of SREs. Bone metastases in PCa are frequently osteoblastic, however an osteolytic element has also been confirmed in various reports , and the majority of lesions tend to be heterogeneous .
In clinical trials of bone-modifying agents for the treatment of bone metastases, the incidence of SREs was used as a composite primary endpoint , and they are recognized by the US Food and Drug Administration as a suitable endpoint to assess the efficacy of agents for the treatment of bone metastases in patients with cancer .
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Intradural Extramedullary Spinal Cord Metastasis Of The Prostate: A Case Presentation And Review Of The Literature
Published online by Cambridge University Press: 10 May 2016
- Amparo Wolf
- Affiliation:Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
- Ryan Johnstone
- Affiliation:Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
- Fawaz Siddiqi
- Affiliation:Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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Cancers That May Lead To Spinal Cord Compression
Spinal cord compression may be a complication of many forms of cancer, but the most common are breast cancer , lung cancer , and prostate cancer.
Other adult cancers often associated with the condition include kidney cancer , lymphomas, myeloma, thyroid cancer, genitourinary cancers, and digestive tract cancers. In children, spinal cord compression occurs most often with sarcomas and neuroblastomas.
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Can You Prevent Prostate Cancer From Spreading
The only 100% reliable way to prevent cancer from spreading is by taking it down while it is still localized. Other than that, we can only slow its progression or keep a careful look at it for any alarming sign.
Some patients treat their prostate cancer with a combination of surgery, radiation therapy, and other treatments.
Other patients may engage in watchful waiting or active surveillance. It consists of following-up cancer when it has a very low chance of spreading.
Worsening Back Or Neck Pain
As noted, the most common symptom of spinal cord compression is the new onset or worsening of pain in the back or neck, with these symptoms occurring in over 90 percent of people with the condition. Initially, the pain can be subtle, and easily dismissed.
The pain may be mild at first and worsen with time. It may become so severe that people are unable to sleep. It often worsens with lying down , and with weight-bearing, lifting, coughing, sneezing, and when bearing down to have a bowel movement. Early on, the pain may be localized to the spine, but eventually, radiate to the arms or legs if there is compression on the nerve root .
That said, it can be difficult to distinguish pain due to malignant spinal cord compression from benign causes, and it should always be evaluated.
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Quality Assessment Of Included Studies
Two reviewers performed the process of quality assessment independently using the Newcastle-Ottawa Scale . This scale employs a 9 stars system that assesses three domains: patient selection, comparability of study groups and ascertainment of study outcome. Studies with a score of less than 6 indicates a high chance of bias.
Quantitative data analysis
As the prognostic effects of the factors were represented with hazard ratio and 95% confidence interval in the primary studies, meta-analysis was performed using HR as effect size. In case with significant heterogeneity , random-effect model would be employed, while fixed-effect model was selected when no significant heterogeneity exists . Z test was used to test the significance of the pooled effect size.
When five or more studies were included in a quantitative analysis, sensitivity analysis and publication bias test would be conducted .
The statistical procedures were conducted through software of Stata version 15.0 . The statistical significance was defined at a two-sided p value of less than 0.05.
Specific Treatments For Bone Metastases
Specific treatment for bone metastases may also be used in addition to management of spinal cord compression, especially with cancers of the breast and prostate, lymphomas, and myelomas. Bone-modifying drugs such as bisphosphonates and the monoclonal antibody denosumab may help treat pain from bone metastases as well as decrease the risk of further metastases occurring.
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Causes And Risk Factors
- Lung cancer with bone metastases
- Breast cancer with bone metastases
Risk factors for spinal cord compression include cancers that commonly spread to bones. For example, with breast cancer, nearly 70 percent of people with metastatic breast cancer have bone metastases. They are more common in women who have invasive ductal carcinomas of the breast than lobular carcinomas, in which tumors that are estrogen and progesterone-receptor positive.
With all cancers, the risk of spinal cord compression is higher for tumors that are more aggressive and are diagnosed at more advanced stages of the disease.
What Symptoms Do I Need To Watch Out For
MSCC can cause any of the following symptoms.
- Pain or soreness in your lower, middle or upper back or neck. The pain might be severe or get worse over time. It might get worse when you cough, sneeze, lift or strain, go to the toilet, or lie down. It may wake you at night or stop you from sleeping.
- A narrow band of pain around your chest or abdomen that can move towards your back, buttocks or legs.
- Pain that moves down your arms or legs.
- Weakness or loss of control of your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.
- Numbness or tingling in your legs, arms, fingers, toes, buttocks, stomach area or chest that doesnt go away.
- Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.
These symptoms can also be caused by other conditions, but it’s still important to get medical advice straight away in case you do have MSCC.
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Data Source And Studies Retrieval
This review was conducted according to the guidelines outlined in Preferred Reporting Items for Systematic Reviews and Meta-analysis statement . Two individual reviewers retrieved the platforms of PubMed, Embase and CENTRAL, from the inception to October 2019. The key words used for searching include spinal metastasis, prostate cancer, overall survival and prognostic factor. In additional, the reference lists of the included studies were screened and potentially related studies were hand-searched for possible inclusion.
Developing Spinal Cord Compression From Cancer
Spinal cord compression due to cancer may occur when cancer spreads to the bones of the spine, and is sometimes the first symptom of cancer. Symptoms usually begin with back pain, that may radiate down the legs or arms, cause weakness or tingling, a band-like sensation in the chest, and/or bladder and bowel problems.
An MRI is the best test to diagnose the condition, though the entire spine should be examined. Treatments may include steroids, radiation, surgery, and more depending on the type of cancer. It occurs most commonly with cancers of the breast, lung, and prostate, though other cancers may cause the condition as well.
The prognosis of spinal cord compression depends on how quickly it is recognized and treated, and the possibility should be considered in anyone who has cancer and develops the new onset of back pain.
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Treatment For Spinal Cord Compression
Treatment for spinal cord compression should start as soon as possible, usually within 24 hours of diagnosis. This reduces the chance of permanent damage to the spinal cord.
Treatment can also control symptoms of compression. Some people have pain. Other people have nerve symptoms, such as numbness or tingling.
Your doctor will talk to you about your options. Treatment aims to get you back to normal as much as possible and as soon as possible.
Inclusion And Exclusion Criteria
All retrieved records were screened for final inclusion based on the following inclusion criteria: patients diagnosed as spinal metastasis from PCa studies associated with evaluating the prognostic effect of predict factors of overall survival studies designed as observational clinical study, including cohort studies and case-control studies would be eligible for inclusion. Studies would be excluded based on the following criteria: duplicated studies animal studies, literature review, commentary studies and meta-analyses studies used the same cohort.
Study selection and data extraction
After excluding the duplicates, the remained records were screened with their titles /abstracts according to the inclusion criteria. Then, the potentially related titles /abstracts were further assessed for the final inclusion using their full texts.
Two authors independently extracted the following data from included studies:
Study characteristics: lead author, publication year, lead authors country, study design and study period
Patients information: numbers of involved patients and patients with MSCC, median age, pre- and post-treatment neurological status, performance status, visceral metastasis, extraspinal bone metastasis, number of involved vertebrae, distribution of involved vertebrae, prostate-specific antigen , Gleason grade of PCa, and hormonal status
Outcomes information: overall survival and the associated prognostic factors.
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