Persistent pain in the back? Here’s why you must not ignore it

For some patients, persistent back pain may be an early symptom of a tumour in the spinal column, which if not treated on time may lead to cancer, writes Shillpi A Singh

A normal pain in the back is what most of us suffer quite often and tend to ignore it on most occasions thinking what’s the big deal about it? Well, it might not be. But in some cases, back pain may be an early symptom of a tumour in the spinal column that if not treated on time may lead to spinal cancer. As we all know that the spine is made up of bones called vertebrae, and it provides three vital functions for the body – support, protection, and flexibility. Dr Mihir Bapat, Director of Spine Department, Nanavati Super Speciality Hospital, Mumbai, says, “Spine is one of the most frequent locations where medical professionals are seeing metastatic disease. Complications related to spine are many and spinal cancer, though rare, it is a major concern.”

As it happened in the case of Matunga-resident Malti Shri, 66, who had a history of cancer and suddenly developed a nagging pain in her back that was persistent and progressive. “I realised that it was not activity related and got worse at night. What added to my woes was when I started developing other symptoms of cancer, such as nausea, vomiting or dizziness. I had survived a bout of breast cancer in my late fifties, and this was a scary situation to start my new year,” says Shri, who started having progressive muscle weakness or numbness and loss of sensation in her legs and arms. The pain worsened over a period and spread beyond her back to hips, legs, feet or arms.

Decoding tumour

The tumours may affect your spinal cord or the nerve roots, blood vessels or bones of your spine. A spinal tumour is a cancerous (malignant) or noncancerous (benign) growth that develops within or near the spinal cord or within the bones of the spine. A cancerous spinal tumour can threaten life and cause permanent disability. Unfortunately, these tumours are not preventable. However, with new treatments, spinal cancer can be managed effectively. “Spinal tumours are classified based on their type, severity and location on the spine. Some tumours are metastatic tumours, which means they spread to the spine from another location in the body, such as the breast, lungs, prostate or kidney as it happened in Shri’s case,” says Dr Sara Ansari, Spine Consultant, QI Spine Clinic, Ghatkopar (East).

Evaluating symptoms 

Among all the body tumours, nearly 5% involve spine tumours, and most spine tumours occur sporadically. These tumours can compress spinal nerves, leading to a loss of movement or sensation below the location of a tumour that can sometimes cause changes in bowel and bladder function. In some cases, nerve damage may be irreversible. But if diagnosed early and treated aggressively, it may be possible to prevent further loss of function and regain nerve function. Depending on its location, a tumour that presses against the spinal cord itself may be life-threatening.

But if a tumour is found in the spine, and the patient has never had any previous history of cancer, a thorough examination of all common organs where cancer develops is usually done at the first instance. “The evaluation includes taking into account the complete medical history, physical and neurological examination, radiographic studies of the spine, chest and GI system to screen for tumours and MRI and CAT scans to examine the spine to ascertain a tumour and the spinal health,” says Dr Ansari.

Course of treatment

Most common age group for primary spine tumour is 30-40 years, and for a secondary tumour, it is more than 60 years. “Newer advances in spinal tumour treatment offer more options than ever before. Most vertebral body tumours are treated surgically by removing affected bone and stabilising vertebral columns with rods and screws,” adds Dr Bapat.

Surgical removal is the best option for some forms of tumours as was in Shri’s case, yet large tumours at the end of the spine may be impossible to remove from the many nerves in this area. Although non-cancerous tumours in the vertebrae can usually be removed entirely, metastatic tumours are less likely to be operable. “When a tumour has spread to the spine, radiation alone is usually the most viable treatment of choice. However, research has found that surgery combined with radiation may be more effective at preventing loss of nerve function in people who are healthy enough to tolerate an operation and who have tumours that have spread from an unknown location. It may also be useful for those who have some evidence of nerve injury and have tumours resistant to radiation or have recurrent tumours that were previously irradiated,” he adds.

Standard radiation therapy and Stereotactic Radio Surgery (SRS) are the newer methods, capable of delivering a high dose of precisely targeted radiation and are being studied for the treatment of spinal tumours because some tumours, benign or malignant, may reoccur.

Signs and symptoms may include:

• Pain at the site of a tumour due to tumour growth.
• Back pain, often radiating to other parts of the body.
• Feeling less sensitive to pain, heat and cold.
• Loss of bowel or bladder function.
• Difficulty walking.
• Back pain that worsens at night.
• Loss of sensation or numbness, especially in arms or legs.
• Muscle weakness, which may be mild or severe, in different parts of the body.