SPINAL CORD TUMOURS

 

SPINAL CORD TUMOURS 

What is spinal cord tumours?

Spinal cord tumor is a cancerous growth in the spinal cord which  may be benign or malign ant. If the tumor presses against the spinal cord or nerve roots urgent medical attention is needed as the compression of the nerves can lead to paralysis even if the tumor is benign. spinal cord tumors often originate in other parts of the body and travel (metastasize) to the spinal cord.

 

Types of spinal cord tumors

Tumors that start in spinal tissue are called primary spinal tumors. Tumors that spread to the spine from some other place (metatastasis) are called secondary spinal tumors.

Ø  Intramedullary tumours:   are located within the nerves of the spinal cord . there are several different types of cancer of the spinal cord, but the most common are astrocytomas and ependymomas.

Ø  Intradural extramedullary tumours: start inside the covrings of the spinal cord ,but out side the cord itself. Meningiomas and  nerve-sheath tumours ,such as schwannomas ,are the most common types of intradural extramedullary  spinal tumour .

Ø  Extradural spinal tumours : some tumours start in the bones of the spinal (priymary bone tumours). There are several  different types of primary bone tumours. Benign tumours include chordomas and osteomas. Malignant tumours include osteosrcomas , chondrosarcomas and fibrosarcomas.

Ø  Secondary bone cancers: some cancers can spread into the bones of the sine (vertebrae) from elsewhere in the body .they are known as secondary bone cancers. The most common primary cancers to spread to the vertebrae include lung , breast,lymphoma and prostate cancer . myeloma is a cancer of the plasma cell that commonly affects the vertebrae.

 

Causes and Risk factors

     Symptoms are caused by pressure on the spinal cord and nerve roots. Pressure on the spinal cord may cause the following:-

 

o   Back and neck pain that  progressively worsens

o   Numbness, tingling and weakness or paralysis in either the arms or legs, or both

o   Decreased sensation

o   Erectile dysfunction

o   Loss of bladder and bowel control

o   Clumsiness and difficulty in walking

o   Muscle contactions or spasms

 

Pressure on the spinal cord may also block the blood supply to the cord, resulting in death  of tissue, fluid accumulation , and swelling . fluid accumulation may block more of the blood supply, leading to a vicious circle of damage.symptoms due to pressure on the spinal cord can worsen quickly.

Pressure on spinal nerve roots can cause pain, numbness, tingling, weakness in areas supplied by the compressed nerve root . pain may radiate along the nerve whose root is compressed . if compression continues, the affected muscles may waste away. Walking may be com difficult.

 

Diagnostic evaluations

       The first test to diagnose  drain and spinal column tumors is a neurological  examination. Special imaging techniques such as computerized tomography (CT), magnetic resonance iminclude the electroencephalogram (EEG) and the spinal tap. A  biopsy , a surgical procedure in which a sample of tissue is taken from a suspected tumor ,helps doctors diagnose the type of tumor.

 

Management

 

     The goal of treatment is  to reduce or prevent nerve damage from pressure on (compress ion of) the spinal cord . the treatment for a spinal tumor depends on a number of things, including age , general health,  and the position, size and type of tumor.

§  Surgery:  the aim of thesurgery is to remove the tumor without weakening the spine . surgery may be needed to relive compression on the spinal cord some tumors can be completey removed .  in other cases, part of the tumor may be removed to relieve pressure on the spinal cord.

            A  surgical technique called a decompressive laminectomy is  sometimes performed to                   relive pressure within the spinal canal . parts of several vertebrae , and some of the tumor , are removed. As well as relieving pressure, this enables samples of cell from the tumor to be taken (biopsy)to be taken , to find out which type of tumor it is.

§  Radiotherapy : radiotherapy uses high- energy rays to destroy the cancer cells while  doring as little harm as possible to normal cells .it is usually given by direction radiotherapy rays at the tumor from outside the body – known as external radiotherapy . it is used to treat spinal tumors that have not been completely removed  with surgery ,or if the tumor comes back after initial treatment. Radiotherapy is also sometimes used to relieve symptoms , such as pain.

§  Chemotherapy  :  chemotherapy is the use of anti-cancer  (cytotoxic) drugs that destroy cancer cells . chemotherapy is only occasionally used for certain types of spinal tumors . research is looking at ways of developing this types of treatment.

§  Steroids: steroids are chemicals ,naturally produced in the body by the reproductive organs , and the  adrenal  glands above the kidney .thy help control and regulate how the body  works. Steroids can be given as tablets or by injection, and can reduce the swelling that often surrounds spinal tumors. They may be used before or after surgery;or before , during or after radiotherapy. 

 

Nursing management of patlent with spinal cord tumor

Nursing  diagnosis	Nursing  interventions
1 . pain	Monitor pain of patient at least every 4 hourly. Assess quality(dull, piercing) location and other characteristics of pain.   ·         Identify activities that aggravate pain. ·         Administer analgesics as prescribed.   ·         Provide physical comfort measures. -Change position every 1-2 hours. -Maintain proper body alignment. ·         Provide special mattress e.g water or air mattress. Teach stress- reducing techniques for pain control e. g. relax-ation, guided imagery etc.
2. Impaired physical mobility
	·         Monitor motor function every 8 hours. ·         Teach the proper use of assistive devices ·         Administer range of motion exercises ·         Position the patient in proper body alignment every 2 hours: use supportive devices.
3. . Self care deficit	·         Monitor the effect of impaired mobility on ADLs. ·         Develop specific interventions to compensate for deficits. ·         Assist/provide the care to patient e.g skin care, turning every ·         2 hourly
4.Sensory/perceptual alterations       5. Urinary retention         6. Constipation       7.High risk for injury	Monitor sensory function • Protect involved area from injury (eg burns, bruising) Monitor voiding pattern and amount for voiding. Maintain accurate I/O chart. • Monitor the patient for suprapubic distension Remove indwelling catheter as soon as possible ·         Establish patient’s previous bowel elimination  pattern ·         Palpate abdomen for distention. ·         Increase fiber in diet. ·         Encourage an adequate fluid intake.   • Teach the patient to -Check the position of affected limbs visually. -Check skin integrity daily on pressure points. -Check temperature of the unaffected limb before applying heat to affected areas. -Use heat devices very carefully. Assist the patient with ambulation.