Cancers and Tumors

Spinal Tumors

What are spinal tumors?

Spinal tumors are abnormal lumps of tissue that form in the bones of the spine (vertebrae) or in the soft tissue between and around the vertebrae.

Tumors in the spine are different from tumors in the spinal cord, a column of nerves that runs through small holes in each of the vertebrae. The spinal cord and brain make up the central nervous system. Read about brain and spinal cord tumors.

One of the spine’s jobs is to protect the spinal cord. If a tumor grows in the spine, it can press on the spinal cord and:

  • Cause pain
  • Affect bodily functions, such as the ability to move or to control the bowel and bladder

Tumors form when cells grow out of control. In most cases, doctors do not know exactly what causes these tumors. There is no known way to prevent them.

  • There are many types of spinal tumors. Most spinal tumors are not cancerous (benign). Cancerous (malignant) tumors in the bones or soft tissue are called sarcomas.

    Only cancerous tumors can spread from their original (primary) location to other parts of the body. This is called metastasis.

    Both benign and cancerous tumors can grow back in the same place after they are removed. This is much more common with cancerous tumors than with benign tumors.

Spinal Tumors at Seattle Children’s

Children with spinal tumors receive care from experts in our Bone Tumor and Sarcoma Clinic. Our clinic is one of the first in the country where doctors who specialize in bones, joints and muscles (orthopedic surgeons) work side by side with doctors who specialize in cancer (oncologists).

The clinic is part of the Cancer and Blood Disorders Center at Seattle Children’s. We will diagnose your child’s tumor and provide the right treatment, whether or not their tumor is cancerous. We care for a wide range of patients, from babies to young adults.

Please contact the center at 206-987-2106 for more information, a second opinion or to make an appointment.

  • The makeup of the team of experts who care for your child depends on whether the tumor is cancerous. Your child may need care from these different specialties:

    The Bone Tumor and Sarcoma Clinic team meets weekly to discuss each child’s care in detail as a group. This way all our specialists can work together to provide the safest, most effective care for your child and stay in close contact about how your child is doing.

    If your child’s tumor is cancerous, their care is guided by a doctor specially trained in diagnosing and treating cancer in children (pediatric oncologist). The team will include a nurse practitioner who focuses on bone and soft tissue tumors in children.

    If the tumor is not cancerous, an orthopedic surgeon will lead your child’s team. Seattle Children’s has surgeons trained in both pediatric orthopedic surgery and musculoskeletal oncologic surgery. Only about a dozen surgeons in the country have this dual training.

    A neurosurgeon will join the team if your child’s tumor has grown into the spinal canal or onto the nerves that branch off the spinal cord. Seattle Children’s neurology and neurosurgery programs are consistently ranked among the nation’s best programs by U.S. News & World Report. We were ranked #1 in the Northwest in 2017. Research shows that centers like Seattle Children’s that do many surgeries every year are more likely to have better results for their patients.

    We care for your whole child. We don’t just treat their disease. As needed, your child will receive care from specialists in nutrition, pain management, pharmacy, physical therapy and emotional health. Read more about the supportive care we offer.

  • For the past decade, U.S. News & World Report has consistently ranked Seattle Children’s Cancer Center among the best in the nation. In 2017 our program was ranked #1 in the Northwest.

    Our survival rates for a wide range of cancers have been significantly better than the national average for 20 years. See our statistics and outcomes.

    Through our partnership in the Seattle Cancer Care Alliance (SCCA), your child will benefit from the work of physician-scientists at Fred Hutch and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has designated our partnership a comprehensive cancer center.

  • We offer the most advanced treatment options for spinal tumors, including surgery, chemotherapy and radiation therapy.

    Our surgeons are specially trained to care for kids and are board certified in pediatric surgery. We are developing ways to remove tumors that are less invasive than traditional surgery. We have published more results in the medical literature on using minimally invasive surgery than most other children’s hospitals.

    Proton therapy may be an option if your child needs radiation therapy. Proton therapy delivers radiation more precisely than X-rays. We offer this treatment at SCCA Proton Therapy, the only proton therapy center in the Northwest.

    Our doctors are leaders in research groups like the Children’s Oncology Group (COG) and Sarcoma Alliance for Research through Collaboration (SARC). The COG is an international organization of childhood cancer specialists who work to develop new therapies and reduce late effects of treatments. This leadership means we can offer our patients the very latest options being studied in clinical trials. The knowledge we gain through research improves the care we give all children with cancer.

    Read more about cancer research and clinical trials at Seattle Children’s.

  • Our Bone Tumor and Sarcoma team is expert at treating bone and soft tissue tumors in children, whose bodies are still growing. Our specialty is treating children’s disease while helping them grow up to be healthy and productive adults.

    Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. Our team bases your child’s treatment plan on years of experience and the newest research on what works best – and most safely – for children.

    Our doctors focus on how treatments today affect growing bodies in the future. Dr. Eric Chow chairs the COG Outcomes and Survivorship Committee.

  • Learning that your child has a spinal tumor can be scary. We help take positive steps right away by offering appointments in 1 to 3 days to children suspected to have cancer.

    Our Bone Tumor and Sarcoma Clinic provides 1-stop care. We coordinate your child’s complex care and tailor treatment to their exact condition. During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

    Our doctors, nurses child life specialists and social workers help your child and your family through the challenges of their illness. We connect you to community resources and support groups.

    At Seattle Children’s, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Symptoms of Spinal Tumors

Symptoms of spinal tumors depend on the location and type of tumor. Check with a doctor if your child has any of these symptoms. They may be caused by a spinal tumor or by another condition.

  • Back pain
  • Unusual feelings in the legs, such as numbness or tingling
  • Problems with bowel or bladder control
  • Weakness in the muscles, especially the legs

Diagnosing Spinal Tumors

To find out if your child has a spinal tumor, your doctor will:

  • Check your child for signs of illness
  • Ask about your child’s health

If your child has back pain, we will ask about warning signs of a serious problem in the spine:

  • How bad is the back pain? Has it lasted for more than 2 months? Is the pain getting worse instead of better?
  • Does the back pain wake your child up from a deep sleep?
  • Does the back pain cause funny feelings in the leg muscles? Has your child felt numbness, tingling or weakness in the legs?
  • Does the back pain make it hard to control their bowel or bladder?
  • Is the back pain happening along with severe weight loss or high fever?

Figuring out exactly what kind of tumor your child has is important so we can plan the best treatment for them. In children younger than 15 years, most cancers that press on the spinal cord are not sarcomas. They are much more likely to be neuroblastoma or non-Hodgkin lymphoma. Those tumors are treated very differently than tumors that start in bone or soft tissue.

These tests help the doctors accurately diagnose your child’s tumor:

  • Taking pictures of your child’s backbone (imaging studies) to look for tumors or areas where cancer is active. Doctors can identify most spinal tumors using X-rays and MRI (magnetic resonance imaging).
  • Doing a biopsy. In this test, the doctor inserts a needle into your child’s back and takes a small sample of the tumor to check under a microscope.

Getting pictures of your child’s tumor is also very important as we treat your child. Before and after treatment your child may need:

  • X-rays
  • MRI (magnetic resonance imaging) scan
  • CT (computed tomography) scan
  • PET (positron emission tomography) scan

Treating Spinal Tumors

Our goal of treatment is to give your child or teen the best chance of a long and healthy life. Your child’s health care team will suggest a treatment plan for your child based on:

  • Whether the tumor is benign or cancerous
  • The tumor size and location
  • How the cancer cells look under a microscope
  • Your child’s age and overall health
  • Your family’s preferences

Your child will most likely need surgery to remove part or all of the tumor. If your child’s tumor is cancerous, they may also need medicines that kill cancer cells (chemotherapy), radiation therapy or both.

Treatment Options for Spinal Tumors

  • The main treatment for spinal tumors is surgery. In general, surgery for cancerous spinal tumors removes more tissue than surgery for benign tumors. During surgery, the cancerous tumor is removed as well as a rim of normal tissue beyond the edge of the tumor, if possible. This is to avoid leaving behind any cancer cells, which could cause the tumor to regrow.

    The best procedure for your child is based on the size, location and type of tumor. In some cases, this may be microsurgery through a very small cut and using an operating microscope. Your child’s doctor will talk with you about what is best for your child.

    Surgeons remove as much tumor as they can. Sometimes the whole tumor cannot be removed because that would limit mobility or function too much. If only part of the tumor is removed, doctors use chemotherapy medicine or radiation. These are used before surgery to make the tumor smaller or after surgery to kill any remaining cancer cells.

    Some noncancerous tumors are removed by scraping the tumor out of the bone (curettage) and filling the hole with a bone graft or other material to give support. The bone graft helps your child’s bones join together while healing.

    The replacement bone may come from a donor or your child’s own body. We work with a special bone bank to be sure bone grafts come from healthy donors and are carefully screened for diseases. Before surgery, your doctor will talk with you about the type of material we plan to use.

    Other tumors require more complicated surgery. Surgeons may need to remove all or part of some spine bones and do reconstructive surgery to make the spine stable, such as:

    • Replacing parts of the spine bones with bone grafts or other material.
    • Joining the affected spine bones so they heal into a single, solid bone. This is called spinal fusion.
    • Attaching a rod and screws or other instruments to help make your child’s spine stable and prevent a curve (scoliosis) or abnormal hunch (kyphosis) from developing in their back.

    Usually surgery is done at our hospital’s main campus in Seattle. Sometimes small, noncancerous tumors are removed as an outpatient procedure.

    Learn more about surgery to treat tumors at Seattle Children’s.

    Recovery after surgery

    Some children use a brace to protect their spine while they heal after surgery. But many children do not need a brace.

    After surgery, your child will get help to improve their flexibility and mobility and return to their usual activities. Some children see a physical therapist (PT), who uses play and exercise to help build strength and coordination and reduce pain.

    Depending on the tumor, some children may need adaptive equipment after surgery. Occupational therapists (OTs) help your child learn to use equipment or change how they do tasks of daily life, if needed.

    Read more about our physical therapy and occupational therapy services.

  • Chemotherapy means giving your child medicines that kill cancer cells.

    Your child’s doctors may suggest chemotherapy to shrink the spinal tumor or to kill cancer cells that might be elsewhere in your child’s body.

    Children with spinal tumors get these medicines by mouth or through a vein (called intravenous or IV). The type of medicine your child gets depends on the type of tumor.

    Our patients receive chemotherapy at our main hospital campus in Seattle. Depending on the medicine, your child may stay overnight in our Cancer Care Unit or get treatment at our infusion center as a day procedure.

    See more about getting chemotherapy at Seattle Children’s.

  • Radiation therapy uses high-energy particles to kill cancer cells. A machine sends a dose of radiation into the body. Doctors aim the radiation at the place where they know or suspect there is cancer.

    The best radiation treatment depends on your child’s tumor. Options at Seattle Children’s include X-rays and proton therapy. Unlike X-rays, protons stop once they reach their target. The tumor gets the high dose of radiation, and healthy tissue away from the tumor receives even less radiation than with targeted X-rays.

    Radiation can harm a young child’s developing nervous system and affect bone growth. Our radiation oncologist, Dr. Ralph Ermoian, is very experienced in caring for children. He helps your child’s team decide if radiation may be helpful and what type of radiation to use.

    Learn more about Seattle Children’s Radiation Therapy Service.

Follow-Up Care

Follow-up care is important after treatment ends – no matter what type of treatment your child had. The follow-up routine will depend on your child’s tumor and their treatments.

Most of our patients who had cancerous tumors visit Seattle Children’s regularly for follow-up care for at least 5 years. If you live far from Seattle, your child may get some follow-up care from a cancer doctor in your own community.

Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after being treated for cancer in childhood.

During follow-up visits at Seattle Children’s, your child’s team will:

  • Look for any signs that cancer is returning
  • Check for effects that may happen months or years after treatment
  • Tell you and your child about any risk for other cancers and signs to watch for

Contact Us

Contact the Cancer and Blood Disorders Center at 206-987-2106 for an appointment, a second opinion or more information. We help your child get the right treatment, whether their tumor is cancerous or not.

To make an appointment, you can call us directly or get a referral from your child’s primary care provider. We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children’s.

Providers, see how to refer a patient.