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How to recognise the signs & symptoms
Before you read this leaflet it is important that you understand that spinal cord compression only occurs in a small number of people. However, being aware and reporting the early warning signs is extremely important in order to prevent the problem worsening or becoming permanent.
Why have I been given this leaflet to read?
You have been given this leaflet to read because you have cancer which can sometimes spread to the bones of the spine (vertebrae). The most common cancers that spread to the spine are breast, lung, kidney or prostate and in people who have lymphoma or myeloma. The vertebrae protect the spinal cord, which is a large bundle of nerves which transfers messages from the brain. As it passes through each vertebra it sends off smaller nerves called nerve roots. These supply the body, arms and legs with sensation and controls the movement of muscles, including the bowel and bladder.
Metastatic Spinal Cord Compression (MSCC) is pressure on the spinal cord.
This may happen because:
• The vertebrae are affected by cancer or
• A secondary tumour is damaging the vertebrae or
• The cancer has spread to the tissues around the vertebrae.Cancer that has spread to other areas in the body from your original Cancer site are called metastases or secondaries.
When metastases affect the bones (boney metastases) of the spine, they can cause swelling and pinch the spinal cord/nerve, or sometimes weaken and destroy the bone.
What symptoms will I have?
The spinal cord acts as a messenger for the brain, telling your arms and legs to move and sending messages back to the brain. When the spinal cord is squashed the messages are prevented from travelling along it. As a result, you may experience certain symptoms. In most people, symptoms occur in the lower half of the body, but some people can be affected in the upper body including the neck and arms. Symptoms can vary, but may not happen in any particular order.
• New pain or acute worsening of an existing pain in your neck or back. This can sometimes feel like a band of pain spreading round the sides of the chest. Sometimes the pain is worse when you cough or sneeze or go to the toilet and strain.
• Weakness in your feet / legs or difficulty in walking.
• Sometimes you may get a ‘heavy feeling’ in your legs
• and they may ‘give way’.• Numbness and /or pins and needles in your hands/arms or feet/legs associated with other symptoms
• Difficulty in emptying or controlling your bladder or bowels.
• Numbness / loss of sensation in the perineum (the area between the front and back passage in females and scrotum and back passage in males). This may lead to you not being aware when you are passing urine or opening your bowels.
What should I do if I get any of the symptoms listed above?
It is important that you are aware of the early signs and symptoms and report them to your Specialist Cancer Nurse, Acute Oncology Nurse, GP or Hospital Clinician immediately.
If you cannot make contact with them, go to the Emergency Department (ED) at Milton Keynes Hospital or your nearest ED. Please show this leaflet to your Nurse or Doctor/GP to help them decide on the right tests and treatment for you.
Remember the sooner spinal cord compression is diagnosed the sooner treatment can begin to prevent permanent damage leading to serious disability such as paralysis and loss of bowel and bladder function.
What happens next?
Your doctor will need to be sure whether these symptoms are due to spinal cord compression, therefore you will need some tests carrying out.
These are likely to include:
• Questions about your signs and symptoms.
• MRI scan (Magnetic resonance Imaging) of the whole of your spine
• to show which part of the spine and nerves are affected.
• An examination of the range of movement and reflexes in your arms and legs and a simple sensitivity test to measure skin sensation over your abdomen, arms and legs.
Treatment for Spinal cord compression
If you are diagnosed with Spinal cord compression your Consultant or Clinical Nurse Specialist will discuss the treatment you are likely to be offered. Treatment will be discussed with your Cancer Doctor and specialist clinicians who manage Metastatic Spinal Cord Compression.
Please remember that metastatic spinal cord compression is a rare complication of cancer. However, being aware of the early signs and symptoms and reporting them straight away will enable early diagnosis and treatment. The earlier it is diagnosed, the better the chances of the treatment being effective.
This leaflet has been written and agreed by Thames Valley Cancer Network, Acute Oncology & Metastatic Spinal Cord Compression Groups in conjunction with Patient representatives & Patient Partnership Groups and has been adopted and adapted for use locally b y Milton Keynes University Hospital NHS Foundation Trust.
Milton Keynes Hospital (Switchboard) Tel 01908 660033 Specialist Cancer Nurse (Key Worker) Acute Oncology Nurse Practitioner Hospital Switchboard ask for Bleep 1090 Macmillan Unit Oncology Suite Tel 01908 996352 Tel 01908 996431.