Spinal cancer refers to abnormal cell growth in or around the spinal cord and spinal column. Most spinal tumors are actually metastatic, meaning they started as cancer somewhere else in the body and spread to the spine. Between 5% and 30% of people with cancer develop metastatic spinal tumors. Primary spinal tumors, which originate in spinal tissue itself, are far less common but can be either benign or malignant.
Primary vs. Metastatic Spinal Tumors
The distinction between primary and metastatic spinal cancer matters because it determines how the disease is treated and what the outlook looks like. Primary spinal tumors grow from cells within the spinal cord, its protective membranes, or surrounding nerves. These are relatively rare. Metastatic spinal tumors are much more common and arrive via the bloodstream from cancers elsewhere in the body.
The cancers most likely to spread to the spine, in order of frequency, are breast cancer, lung cancer, prostate cancer, kidney cancer, colorectal cancer, and thyroid cancer. When a tumor in the spine is metastatic, treatment focuses on both the original cancer and the spinal growth.
How Spinal Tumors Are Classified
Doctors categorize spinal tumors based on where they sit in relation to the spinal cord. Intramedullary tumors grow inside the spinal cord tissue itself. Intradural-extramedullary tumors develop within the spinal canal but outside the cord, typically in the surrounding membranes or nerve coverings.
Intramedullary Tumors
These tumors arise from cells within the spinal cord. The most common type in adults is ependymoma, which accounts for about 60% of adult spinal cord tumors. Ependymomas develop from cells that line the central canal of the spinal cord and help direct fluid flow. In children, astrocytomas are the most common, making up roughly 60% of pediatric spinal cancers. Astrocytomas grow from star-shaped cells that support nerve function and can range from slow-growing to aggressive. Less common intramedullary tumors include hemangioblastomas (blood vessel-rich growths) and lipomas (fatty tissue growths, usually in the middle back).
Intradural-Extramedullary Tumors
These grow in the membranes or nerve coverings surrounding the spinal cord rather than inside it. Meningiomas form in the thin membranes covering the cord. Schwannomas develop from the cells that produce nerve insulation. Neurofibromas arise in the protective covering of the spinal cord and nerves. Many of these tumors are benign, but they can still cause serious problems by pressing on the spinal cord or nerve roots.
Symptoms of Spinal Tumors
Back pain is the most common symptom of both benign and malignant spinal tumors. Tumors in the middle or lower back produce pain more frequently, simply because tumors develop in those regions more often. What distinguishes spinal tumor pain from ordinary back pain is its pattern: it typically isn’t linked to any injury or physical activity, feels deep and aching, starts slowly and gradually worsens, and persists at night, sometimes enough to disrupt sleep. Straining, sneezing, or coughing can make it worse.
Some spinal tumors cause no symptoms at all when they’re small enough to avoid pressing on nearby tissue. As a tumor grows, symptoms depend on its size, type, and location along the spine. Larger tumors can compress the spinal cord or nerve roots, potentially causing numbness, weakness in the arms or legs, difficulty walking, or changes in bladder and bowel function.
Risk Factors and Genetic Links
Most spinal tumors have no clear cause, but certain inherited genetic conditions significantly raise the risk. Neurofibromatosis type 2 (NF2) is caused by a mutation on chromosome 22 that disables a gene responsible for suppressing tumor growth. People with NF2 are prone to developing schwannomas, meningiomas, and ependymomas in the brain and spine. Roughly 50% to 75% of people with NF2 develop meningiomas along the brain or spine, and about 20% develop ependymomas inside the spinal cord.
Von Hippel-Lindau disease, another inherited condition, increases the risk of hemangioblastomas in the spinal cord. For metastatic spinal cancer, the primary risk factor is simply having cancer elsewhere in the body, particularly one of the types that commonly spreads to bone.
How Spinal Cancer Is Diagnosed
MRI is the preferred test for detecting spinal cord tumors. It produces detailed images of the spinal cord and surrounding structures, and a contrast dye injected into a vein during the scan makes tumors show up more clearly. If the MRI reveals a suspicious growth, a biopsy (removing a small tissue sample for examination under a microscope) confirms whether the tumor is benign or malignant and identifies its specific type, which guides treatment decisions.
Treatment Approaches
Surgery is often the first-line treatment for primary spinal tumors, with the goal of removing as much of the tumor as possible without damaging the spinal cord. Some tumors, particularly benign meningiomas and schwannomas, can be completely removed. Others, like astrocytomas that blend into surrounding cord tissue, may only be partially resectable.
Radiation therapy plays a major role in treating tumors that can’t be fully removed surgically and in managing metastatic spinal disease. Stereotactic radiosurgery is a highly precise form of radiation that aims multiple beams through the skin from different angles, focusing them on the tumor while minimizing damage to surrounding healthy tissue. It requires no incision. The beams damage the DNA of tumor cells so they can no longer reproduce, causing the growth to gradually shrink. Most patients need only one to five treatment sessions.
Chemotherapy is less commonly used for primary spinal tumors than for brain tumors, but it may be part of the plan for aggressive or metastatic disease. For metastatic spinal cancer, treatment typically combines approaches aimed at controlling the original cancer with local treatments for the spinal tumor itself.
Survival Rates by Tumor Type
Outcomes vary dramatically depending on the tumor type, its grade, and the patient’s age. Based on data from the Central Brain Tumor Registry covering patients treated between 2004 and 2020, ependymomas have a 5-year relative survival rate of 95% in people aged 15 to 39 and 91% in those over 40. Meningiomas are similarly favorable at 97% and 88% for those age groups.
More aggressive tumors carry lower survival rates. Low-grade astrocytomas have a 5-year survival of 79% in younger adults but only 34% in those over 40. Anaplastic astrocytoma drops to 64% and 21%, respectively. Glioblastoma, the most aggressive type, has a 5-year survival of 28% in younger adults and 6% in those over 40. Age at diagnosis is one of the strongest predictors of outcome across nearly every tumor type.
Recovery and Rehabilitation
Rehabilitation is a critical part of treatment for spinal cancer, not an afterthought. Research from Memorial Sloan Kettering shows that structured rehabilitation improves function, mood, pain levels, quality of life, and even survival in people with malignant spinal cord compression. Recovery programs typically include physical and occupational therapy focused on strengthening, range of motion, balance, gait training, and relearning daily activities.
For patients with neurological impairments from tumor compression or surgery, rehabilitation may also involve bracing for the arms, legs, or trunk to provide joint stability and compensate for weakness. Core strengthening and postural training help prevent spinal instability. The specific recovery timeline depends on the extent of surgery, the degree of neurological involvement before treatment, and the tumor type, but the evidence consistently shows that early, active rehabilitation produces better functional outcomes than a wait-and-see approach.