Spinal cord tumors in children are difficult diseases with a serious prognosis. The spinal cord is part of central nervous system and performs a large number of important functions in body – it controls many internal organs activity, sensitivity and mobility of our body, it is nerve signals conductor from periphery to brain and back. Accordingly, when spinal cord is damaged by tumor, even a benign one, severe disorders occur, leading to permanent disability, and sometimes to death.
Accordingly, when spinal cord is damaged by tumor, even a benign one, severe disorders occur, leading to permanent disability, and sometimes to death.
If your child is suspected of spinal cord tumor or has already been diagnosed with such a diagnosis and you do not know what to do next, seek professional help from Pediatric Oncology department of Maimonides Multidisciplinary Medical Center. Our Pediatric Oncology Department closely cooperates with the best pediatric oncology clinics in Israel. Pediatric Oncology Project of Maimonides Medical Center is headed by Dr. Serhiy Postovsky from Israel – the chief pediatric oncologist. He oversees all cases directly from Israel. Together with the head of Pediatric Oncology Department of Maimonides Clinic, Dr. Yuri Tymoshchuk, he takes part in each individual clinical case management. Also children's oncology project in the field of brain tumors are accompanying such Israeli doctors as Professor Konstantini and Dr. Rina Dvir. Thus, in Ukrainian conditions, you can get access to all modern Israeli medicine advantages.
A special feature of Pediatric Oncology Department at Maimonides Medical Center is the opportunity to receive financial assistance for child’s treatment with serious diseases, including spinal cord tumors. It is possible, because clinic works under the patronage “Keren Or for our Child” the Charitable Foundation.
All children's oncologists have appropriate qualifications and have completed internships at the best global oncology centers. In their work, they are guided by evidence-based medicine principles, that is, they work according to global protocols, while actively practicing an individual approach to each child and his clinical situation. All diagnostic procedures and treatment regimens are selected for each child individually , and template treatment regimens are not used. Doctor takes into account child's main diagnosis, general state of health, age, stage of disease, parents' wishes regarding treatment process.
Our pediatric oncology department is staffed not only by oncologists, but by a whole multidisciplinary team of specialists: pediatricians, hematologists, neurosurgeons, vertebrologists, rehabilitation specialists, psychologists and many others. Thus, in conditions of one institution, we can provide patient with all necessary medical assistance, starting from initial stages of diagnosis, ending with rehabilitation after complex treatment of spinal cord neoplasms.
If a specific narrow specialist or certain rare diagnostic equipment is not available, patient, together with his parents or custodians, is referred to Maimonides affiliated clinics or Israeli partner medical centers, where he will certainly receive the full range of necessary medical services.
The most common types of spinal cord tumors in children
Central nervous system tumors in children are quite common and rank second among all oncological diseases after malignant lesions of blood system. Spinal cord neoplasms are divided into:
- Intramedullary – localized in parenchyma (substance) of spinal cord. The most common types of intramedullary neoplasms are gliomas, ependymomas, and low-grade astrocytomas. These tumors spread inside spinal cord, destroy it, lead to formation of cavities inside the organ, filled with cerebrospinal fluid.
- Extramedullary – located outside parenchyma of spinal cord. They can be intradural – located inside dura mater of spinal cord, but on parenchyma surface and do not penetrate into it, and extradural – located outside dura mater of spinal cord. As a rule, first tumors are benign (most often – meningiomas, neurofibromas), the second – malignant and metastatic. A group of extramedullary tumors does not destroy spinal cord substance, but compresses it together with nerve roots of spinal cord, which determines spinal cord impression with these tumors.
The most common spinal cord tumors in children are:
- Glioma. It is an intramedullary neoplasm, relatively benign, that grows slowly, but leads to spinal cord parenchyma destruction and appearance of symptoms associated with persistent neurological deficits.
- Neuroma. This is an extramedullary benign tumor from Schwann cells that can affect any spinal nerve roots. Symptoms develop slowly and are mainly associated with certain spinal roots compression (root syndrome).
- Secondary (metastatic) spinal cord cancer . Malignant neoplasms can spread to spinal cord and spinal canal either hematogenously or as a result of sprouting from nearby anatomical structures. Most of these tumors are extramedullary extradural (located outside dura mater). Spinal cord metastatic lesions most often occur in case of primary malignant tumors of kidneys, thyroid gland, lungs, and lymphomas in children.
- Astrocytoma. This is an intramedullary tumor that leads to destruction of spinal cord substance. Most often, the cervical part of organ is affected with corresponding neurological symptoms development.
- Ependymoma. It also belongs to the group of intramedullary tumors. It is often diagnosed in childhood. It mainly affects spinal cord lumbar and sacral segments, which is clinically manifested by symptoms of cauda equina syndrome.
- Meningioma. This is an extramedullary intradural neoplasm that grows rather slowly and manifests itself according to spinal cord or its roots compression. Most often, thoracic part of organ is affected. It occurs quite often in children.
- Atypical teratoid-rhabdoid tumor (ATRO). This is a very aggressive invasive malignant tumor from embryonic tissues. It is rare – no more than 2% of all CNS tumors in children. As a rule, children under 3 years old suffer. Tumor mainly affects cerebellum, brain stem with the transition to upper parts of spinal cord.
- Teratoma. This type of tumor is germinogenic. This means that the source of development is embryonic poorly differentiated tissues. It is rare, can be both benign and malignant.
Symptoms of spinal cord tumors in children
There are quite a lot of spinal cord tumors types and their symptoms can vary significantly. First of all, manifestations of disease depend on neoplasm location, its size, growth rate, and stage of process. In the vast majority of cases, spinal cord tumors grow slowly, symptoms appear gradually, may disappear for a while, and then appear again.
The most frequent manifestations of spinal cord neoplasms:
- Pain in back that progresses, does not depend on physical activity, worsens when lying down.
- Various neurological disorders – impaired sensitivity, motor function in certain parts of body (depending on lesion location).
- Disorders of pelvic organs function – urinary incontinence or urine retention, fecal incontinence, impaired sensitivity in perineum.
- Pony tail syndrome.
- Monoparesis, paraparesis and other motor function disorders.
- Muscle weakness, muscle atrophy.
If you notice at least one of symptoms listed above, consult a neurologist, who will conduct a detailed examination and, if necessary, refer you to a neurosurgeon or pediatric oncologist.
Modern diagnostic methods
As you know, in order to overcome any disease successfully, especially cancer, you need high-quality, fast and accurate diagnosis . Specialists of Pediatric Oncology Department of Maimonides Medical Center have all modern diagnostic examinations, in their practice they use only modern technologies and the latest equipment of expert class.
After an initial examination, a detailed neurological examination, and an anamnesis collection, doctor will make up an individual examination plan for each child with suspicion of spinal cord tumor. This plan may include:
- General clinical tests of blood and urine.
- Spinal puncture and cytological examination of cerebrospinal fluid.
- Ultrasound of head and neck vascular examination techniques.
- Various modern methods of medical imaging – CT and MRI with or without contrast , MSCT, PET-CT, PET-MRI, myelography.With their help, we can get a detailed image of tumor and surrounding tissues, it is possible to understand the size of neoplasm, its spread limits, make up conclusions about which parts of organ are affected, plan the scope of future surgery, and even get a 3D or 4D model of neoplasm.
- Head, neck, spine vessels angiography.
- Neurophysiological methods of spinal cord function studying , for example, electromyography (EMG).
- Neoplasm biopsy with followed histological examination to obtain an accurate diagnosis with verification of tumor type and its individual characteristics.
Neoplasm biopsy is an extremely important stage of modern diagnostics, not only in terms of making an accurate diagnosis, but also in terms of selecting individual therapy. All received after a biopsy material is sent to the best pathogistological laboratories in USA, Germany, and Israel for revision. Thanks to such double checks, we are absolutely sure of diagnosis correctness and subsequent selection of adequate treatment scheme.
All biopsy procedures are performed on children under sedation or general anesthesia , so that our little pationts do not have the slightest feeling of pain, fear or other psychological discomfort.
Also,biopsy specimens are sent abroad for "molecular tests". With the help of innovative molecular genetic tests, characteristics of malignant cells are studied – present mutations and receptors that are on the surface of these changed cells. Thanks to this in-depth analysis, it is possible to create drugs with individual action (personalized oncology). In this way, targeted drugs and other drugs for immunobiological therapy are manufactured, which purposefully destroy only malignant cells in body, without affecting healthy surrounding cellular elements. Such test system for molecular genetic testing are the Foundation One panel and Caris Molecular Testing. All patients of Maimonides Medical Center have access to such modern diagnostic tests, which will only have a positive effect on their further treatment.
Innovations in spinal cord tumors treatment in children
Spinal cord tumors are difficult diseases, and the earlier specific and comprehensive treatment is started, the better prognosis. Considering all the variety of neurological lesions in spinal cord diseases, treatment scheme is planned not only by oncologist, but by a large multidisciplinary team with involvement of pediatric neurologists, radiation therapists, chemotherapists, neurosurgeons, pediatricians and other specialists if necessary. Only by joint efforts, the right tactics are chosen for each individual child and his disease. And all this happens under supervision of the best children's oncologists in Israel, who moderate the project on children's oncology of Maimonides Medical Center.
The main treatment method is surgical intervention. Planning it, neurosurgeons try to find the most optimal access to pathological focus in order to remove it and not damage surrounding tissues. All surgical interventions are performed using modern equipment, most procedures are minimally invasive and organ-preserving.
Radiation therapy is also used in complex treatment. It can be prescribed before surgery to reduce the size of pathological focus for its more effective removal, it can be prescribed after surgery to reduce recurrence risk of disease in future. Sometimes, modern procedure of intraoperative radiation therapy can be used, when tumor bed is irradiated after its removal. This makes it possible to completely destroy every single malignant cell that may have remained after tumor removal.
Treatment must be supplemented with modern schemes of chemotherapy, targeted therapy and other drugs of immunobiological action. We use only modern and safe medicine from the world's leading manufacturers. Thus, we are confident in their effectiveness and minimal side effects.
Targeted drugs are actively used in treatment of patients with spinal cord malignant tumors. They act purposefully only on tumor cells, while not harming the surrounding healthy tissues, and this is their main difference from classical chemotherapy medicines.
On the basis of leading Israeli centers of children's oncology, clinical studies of experimental drugs,diagnostic and treatment procedures are constantly conducted. All our patients can become participants in such studies absolutely free of charge, and for some of sick children, this is the only chance for a full recovery, especially for those for whom standard treatment regimens have proven ineffective.