This occurs in 5–10% of cancer patients, the most common underlying tumours being lung, breast and prostate (40% of all cases).
Early detection has a significant outcome on morbidity and mortality.
Symptoms and signs
1. NICE recommends that in the following instances the Metastatic Spinal Cord Coordinator (e.g. Acute Oncology Nurse Specialist, on call Consultant Oncologist/Spinal Surgeon/Neurosurgeon) is contacted within 24 hours to discuss the care of patients with cancer and any of the following symptoms suggestive of spinal metastases:
- pain in the middle (thoracic) or upper (cervical) spine
- progressive lower (lumbar) spinal pain
- severe unremitting lower spinal pain
- spinal pain aggravated by straining (for example, at stool, or when coughing or sneezing)
- localised spinal tenderness
- nocturnal spinal pain preventing sleep
2. is contacted immediately to discuss the care of patients with cancer and symptoms suggestive of spinal metastases who have any of the following neurological symptoms or signs suggestive of MSCC, and view them as an oncological emergency:
- neurological symptoms including radicular (nerve root) pain, any limb weakness, difficulty in walking, sensory loss or bladder or bowel dysfunction
- neurological signs of spinal cord or cauda equina compression
Immediate treatment
Oral dexamethasone 16mg daily and spinal immobilisation.
If a patient with suspected MSCC is considered fit for investigation and treatment an urgent MRI of the whole spine is the investigation of choice.
Corticosteroid use and withdrawal in MSCC
- Give a loading dose of 16 mg of dexamethasone as soon as possible after assessment, followed by a short course of 16 mg dexamethasone daily while treatment is being planned
- Continue dexamethasone 16 mg daily in patients awaiting surgery or radiotherapy for MSCC. After surgery or the start of radiotherapy the dose should be reduced gradually over 5–7 days and stopped. If neurological function deteriorates at any time the dose should be increased temporarily
- Reduce gradually and stop dexamethasone 16 mg daily in patients with MSCC who do not proceed to surgery or radiotherapy after planning. If neurological function
deteriorates at any time the dose should be reconsidered. - Monitor blood glucose levels in all patients receiving corticosteroids
- Gastroprotection should be considered whilst patient is on steroids
See also Chapter: Corticosteroids.
Disclaimer
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.