Nov 26, 2008 this guideline covers detecting and managing metastatic spinal cord compression in adults with cancer that has spread to the spine. Metastatic spinal cord compression mscc happens when cancer cells grow in or near to the spine and press on the spinal cord. To ensure that all patients at risk of mscc receive patient information leaflet spinal cord compression what you need to know, by a doctor, nurse, ahp or appropriate clinician with a verbal explanation 2. Metastatic spinal cord compression guidelines november 2018 objectives 1. Controversy surrounds the care for patients with metastatic spinal cord compression mscc. Aug 31, 2018 metastatic spinal cord compression mscc is defined in the national institute of health and clinical excellence nice guidelines as spinal cord or caudaequina compression by direct pressure andor induction of vertebral collapse by metastatic spread or direct extension of malignancy that threatens neurological disability. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis 76 4 an economic evaluation of treatments for people with suspected metastatic spinal cord compression 78 5 abbreviations 102. Management of spinal cord compression palliative care.
Corticosteroids are established as the initial treatment modality of choice for acute metastatic epidural spinal cord compression. Metastatic spinal cord compression guidelines november 2018 definition impending mscc is diagnosed when all of the following conditions are met. This can cause a range of symptoms which can get worse if left untreated. The neuropathology of cord necrosis due to metastatic spinal disease is therefore different to trauma. How not to miss metastatic spinal cord compression. Purpose metastatic spinal cord compression mscc can be a catastrophic manifestation of advanced cancer that causes immobilizing pain and significant neurologic impairment. Metastatic spinal cord compression is an oncology emergency. Mescc is a common complication of malignancy that a. Metastatic spinal cord compression is defined radiographically as an epidural metastatic lesion causing true displacement of the spinal cord from its normal position in the spinal canal.
Around 3 to 5 in 100 people 3 to 5% with cancer develop spinal cord compression. Primary spinal cord tumors account for 2 to 4 percent. To ensure that all patients at risk of mscc receive patient information leaflet spinal cord compression what you need to. The resulting spinal cord injury may be acute, subacute, or chronic and occurs due to direct cord damage, by compression andor infiltration, or. Metastatic spinal cord compression is an oncological emergency and may be the first presentation of a cancer. Prompt diagnosis and treatment are critically important. These patients were combined with a previous survey of 105 patients to compare the effectiveness of radiation therapy rt alone with that of surgical decompression followed by rt. Metastatic spinal cord compression mscc this fact sheet is for men with advanced metastatic prostate cancer that has spread to the bones. Spinal cord tumors can occur within or adjacent to the spinal cord. This noninferiority randomized clinical trial compared the effect of external beam singlefraction 8gy radiotherapy vs 20 gy of radiotherapy in 5 fractions over 5 days on ambulatory status among patients with spinal canal compression from metastatic prostate, lung, and other cancer.
They are considered to be intraaxial in location and can be either primary or metastatic. Metastatic epidural spinal cord compression request pdf. Malignant spinal cord compression royal college of physicians. The resulting spinal cord injury may be acute, sub. Between five and 10 in every 200 patients with terminal cancer will have metastatic spinal cord compression mscc within their last two years of life. Spinal cord compression guidelines page 4 of 28 guidelines for the dagnosis and management of adults at risk of and with metastatic spinal cord compression key points 1. Early detection metastatic spinal cord compression. Update on spinal cord compression for the palliative care. Metastatic epidural spinal cord compression messc is a frequent event in patients affected by solid tumor metastases. We talk about a condition called metastatic spinal cord compression mscc.
Current available approaches for mescc include corticosteroids. Metastatic epidural spinal cord compression john s cole, roy a patchell metastatic epidural spinal cord compression mescc occurs when cancer metastasises to the spine or epidural space and causes secondary compression of the spinal cord. Mescc is a common complication of malignancy that affects almost 5% of patients with cancer. This is when the spinal metastases press on the spinal cord and nerves in the spine. Hybrid therapy for metastatic epidural spinal cord. Pdf metastatic spinal cord compression mscc is a potentially life changing oncological emergency.
The clinical findings in consecutive cases of spinal cord compression by metastatic extradural tumors were analyzed. During the period the incidence of scc in cancer patients went up from 4. Metastatic spinal cord compression mscc is defined in the national institute of health and clinical excellence nice guidelines as spinal cord or caudaequina compression by direct. These patients were combined with a previous survey of 105 patients to. Patients with symptoms suggestive of spinal cord compression, particularly severe back or root pain 1 should be investigated urgently with whole spine mri to define. Spinal cord compression management in cancer patients. Metastatic spinal cord compression pathway guidelines for. Spinal cord compression scc is a lifethreatening complication of pri mary and metastatic cancer that can significantly impact a patients quality of life. All such patients need urgent assessment to rule out metastatic spinal cord compression mscc.
A service of the national library of medicine, national institutes of health. Metastatic spinal cord compression mscc is rare, but it can cause damage to the spinal cord and can lead to permanent paralysis. Pain suggestive of spinal mets pain in the thoracic or cervical spine progressive lumbar spinal pain severe unremitting lumbar spinal pain spinal pain aggravated by straining localised spinal. Vertebral bone metastasis grows into the epidural space and compresses the spi nal cord. Outcome after radiotherapy alone for metastatic spinal cord. The tumors that most often cause spinal cord compression from epidural metastases or bone destruction are carcinomas of the lung, breast, and prostate and multiple myeloma. Nice has also produced technology appraisal guidance on denosumab for the prevention. Patients and methods oligometastatic disease was defined as involvement of three or fewer vertebrae and lack of other bone or visceral metastases. Metastatic epidural spinal cord compression an overview. Spinal metastases can be painful and if not treated can lead to metastatic spinal cord compression mscc. The tumors that most often cause spinal cord compression from epidural metastases or bone destruction are carcinomas of the lung, breast, and prostate and multiple. Management of metastatic spinal cord compression in. A subscription is required to access all the content in best practice. Department of clinical effectiveness v4 approved by the executive committee of the medical staff on 01292019.
It aims to improve quality of life by promoting early detection and management, and reducing spinal cord damage and disability. For people with breast cancer even with spinal cord compression, bone metastases carry a better prognosis than metastases to other regions of the body, and some people may live several years after treatment. Approximately 70% of cancer patients have metastatic disease at death. Pdf cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Explain that you are worried that you may have spinal cord compression and that you need to be seen urgently. Treating metastatic spinal cord compression nice pathways bring together everything nice says on a topic in an interactive flowchart. Management of pain and spinal cord compression in patients with advanced cancer janet l.
Introduction metastatic spinal cord compression mscc is a medical emergency, prompt management is required to preserve neurological function. Guidelines for the rehabilitation of patients with metastatic spinal. Early detection metastatic spinal cord compression ncbi. The level of spinal cord involvement determines the clinical neurologic deficit. Management of pain and spinal cord compression in patients. Patients with spinal metastases frequently present with pain. Metastatic epidural spinal cord compression mescc occurs when cancer metastasises to the spine or epidural space and causes secondary compression of the spinal cord. Guidelines for the rehabilitation of patients with metastatic. Spinal cord compression management in cancer patients page 1 of 6. Investigation and management of patients with suspected. Metastatic disease can promote endorgan dysfunction and even failure through mass effect compression of various vital organs including the spinal cord.
However, less than 50% of patients with malig nancy, considered clinically to have metastatic epi dural spinal cord compression, will have this diag. An audit carried out at the christie in 2007 showed that when investigated, 50% of these patients. Cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Choose one of the access methods below or take a look at our subscribe or free trial options. Understanding spinal cord compression spinal cord compression scc is a lifethreatening complication of primary and metastatic cancer that can significantly impact a patients quality of life. The resulting spinal cord injury may be acute, subacute, or chronic and occurs due to direct cord damage, by compression andor infiltration, or by compromise of the vascular supply to the cord. Can occur as a result of spine trauma, vertebral compression fracture, intervertebral disk herniation, primary or metastatic spinal tumor, or infection. Spinal cord compression may develop in 5% to 10% of cancer patients and up to 40% of patients with preexisting nonspinal bone metastasis 25,000 casesy. Metastatic spinal cord compression is a medical emergency 2. This leaflet is not intended to scare you but to help you recognise the important symptoms of spinal metastases and metastatic spinal. Pressure on the spine stops the nerves working normally. Jan 22, 2020 the life expectancy after spinal cord compression varies, and often depends on the course of underlying cancer. Your partner, family or friends might also find it helpful. Adults with metastatic spinal cord compression mscc, who present with neurological symptoms or signs, start definitive treatment if appropriate within 24 hours of the.
Mescc is a medical emergency that needs rapid diagnosis and treatment if permanent paralysis is. Identified by the oncology nursing society as a structural oncologic emergency, scc occurs. Metastatic epidural spinal cord compression is a medical emergency which occurs in 510% of all cancer patients, or approximately 15 000 each year in the united states. Clinical pathways of metastatic spinal cord compression. These observations have clinical importance in planning treatment. Metastatic epidural spinal cord compression the lancet. However, less than 50% of patients with malig nancy. Magnetic resonance imaging of the whole spine is the investigation of choice. Background metastatic spinal cord compression scc is a medical emergency. Metastatic spinal cord compression mscc is a wellrecognised complication of cancer and usually presents as an oncological emergency. National institute for health and clinical excellence. Metastatic spinal cord compression mscc is a devastating complication of cancer. The three therapeutic approaches to managing metastatic spinal cord compression include corticosteroids, surgery, and radiation therapy.
Agreement in metastatic spinal cord compression in. Spinal cord compression management in cancer patients page. This guideline covers detecting and managing metastatic spinal cord compression in adults with cancer that has spread to the spine. Spinal cord compression symptoms, diagnosis and treatment. The minimum radiological evidence for a diagnosis of spinal cord. The series comprised 398 cases, with carcinoma of the prostate 19%, lung 18%. Steroids decrease spinal cord edema and may have a tumoricidal effect with certain neoplasms e.
Offer corticosteroids and analgesia and consider spinal stability while the patient is assessed. If in emergency center, triage patient as emergent. Diagnosis and management of patients at risk of or with metastatic spinal cord compression. These patients have substantial morbidity caused by moderate to severe pain and by spinal cord compression. May 19, 2016 metastatic spinal cord compression is an oncological emergency and may be the first presentation of a cancer. Metastatic spinal cord compression overview nice pathways bring together everything nice says on a topic in an interactive flowchart. Contact someone today even if it is a weekend or holiday period. Management of metastatic spinal cord compression in ireland. It aims to improve quality of life by promoting early. Spinal cord compression cancer in general cancer research uk. Epidural spinal cord compression from metastatic tumor. Abrahm, md, for the acpasim endoflife care consensus panel general internists often care for patients with advanced cancer. We are committed to promoting best practice by reducing delays and avoidable disability, including preventing paralysis, from adversely affecting the quality of life for people with metastatic spinal cord compression.
Nice pathways are interactive and designed to be used online. Magnetic resonance imaging of the whole spine is the investigation of. Spinal cord metastasis an overview sciencedirect topics. This fast fact discusses management of scc in adults. British journal of general practice, 64626, e596e598. The authors emphasize the need for circumferential decompression of the spinal cord, which must include resecting the pll and separating epidural tumor and retropulsed bone away from.
Five hundred twentyone patients with oligometastatic disease and mscc were evaluated. Malignant or metastatic spinal cord compression of the thecal sac is a devastating medical emergency presented by 5% to 20% of patients with spinal metastases. Pdf management of metastatic spinal cord compression. Sep 21, 2016 purpose to investigate outcome and prognosis of metastatic spinal cord compression mscc patients with oligometastatic disease treated with radiotherapy alone. Over half of adult patients presenting with an acute myelopathy will be found to have metastatic spinal cord compression. Assessment and management of patients with metastatic. We are committed to promoting best practice by reducing delays and avoidable disability, including preventing paralysis, from adversely affecting the. Corticosteroids dexamethasone is the most tested steroid in clinical trials. Overview metastatic spinal cord compression in adults. Radiotherapy for metastatic spinal cord compression with.
Suspected spinal cord compression 16 severe pain or abnormal neurology, or incidental finding on mri not intended for traumatic injuries. Treatment options include corticosteroids, radiotherapy and surgery. Oncology emergency series understanding spinal cord compression. Patients with metastatic spinal cord compression mscc and favorable survival prognoses can benefit from radiation doses greater than 30gy in 10 fractions in terms of improved local. Metastatic spinal cord compression mscc is defined in this guideline as spinal cord or cauda. A retrospective audit of mscc management in the mid yorkshire nhs trust in 2012 was conducted. Effect of singlefraction vs multifraction radiotherapy on. Timely referral for neurosurgery or radiotherapy, or both. Palliative care clinicians are often called to help manage the pain of such patients, and they can continue to assist. The spine is involved in up to 40% of those patients. There is some evidence to indicate that care for patients with mscc is based on individual clinician preference rather than evidencebased guidelines which has been shown to cause delays and discrepancies in patient treatment. Referral early for investigation to improve quality of life outcomes and minimise disability 3.
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