Metastatic Spinal Tumours

Metastatic spinal tumours occur when cancer cells spread from another part of the body to the spine (vertebrae) or the tissues around the spinal cord. These secondary tumours can cause pain and, in some cases, weakness, numbness or problems with walking.

A key concern is metastatic spinal cord compression (MSCC), where a tumour presses on the spinal cord or nerve roots. MSCC is a medical emergency because delays in treatment can lead to permanent nerve damage. Early recognition and urgent assessment are important.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and can coordinate the appropriate pathway for investigation and urgent management where needed.

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Types of Metastatic Spinal Tumours

Metastatic spinal disease may affect different structures:

• Spinal bone (vertebral) metastases
  Tumour deposits in the vertebrae, which can cause pain and sometimes weaken the bone (risk of fracture or collapse).
• Epidural metastatic disease / MSCC
  Tumour growth in the space around the spinal cord, causing pressure on the spinal cord.
• Nerve root compression (radiculopathy)
  Pressure on nerve roots as they exit the spine, causing pain, numbness or weakness radiating into an arm or leg.

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Common Causes

Metastatic spinal tumours are caused by cancer spreading through the bloodstream or lymphatic system. They may occur in people with a known cancer diagnosis, but occasionally spinal symptoms can be an early sign of previously undiagnosed cancer.

Common primary cancers that can spread to bone include (among others) breast, prostate and lung cancers, but spinal metastases can occur from many cancer types.

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Symptoms of Metastatic Spinal Tumours

Symptoms depend on the location and whether nerves are affected. Common symptoms include:

• New or worsening back or neck pain
• Pain that is persistent, may be worse at night, or not relieved by rest
• Pain that radiates into the chest wall, abdomen, arms or legs (nerve root pain)
• Pins and needles, numbness, or altered sensation
• Weakness in the arms or legs, heaviness, or legs “giving way”
• Unsteadiness or difficulty walking
• Localised tenderness over the spine

Red flag symptoms (possible spinal cord compression)

Seek urgent same-day assessment if you experience any of the following alongside back pain:

• New weakness in the legs or arms
• New numbness, especially around the inner thighs or buttocks (saddle area)
• New or worsening difficulty walking
• Problems passing urine, urinary retention, or new incontinence
• Bowel control problems, new constipation that is worsening, or new incontinence

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Diagnosis

Assessment focuses on identifying the cause of symptoms and checking for signs of nerve or spinal cord involvement. Your consultant may:

• Take a detailed history (pain pattern, neurological symptoms, cancer history, treatments)
• Examine strength, sensation, reflexes, coordination and walking
• Arrange urgent imaging when indicated

Investigations may include:

• MRI scan (often the preferred test when spinal metastases or cord compression is suspected)
• CT scan where appropriate (for bone detail or if MRI is not suitable)
• Blood tests as part of broader assessment
• Coordination with oncology teams and specialist spinal services where required

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Treatment & Management

Treatment depends on symptoms, tumour location, spinal stability, and the underlying cancer type. Management is often shared with oncology and specialist spinal teams.

Options may include:

Pain control and symptom management

• Tailored pain relief plan
• Management of nerve pain symptoms where present
• Support for mobility and function

Steroid medication (when cord compression is suspected)

If MSCC is suspected, clinicians may use steroids to help reduce swelling around the spinal cord while urgent investigations and definitive treatment are arranged (this is prescribed and monitored by clinicians based on your individual situation).

Radiotherapy

Radiotherapy may be used to shrink tumour deposits and relieve pain or pressure on nerves/spinal cord.

Surgery (selected cases)

Surgery may be considered to:

• Decompress the spinal cord or nerve roots
• Stabilise the spine if there is vertebral collapse or instability risk

Systemic anti-cancer treatments

Depending on cancer type and treatment plan, options can include chemotherapy, targeted therapy, hormonal therapy, or immunotherapy, coordinated with oncology.

Rehabilitation support

Physiotherapy and occupational therapy can help with:

• Safe mobility and walking
• Strength and confidence rebuilding
• Falls prevention and home adaptations if needed

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When to seek urgent help

Seek urgent medical advice if you develop:

• Back pain plus new weakness, numbness, or walking difficulty
• Bladder or bowel changes
• Severe, rapidly worsening pain
• Fever or feeling acutely unwell alongside spinal pain

These can indicate spinal cord compression or other complications that require immediate assessment.

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If you’re experiencing persistent back pain, new nerve symptoms, or have concerns about metastatic spinal disease, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.