INTRODUCTION:

According to World Health Organisation (WHO), Cancer is a leading cause of death worldwide,
accounting for nearly 10 million deaths in 2020. Cancer can affect any part of the body and invade adjoining
parts of the body and spread to other organs; the latter process is referred to as metastasis. Widespread
metastases are the primary cause of death from cancer.

Cancer arises from the transformation of normal cells into tumour cells in a multi-stage process that
generally progresses from a pre-cancerous lesion to a malignant tumour. These changes are the result of the
interaction between a person's genetic factors and three categories of external agents, including:

 physical carcinogens, such as ultraviolet and ionizing radiation;

 chemical carcinogens, such as asbestos, components of tobacco smoke, alcohol, aflatoxin (a food
contaminant), and arsenic (a drinking water contaminant); and
 biological carcinogens, such as infections from certain viruses, bacteria, or parasites.

Several theories and hypotheses have been proposed to explain how and why cancer occurs from a
continuum spanning tumorigenesis to metastasis. Many of these share similar information. Nevertheless,
complete explanation of how tumors develop and how cancer progresses remain an enigma.

Cancer of the central nervous system (CNS) includes tumors of the brain and spinal cord that
originate in the CNS (primary) and those that metastasize from systemic cancer (secondary or metastatic).
Central nervous system cancers are relatively uncommon, but are unique in the associated neurologic
symptoms that occur in these patients. Whether benign or malignant, primary or secondary, CNS tumors can
be associated with significant morbidity and mortality, having a drastic effect on the patients' functional
ability and cognition.

Knowledge of the various tumor types and their differences, associated neuroanatomy and
neurophysiology and the many issues related to symptoms associated with both the tumor and its treatment
is essential to provide accurate assessment, on-going intervention, and supportive management for these
individuals.

DEFINITIONS:

1. TUMOR: An abnormal mass of tissue that forms when cells grow and divide more than they should
or do not die when they should. Tumors may be benign (not cancer) or malignant (cancer).Benign
tumors do not spread into, or invade, nearby tissues. Cancerous tumors spread into, or invade, nearby
tissues and can travel to distant places in the body to form new tumors (a process called metastasis).
Cancerous tumors may also be called malignant tumors.
2. CANCER: Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to
other parts of the body.
3. Ca SPINAL CORD : Cancer that begins in the spinal column (backbone) or spinal cord.
4. SPINAL CORD TUMOR: A spinal cord tumor is an abnormal mass of tissue within or surrounding
the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly
unchecked by the mechanisms that control normal cells. There are many different types of spinal
tumors and not all of them are malignant (spinal cancer).

Primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from
cancer spreading from another site to the spine. Metastatic spinal cord tumors are more common than
primary spinal tumors and can be traced to primary tumors in other organs especially lungs, breast and
prostate. Most metastatic tumors located in the extradural space of the thoracic spine and affect richly
vascular vertebral body or paravertebral tissue. Erosion of the vertebrae may occur, increasing the risk of
fracture and spine instability.

CLASSIFICATION OF SPINAL CORD TUMOR:

1. By the region of the spine in which they occur: These basic areas are cervical, thoracic, lumbar and
sacrum. Most frequently, metastatic seeding involves the thoracic spine (accounting for about 70% of cases),
with the lumbar spine being the next most involved site (20% of cases). The cervical spine is affected in
approximately 10% of cases. Multiple spinal levels are affected in about 30% of patients.  Gastrointestinal
and pelvic malignancies tend to affect the lumbosacral spine. Lung and breast cancers are more likely to
affect the thoracic spine.
2. By their location within the spine: Tumors within the spinal canal are classified according to their
anatomic relation to the spinal cord (Bader, Littlejohns, Olson, et al., 2016). They include:
1) Intramedullary tumors (within the spinal cord) : These tumors grow inside the spinal cord. They
typically derive from glial or ependymal cells (a type of glial cell) that are found throughout the
interstitium of the spinal cord. Frequency of occurrence in this location is approximately
5%. Astrocytomas and ependymomas are the two most common types. Astrocytomas are more
common in the thoracic region followed by the cervical. Ependymomas are most common in the
filum (bottom region of the spinal cord), followed by the cervical region. They are often benign
(compared to intracranial), but can be difficult to remove. Intramedullary lipomas are rare congenital
tumors most commonly located in the cervicothoracic spinal cord.

2) Extramedullary-intradural tumors (within the dura but on the surface of the spinal cord, rather than
within its parenchyma ) :  The tumor is located inside the thin covering of the spinal cord (the dura),
but outside the actual spinal cord. Frequency of occurrence in this location is 40%. The most
common of these types of tumors develop in the spinal cord's arachnoid membrane (meningiomas),
in the nerve roots that extend out from the spinal cord (schwannomas and neurofibromas), or at the
spinal cord base (filum terminale ependymomas). Although meningiomas are often benign, they can
be difficult to remove and may recur. Nerve root tumors are also generally benign, although
neurofibromas may become malignant over time. Ependymomas at the end of the spinal cord can be
large, and the delicate nature of fine neural structures in that area may make removal difficult.

3) Extramedullary-extradural tumors (outside the dural membrane): The tumor is located outside the
dura, which is the thin covering surrounding the spinal cord. Frequency of occurrence in this location
vs the ones above is approximately 55%. These lesions are typically attributed to metastatic cancer or
less commonly schwannomas derived from the cells covering the nerve roots. Occasionally, an
extradural tumor extends through the intervertebral foramina, lying partially within and partially
outside of the spinal canal.
EPIDEMIOLOGY:

Primary spinal cord tumors occur less frequently than primary brain tumor accounting for only 4% of
all primary CNS tumors. Approximately 2700 of these tumors are diagnosed each year. They occur most
often in individuals aged 20 to 60 years. With the exception of meningiomas, which occur more often in
women, spinal cord tumor are found with equal frequency in men and women. Metastatic tumor are much
more common than primary spinal cord tumor, reportedly afflicting 5% to 10% of individuals with systemic
cancer

RELATED ANATOMY & PHYSIOLOGY:

Figure 1: Spinal cord and nerve structures

 Figure 2: Cross section of spinal cord

The spine is a flexible column formed by a series of vertebrae, each stacked one upon another to
support the head and trunk. The vertebral column consists of 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar,
5 sacral, and 4 coccygeal. The five sacral vertebrae fuse to form the sacrum, and the four coccygeal
vertebrae fuse to form the coccyx.

The spinal cord, housed within the vertebral column, is an elongated mass of nerve tissue less than 1
inch in diameter and approximately 17 to 18 inches in length. It arises from the medulla oblongata,
beginning at the top of the first cervical vertebra, and extends down to the lower border of the first lumbar
vertebra, where it ends in a tapered cone like structure called the conus medullaris. The spinal cord is about
10 inches shorter than the vertebral column, and the lower segments of the spinal cord, therefore, are not
aligned opposite corresponding vertebrae. Thus, the lumbar and sacral spinal nerves have very long roots.
These roots descend in a bundle from the conus, and because of its resemblance to the tail of a horse, this
formation is called the cauda equina.

The spinal cord consists of ascending and descending nerve tracts that carry impulses to and from the
brain and peripheral nerves. These impulses result in sensory information and motor ability. The spinal cord
is protected and cushioned by 3 connective tissue membranes known as the leptomeninges: (1) pia mater,
the innermost layer; (2) arachnoid, the middle layer; and (3) dura mater, the outermost layer (Figure 2).
These layers comprise a compartment that surrounds the cord known as the thecal sac and the area outside
the outer most layer of the sac is the epidural space. Between the arachnoid and pia mater layers circulates
the cerebrospinal fluid.

There are 31 pairs of spinal nerves exiting from the spinal cord through the intervertebral foramina: 8
cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. The intervertebral foramina are narrow, and the
nerves may easily be compressed at this site by a protruding disk or arthritic spurring. Each spinal nerve has
a dorsal root by which afferent (sensory) impulses enter the cord and a ventral root by which efferent
(motor) impulses leave the spinal cord. The dorsal roots convey sensory input from skin segments that
represent specific areas of the body known as dermatomes. Interruption of one sensory nerve root may result
in paresthesias or pain in that dermatomal area. The ventral roots convey motor impulses from the spinal
cord to the body, innervating specific areas of muscle groups called myotomes .

The cranial meninges are contiguous within the spinal canal to support and protect the spinal cord.
The spinal dura is a continuation of the inner layer of the cerebral dura. The outer dural layer ends at the
foramen magnum, being replaced by the periosteal lining of the vertebral canal. The spinal dura encloses the
spinal nerves and terminates at the level of the sacrum. The arachnoid layer of the spinal meninges is a
continuation of the cerebral arachnoid. The pia mater in the spinal cord is thicker, firmer, and less vascular
than that of the brain.

A cross section of the spinal cord shows that it is arranged as a butterfy-shaped area of gray matter
surrounded by white matter. The gray matter consists of e bodies, axon, and dendrites. The white matter
consist of longitudinally running fiber tracts. The white matter in each half of the cord is divided into
columns. These columns are further divided into tracts, which the sensory and motor pathways of the spinal
cord. Impulses are conducted up the spinal cord via ascending tracts (sensory) to the brain, and the
descending tracts conduct impulses from the brain down to the spinal cord (motor). The specific motor and
sensory symptoms seen in Spinal cord tumors depend on the tumor's involvement of these specific tracts.
Knowledge of the specific level of involvement is helpful in understanding the signs and symptoms in
relation to the specific dermatomes and myotomes involved.

ETIOLOGY/RISK FACTORS:

The cause of most primary spinal tumors is unknown. Some of them may be attributed to exposure
to cancer-causing agents. Spinal cord lymphomas are more common in people with compromised immune
systems. There appears to be a higher incidence of spinal tumors in particular families, so there is most
likely a genetic component.

In a small number of cases, primary tumors may result from presence of these two genetic diseases:

Neurofibromatosis 2: In this hereditary (genetic) disorder, benign tumors may develop in the arachnoid layer
of the spinal cord or in the supporting glial cells. However, the more common tumors associated with this
disorder affect the nerves related to hearing and can inevitably lead to loss of hearing in one or both ears.

Von Hippel-Lindau disease: This rare, multi-system disorder is associated with benign blood vessel tumors
(hemangioblastomas) in the brain, retina and spinal cord, and with other types of tumors in the kidneys
or adrenal glands.

Secondary or Metastatic tumors occur most frequently as a result of metastasis from breasts,
kidneys, prostate, colon, and lymphomas and multiple myeloma. Prostate tumors tend to metastasize to the
thoracic region of the spinal cord, most commonly T8 through T10. Ovarian cancer usually metastasizes to
the lumbosacral region of the spinal cord. Metastasis from other primary sites usually spreads from the
organ to the adjacent vertebral body. Multiple sites of the spinal cord may also be involved, especially with
metastasis from the breast or prostate.

PATHOPHYSIOLOGY:

Pathophysiological changes that occur with a spinal cord tumor occur most often as a result of compression
of the spinal cord at the level of the lesion. Compression of the spinal cord causes varying losses of motor
and sensory function. Compression may also cause ischemia because of obstruction of circulation. Edema
may be present as injury to the spinal cord occurs and may ascend the spinal cord, leading to death of tissue
above the level of the tumor. Invasion of the spinal cord by tumors will cause loss of impulses and motor
and sensory deficits, compression of spinal nerves, and alterations in reflex activity. Therefore, direct
compression and ischemia, secondary to compression and culminating in arterial or venous obstruction, are
the primary causes of spinal cord dysfunction associated with spinal cord tumors. In more rare
circumstances, intramedullary tumors will cause symptoms from infiltration of spinal cord tissue. The signs
and symptoms of the tumor will lead to validation of the location of the spinal tumor, at the cervical,
thoracic, lumbar, or sacral levels. It will be possible to map the sensory changes with the use of a dermatome
(the area of skin innervated by a posterior spinal root) chart, which will show a correlation with the
particular dermatome .

Flowchart: Pathophysiology of Ca Spinal cord

GRADING AND STAGING:

The TNM Staging System includes the extent of the tumor (T), extent of spread to the lymph nodes (N),
and presence of metastasis (M).

TNM stages for spine tumors

Category Criteria

   TX Primary tumor cannot be assessed

   T0 No evidence of primary tumor

   T1 Tumor confined to 1 vertebral segment or 2 adjacent vertebral segments

   T2 Tumor confined to 3 adjacent vertebral segments

   T3 Tumor confined to 4 or more adjacent vertebral segments, or any non-adjacent vertebral
segments
Category Criteria

   T4 Extension to spinal canal or great vessels

      T4a Extension into spinal canal

      T4b Evidence of gross vascular invasion or tumor thrombus in great vessels

   NX Regional lymph nodes cannot be assessed

   N0 No regional lymph node metastasis

   N1 Regional lymph node metastasis

   M0 No distant metastases

   M1 Distant metastases

      M1a Lung

      M1b Bone or other distant sites

Note that lymph node metastases in the absence of miliary metastases is rare for bone sarcomas; negative
staging and physical examination is generally sufficient to yield an N0 designation.

Histologic grade

Grad Definition
e
GX Grade cannot be assessed
G1 Well differentiated, low grade
G2 Moderately differentiated, high grade
G3 Poorly differentiated, high grade

CLINICAL MANIFESTATION:

The clinical manifestations seen with spinal cord tumors depend on the tumor's rate of growth and
the level of the spinal cord affected. Tumors can compress the cord into a thin, ribbon like structure without
causing significant neurological deficits. By contrast, the spinal cord cannot accommodate a sudden mass or
rapidly growing lesion such as a hematoma or a metastatic tumor. lt has little ability to compensate for such
lesions, which increase pressure and create extensive edema causing sudden neurological dysfunction.
 1. PAIN: The most common early symptom of a spinal cord tumor is back pain or pain radiating
along the compressed nerve route. Location of the pain depends on the level of compression. The
pain may be localized or radicular. Localized pain and tenderness are common over the involved
area, particularly with epidural metastases. Radicular pain may be described as bandlike and
follows the distribution of the spinal nerve roots (dermatomes). The pain can vary from mild to
severe and from dull to sharp or burning, and almost always become more severe with time. Pain
may be worse at night; a recumbent position often aggravates it. Pain that is aggravated by
movement and relieved with immobility may indicate spinal instability. Activities that produce a
valsalva maneuver, such as sneezing, coughing, and straining, increase the spinal pressure and
cause intensification of pain. Back or neck pain in cancer patients, especially those with tumor
types that commonly metastasize to bone, should be evaluated for spinal metastasis.
2. MOTOR WEAKNESS AND MOTOR LOSS: Motor disturbance may also occur as slowly
increasing clumsiness, weakness, and spasticity. Weakness is the most readily identified
objective finding and may follow the appearance of sensory symptoms. The weakness is often
associated with hyperreflexia, spasticity, and a positive Babinski sign. It will eventually progress
to complete paraplegia unless treatment is initiated.
3. SENSORY DISTURBANCES AND SENSORY LOSS: Specific sensory deficits will depend on
where the tumor is located on a cross section of the spinal cord. A lateral tumor will affect pain
and temperature, causing symptoms of coldness, numbness, and tingling. Awareness of vibration
and proprioception of body parts are affected if the posterior aspect is involved. Touch and
pressure on the opposite side of the body will be affected if the tumor is anterior.
4. AUTONOMIC DYSFUNCTION: Autonomic dysfunction involve bowel and bladder function.
Bladder disturbances are marked by urgency with difficulty in starting the flow, progressing to
retention with overflow incontinence.

DIAGNOSTIC EVALUATION:

1. History taking and neurologic examination: The diagnosis of a spinal cord tumor begins with a
detailed history and Neurologic examination. Neurologic examination focuses on assessing pain and
identifying loss of reflexes, sensation, or motor function.
2. Magnetic resonance imaging (MRI): The diagnostic test of choice is the MRI with contrast
administration, it is particularly helpful in detecting epidural spinal cord compression and metastases.
3. CT scan and myelography are sometimes used, especially in patients who are unable to undergo MRI
scanning.
4. Lumbar puncture: Cerobrospinal Fluid (CSF) analysis may reveal tumor cells.
5. Positron emission tomography (PET) scan: Positron emission tomography (PET) scan images will
also be performed to identify cancerous tissue.

COMPLICATIONS:

Complications of Ca Spinal cord includes the following:

1) Nerve or spinal compression from tumor expansion.
2) Spinal cord infarction secondary to compression.
3) Tetraplegia or paraplegia due to spinal cord compression.

TREATMENT MODALITIES:

Treatment of specific intraspinal tumors depends on the type and location of the tumor and the
presenting symptoms and physical status of the patient. Surgical intervention is the primary treatment for
most spinal cord tumors followed by chemotherapy and radiation therapy. Research is on-going with direct,
localized drug delivery and nanomedicine treatment.

Corticosteroids are often the first line of treatment. Benefits include the reduction of edema and a
tumoricidal effect on lymphomas and in some breast cancer patients. The optimum loading and maintenance
dose of corticosteroids have not been determined. Because spinal cord damage becomes irreversible if the
compression is not relieved, clinicians often will prescribe high-dose dexamethasone in patients with rapidly
progressive symptoms or in those who cannot walk, and then taper during the course of treatment. Patients
with minimal symptoms may require lower doses or be able to tolerate therapy without neurologic
compromise without corticosteroids.

SURGICAL MANAGEMENT: In the treatment of spinal cord tumors, the goals of surgery include
provision of a diagnosis and partial or complete removal of the tumor. For most intradural, extramedullary
tumors, surgery is the primary treatment. Schwannomas and meningiomas can often be completely resected
with modern microsurgical techniques and neurosurgical instruments. In most cases, these tumors can be
removed through a posterior (laminectomy) approach. Two surgical approaches may be used to manage
spinal cord tumors:

a. Anterior decompression is typically indicated because most spinal cord rumors are anterior.

b. The posterolateral approach may be used for excision of thoracic tumors. Endoscopy, or other
surgical techniques using instrumentation, can be used to visualize the anterior part of the cord. In thoracic
tumors above T5, posterolateral decompression negates the need for an anterior thoracotomy or sternotomy.

Surgeons uses microscope for surgery and also test different nerves during surgery with electrodes,
thus minimizing nerve damage. In some instances, they may use sound waves to break up tumors and
remove the fragments.

CHEMOTHERAPY:

Chemotherapy may be administered before or after spine surgery to remove the spinal tumor.

 Neoadjuvant chemotherapy: This is the type of chemotherapy administered before surgery. The goal

is to shrink the tumor.
 Adjuvant chemotherapy: This is administered after surgery to kill remaining cancer cells.

Chemotherapy is most often used along with other treatments such as surgery and/or radiation
therapy. Chemotherapy can also be used by itself, especially for more advanced tumors or for tumors that
have come back after other types of treatment. Chemotherapy is used for epidural tumors that are
chemosensitive and in patients with recurrent tumor who have received radiation therapy. Although there
have been no trials of chemotherapy for primary spinal cord tumors, drugs active against intracranial
gliomas might potentially be effective against these same histologies in the spinal cord. Anecdotal evidence
indicates that patients have been treated with nitrosourea-based regimens. Some of the chemo drugs used to
treat brain and spinal cord tumors include:
 Carboplatin
 Carmustine (BCNU)
 Cisplatin
 Cyclophosphamide
  Etoposide
 Irinotecan
 Lomustine (CCNU)
 Methotrexate
 Procarbazine
 Temozolomide
 Vincristine

RADIATION THERAPY:

Radiation therapy is generally not recommended for completely resected intradural low-grade
(intramedullary and extramedullary) spinal cord tumors. Both intramedullary and extramedullary tumors
may be treated with Radiation Therapy (RT) if completely resected or on recurrence if repeat surgical
resection is not feasible. Doses of 50 to 55 Gy are generally used, Ependymomas are radiosensitive tumors.
patients with ependymomas who received adjuvant RT, 5- and 10- year survival rates are 60% to 100% and
68% to 95%, respectively. The 5- and 10-year survival rates tor low-grade astrocytomas who received RT
are 60% to 90% and 40% to 90% respectively. For individuals with high-grade astrocytomas, RT is the
standard treatment approach; even with RT, the prognosis is poor. Survival in such cases is 6 to 8 months.

Radiation therapy is the primary treatment for metastatic spinal cord tumors. Primary spinal cord
tumors may also be treated with irradiation. Since the spinal cord is more sensitive to radiation therapy than
the brain, measure must be taken to protect the spinal cord from excess exposure. Radiation complications
will cause damage manifested as sensory impairments occurring after the completion of the radiation
treatment. This can progress to increasing neurological impairment, paralysis, and loss of bowel and bladder
function.

Radiation therapy and steroids are the most widely used therapies for extradural tumors. The usual
dose of radiation administered is 30 Gy in 300 cGy fractions. Often, higher doses are administered for the
initial treatments, especially if evidence of neurological dysfunction is present.

Spinal RT does not cause acute clinical symptoms. The major complication of spinal cord radiation
is radiation myelopathy, it results from demyelination and white matter necrosis or intramedullary
microvascular injury. Radiation myelopathy may present as a subacute or more severe delayed reaction. A
transient subacute myelopathy is clinicaly manifested by momentary electrical shocklike paresthesias or
numbness radiating from the neck down to the extremities, and it is precipitated by flexing the neck
(Lhermitte's sign). This syndrome develops after an average of 3 to 4 months following treatment and
resolves within 3 to 6 months without the need for intervention.

The more severe delayed radiation myelopathy generally occurs 12 to 28 months following RT, but
can take up to 4 years to appear. The clinical manifestations are irreversible; they begin with weakness and
can progress to a complete functional loss from the level of the radiation portal down. It is estimated that for
doses in the range of 57 to 61 Gy with conventionally fractionated RT, the incidence of myelopathy is 5%.
Risk factors for myelopathy include both the total dose and the dose per fraction.

NURSING MANAGEMENT:

Nursing assessment:

1. Take history and perform motor and sensory components of the neurologic examination.
 2. Monitor vital signs.
3. Assess pain using scale of 0 to 10, as indicated and assess for coping abilities.
4. Assess autonomic nervous system relative to level of lesion pupillary responses, bowel, and bladder
function.
5. Assess for spinal or nerve compression-progressive increase in pain, paralysis or paresis, sensory
loss, loss of rectal sphincter tone, and sexual dysfunction

Nursing Diagnoses:

1. Acute pain related to the effects of tumor growth secondary to spinal cord compression
2. Altered activity level related to back pain, muscle weakness and nerve damage.
3. Impaired Urinary Elimination related to spinal cord compression.
4. Anxiety related to surgery and outcome.
5. Risk for Infection and Risk for Injury related to surgery.

Goal / planning :

1. To reduce pain level and promote comfort of patient.

2. To promote activity level.
3. To maintain normal/near normal urinary elimination as evidenced by voiding at intervals without
residual urine.
4. To relieve anxiety.
5. To prevent infection.

Nursing Interventions:

I. Relieving Pain:

1) Encourage the patient to reduce stress on the back muscle.

2) Change position frequently
3) Instruct the patient in relaxation techniques, such as deep breathing, distraction, and imagery.
4) Administer analgesics, as indicated, and assess the patient’s response to each medication

II. Promoting mobility:

1) Encourage range of motion exercise.

2) Encourage patient to gradually increase range of activities.
3) Provide rest in between activities.
4) Instruct the patient with painful paresthesias regarding appropriate use of ice, exercise, and rest.
5) Assess the patient with sensory and motor alterations and refer to physical therapy for assistance
with ADL, ambulation.

III. Achieving Urinary Continence:

1) Assess the urinary elimination pattern of the patient.

2) Instruct the patient in the therapeutic intake of fluid volume and relationship to elimination.
3) Instruct the patient in an appropriate means of urinary elimination and bowel management
4) Provide bladder training after use of indwelling urinary catheter.

IV. Relieving Anxiety:

1) Provide an accepting environment for patient to verbalize anxieties.

 2) Provide explanations regarding all procedures. Answer questions or refer the patient to someone who
can answer questions
3) Refer to cancer support groups, as needed.
4) Provide the patient/family with written information regarding disease process and medical
interventions.
5) Reduce environmental stimulation.
6) Promote periods of rest to enhance coping skills.
7) Involve the family in distraction techniques.
8) Provide options in care when possible.

V. Preventing Postoperative Complications:

1) Provide routine postoperative care to prevent complications.

2) Monitor surgical site for bleeding, CSF drainage, signs of infection
3) Keep surgical dressing clean and dry.
4) Clean surgical site, as ordered.
5) Pad the bed rails and chair if the patient experiences numbness or paresthesias to prevent injury.
6) Support the weak/paralytic extremity in a functional position.

Evaluation: Expected Outcomes:

1) Reports that pain is relieved

2) Reports decreased paresthesias; ambulatory postoperatively.
3) Voids at intervals without residual urine.
4) Asks questions and discusses care options.
5) Incision healing, skin intact.

HEALTH EDUCATION:

In preparation for discharge, the patient is assessed for the ability to function independently in the home
and for the availability of resources such as family members to assist in caregiving.

1) Encourage the patient with motor impairment to use adaptive devices such as a cane, walker, or
wheelchair. Patients with impaired motor function related to motor weakness or paralysis may
require training in ADLs
2) Demonstrate proper positioning and transfer techniques. Teach the patient to avoid frequent twisting,
bending, turning and running.
3) Teach the patient to change the position slowly
4) The patient is educated to check skin integrity daily.
5) Patients with residual sensory involvement are cautioned about the dangers of extremes in
temperature. They should be educated about the dangers of heating devices (eg, hot water bottles,
heating pads, space heaters) as their sensory integration may be impaired, causing them to lose the
ability to detect dangerous stimulations and to react appropriately.
6) The patient and family members are educated about pain management strategies. Bowel and bladder
management, and assessment for signs and symptoms that should be reported promptly.
7) Teach the patient to eat a balanced, low-fat diet with plenty of fruits and vegetables to avoid
constipation.
8) Refer to cancer and SCI support groups, as needed.
PROGNOSIS:

The majority of extradural spinal tumors result from metastatic disease, which generally carries a
poorer prognosis because of the more advanced stage of disease. Many patients with metastases survive 3 to
6 months. Factors associated with improved survival include the ability to walk before and after treatment,
radiosensitive tumor histologies, no visceral or brain metastases, and a single site of cord compression.

The severity of weakness is the most significant prognostic factor for neurological recovery. Eighty
percent of those patients who are ambulatory at the time of diagnosis remain so after treatment. As the
neurological dysfunction increases, the likelihood of recovery diminishes. Only 30% to 45% of patients who
are initially paraparetic and nonambulatory become ambulatory, and those who are paraplegic at diagnosis
are likely to remain so, with only 5% regaining the ability to walk. The second most common factor is the
rapidity that symptoms develop, with those who develop deficits slowly having a higher likelihood of
recovery. Favorable prognostic factors for intradural tumors include extent of surgical resection, histological
grade, performance status, age, and, as in extradural tumors, slow onset of neurological dysfunction.
Schwannomas, meningiomas, and ependymomas have a low recurrence rate if completely resected. The
same cannot be said for astrocytomas, where the available literature has failed to demonstrate a significant
correlation between prognosis and degree of surgical resection. A patient's preoperative level of
neurological function is the strongest prognostic indicator of postoperative functional outcome.

SUMMARIZATION:

In this class, we have studied about Ca. spinal cord:

1. Definition
2. Classification
3. Epidemiology
4. Related anatomy and physiology
5. Etiology/risk factors
6. Pathophysiology
7. Grading & staging
8. Clinical manifestation
9. Diagnostic evaluation
10. Complications
11. Treatment modalities
12. Nursing management
13. Health education
14. Prognosis

CONCLUSION:

Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing
existing evidence-based prevention strategies. The cancer burden can also be reduced through early
detection of cancer and appropriate treatment and care of patients who develop cancer. Many cancers have a
high chance of cure if diagnosed early and treated appropriately. 
Malignancies of the CNS present tremendous challenges for individuals, families, and caregivers. Because
the clinical manifestations, course of treatment, and complications vary with the type and site of tumors,
individuals with CNS cancers. require highly individualized plans of care. Supportive care takes on a role of
utmost importance and encompasses the entire course of illness from diagnosis through the terminal phase
of disease. Even with advances in overall therapeutic modalities, successful treatment of CNS cancers
remains elusive. Outcomes can range from cure to permanent disability to life prolonged by a few days,
weeks, or months. The ongoing physical and emotional support necessary for both the individual and the
family create a challenging role for oncology nurses. The neurological symptoms and complications
produced by CNS cancers are, unfortunately, profoundly disabling and severely affect quality of life.
Assisting the individual to manage problems of daily living, maintain normal function to the best of his or
her ability and attain quality of life are nurses’ ultimate goals.

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