Metastatic spinal cord compression (MSCC)
On this page
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What is metastatic spinal cord compression (MSCC)?
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The spinal cord
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Signs and symptoms of cancer affecting the spine
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Signs and symptoms of MSCC
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What should I do if I have symptoms of MSCC?
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How MSCC is diagnosed
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How is MSCC treated?
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Coping with symptoms of MSCC
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After treatment for MSCC
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Your feelings and MSCC
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How we can help
What is metastatic spinal cord compression (MSCC)?
Some cancers can spread to the bones of the spine or to the tissues that surround the spinal cord. This is called secondary cancer or metastatic cancer..
Metastatic spinal cord compression (MSCC) can happen when cancer grows and presses on the spinal cord. This stops the nerves from working properly. It is called compression.
Any type of cancer can spread to the bones of the spine and affect the spinal cord. But MSCC is more common in people with breast cancer, lung cancer, prostate cancer and myeloma.
Booklets and resources
The spinal cord
The spinal cord is a bundle of nerves that runs from the brain down the back. It connects the brain to the rest of the body. It is important for many of the body’s functions. These include:
- movement
- bowel and bladder function
- the sensations of touch, pain and temperature.
The spinal cord is surrounded and protected by the bones of the spine (vertebrae).
Signs and symptoms of cancer affecting the spine
Secondary cancers in the spine can occur with any type of cancer. But they are more common in people who have or have had breast, prostate or lung cancer. Myeloma is a type of blood cancer that can affect the bones of the spine.
Back pain is the most common symptom of cancer in the spine. Tell your doctors straight away if you have back pain that:
- is severe
- is getting worse
- gets worse with movement
- gets worse with straining, for example – when coughing or emptying your bowels (pooing)
- disturbs your sleep
- causes tenderness
- causes muscle pain or cramps when walking or exercising.
Signs and symptoms of MSCC
Symptoms of MSCC depend on which part of the spine is affected. The warning signs could be 1 or more of the following:
Bowel problems
These include:
- having problems controlling your bowels (incontinence)
- being newly constipated, or constipation getting worse.
Problems passing urine (peeing)
These include:
- having difficulty controlling your bladder (incontinence)
- only passing small amounts of urine, or none at all.
Feeling unsteady on your feet
These include:
- having difficulty walking
- leg weakness
- your legs giving way.
Feeling that your arms and hands do not work properly
These include:
- weakness in your arms and hands
- not being able to grip things properly.
Numbness or pins and needles
You may feel numbness or pins and needles – this may be anywhere in your body. This could be a symptom if it is new or quickly getting worse.
Back or neck pain
This means pain that is new and may:
- feel like a band around your chest or tummy (abdomen)
- spread down a leg or arm
- spread into your lower back and buttocks.
These symptoms can also be caused by other conditions. But you should always get your symptoms checked, even if you have had previous treatment for MSCC.
What should I do if I have symptoms of MSCC?
If you develop any symptoms of MSCC, you should get medical advice immediately. Even if it is the weekend or a holiday, contact the hospital team where you usually go for cancer treatment and follow-up appointments.
Make sure you have their contact details and you know who to phone at evenings and weekends. If you are unable to get in touch with anyone, go to the nearest Emergency Department (A&E) straight away.
When you speak to a health professional:
- describe your symptoms
- tell them you have cancer and are worried you may have spinal cord compression
- show them your MSCC alert card or leaflet.
Spinal cord compression is an emergency that needs treatment as soon as possible.
Do not wait for further symptoms to develop. The sooner MSCC is diagnosed, the sooner treatment can begin. If left untreated, MSCC can cause permanent nerve damage.
How MSCC is diagnosed
A member of your healthcare team will examine you. If they think you might have MSCC, they may do some, or all, of the following:
- You may be told to lie flat on your back and not move your spine.
- They may arrange an urgent scan of your spine. This is usually an MRI scan (magnetic resonance imaging scan). If you cannot have an MRI, it may be a CT scan (computerised tomography scan).
- They may prescribe some steroids. These help to reduce swelling and pressure on the nerves. Tell the doctor or nurse if you are diabetic, or if you have had problems with steroids before.
Sometimes, MSCC is the first symptom of cancer. If you have not been diagnosed with cancer, your doctor may recommend you have a biopsy of the spine. This will help give an exact diagnosis.
Lying flat
If you have symptoms of MSCC, a member of your healthcare team may advise you to lie flat on your back and keep still. This can help stop any further damage to the spine. Your healthcare team can help you to change position safely if you need to move.
If tests confirm you have MSCC, your healthcare team will decide what movement is safe and what you can and cannot do.
You may be given a collar or brace to wear. This can help to support the neck or spine. A physiotherapist will discuss this with you.
During and after treatment, your healthcare team will examine you regularly. This will include examining your:
- range of movement
- muscle strength
- co-ordination
- sensation to touch.
This will help them understand how well the treatment is working.
How is MSCC treated?
Treatment should be started as soon as possible after MSCC has been diagnosed. The aim of treatment is to:
- minimise the damage to the spinal cord
- treat symptoms.
Treatment will make the tumour smaller. This helps take the pressure off the spinal cord and reduces pain.
Damage to the spinal cord from compression can be very different for each person. Treatment may ease the pressure on the spine and there is no lasting damage. But sometimes, the nerves may be badly damaged. Some people may have some paralysis or bladder and bowel problems when MSCC is diagnosed. Sometimes these may be permanent.
Treatment will depend on several things, including:
- the type of cancer you have
- which part of the spine is affected
- your general health.
The most common treatment is radiotherapy. Depending on the type of cancer, some people may be offered surgery or drug treatments, such as chemotherapy. Your cancer doctor will talk to you about treatment options and how they may help.
Treatment to your spine has some risks. Before you have treatment, your cancer doctor will talk to you about these risks and ask about your preferences for treatment. They will ask you to sign a form saying you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.
Treatment usually involves a combination of the following:
Steroids
Your healthcare team may give you high doses of a steroid called dexamethasone straight away if they think you may have MSCC. This helps reduce pressure and swelling around the spinal cord. It can also help with symptoms, such as pain. You may be given steroids as tablets or an injection.
After you have started treatment with radiotherapy or have had surgery, the dose of steroids is reduced slowly and then stopped. When this happens will depend on your symptoms.
Radiotherapy
Radiotherapy uses high-energy rays called radiation to treat cancer. It may be used on its own, or sometimes with other treatments such as surgery. It is given by a radiotherapy machine that aims radiation at the tumour from outside the body. This is called external beam radiotherapy.
Radiotherapy starts as soon as possible after MSCC is diagnosed. You may have just one treatment. Or you may have a short course of 1 treatment a day for 1 or 2 weeks. It may be given for longer for some types of cancer. Your cancer doctor will talk to you about how long your treatment will be.
Surgery
Some people with metastatic spinal cord compression (MSCC) may be offered surgery. The aim of surgery is to:
- reduce pressure on the spinal cord and nerves
- stabilise the spine.
Different types of surgery can be used. It may involve:
- removing as much of the tumour as possible
- removing parts of the bones of the spine (vertebrae)
- using metal rods, screws or bone grafts to make the spine stable
- injecting a special cement into the bones of the spine.
Your surgeon or specialist nurse will explain the operation in more detail if surgery is an option for you.
You will usually have radiotherapy after surgery to help remove any cancer cells that remain.
Other treatments
Anti-cancer drug treatments such as chemotherapy or immunotherapy may be used to treat MSCC for tumours that are sensitive to these treatments.
Your healthcare team will talk with you about the different treatment options.
Coping with symptoms of MSCC
Your healthcare team will give you advice and support to manage symptoms of MSCC.
Pain
Most people with MSCC have pain from the cancer in the spine. Your healthcare team will talk with you about the ways it can be managed. There are different drugs that can be used to help manage pain. Your healthcare team will check to make sure the drugs are working well. Tell them if you still have pain. They can change the doses of the painkillers or prescribe some that work better for you.
Your healthcare team may also give you drugs called bisphosphonates. These can only be used with some types of cancer. Bisphosphonates can help treat your pain and strengthen the bones. The drug denosumab can also help reduce pain caused by secondary bone cancer. Denosumab cannot be used if secondary bone cancer is caused by prostate cancer.
Difficulty moving
You may have difficulty moving around and your muscle strength may be affected. You may not be able to feel and control movement in your muscles.
This can affect people differently. Some people may have poor coordination. Other people may be unable to walk. A physiotherapist will help you to move as much as possible. An occupational therapist can give you practical advice and provide equipment to help you stay as independent as possible. We have information about walking (mobility) problems.
Bladder changes
Your healthcare team will check how well your bladder is working. Tell them if you have any problems controlling your bladder or passing urine (peeing). You may need a tube (catheter) put into the bladder to help drain urine.
Bowel changes
You may be given medicine to help with constipation or problems controlling your bowels.
After treatment for MSCC
You may need some help and support to manage at home. The help you need will depend on:
- how well the treatment has worked
- your mobility
- your general health.
If you were unable to walk or had difficulty moving before treatment, this may not get better. In this case, you may need further care and support from staff at your cancer centre, local hospital, community team or hospice. They will work closely with you and your family to plan care and rehabilitation to suit your needs. The staff will organise any care you need before you leave the hospital.
Your cancer team may refer you to a palliative care team. This is a team of specialists who can help you manage symptoms and offer emotional and psychological support. They are usually based in hospitals and hospices. The cancer team or palliative care team may talk to you about advance care planning. Planning ahead makes sure people know what your wishes are when it comes to your treatment and future care.
If you have any questions about your care, you should discuss this with your healthcare team.
Your feelings and MSCC
It can be difficult to cope with the changes caused by MSCC. You may feel many different emotions including anger, fear, and anxiety.
Everyone has their own way of coping with difficult situations. Talking about it can often help. You might find it helpful to talk to family or friends. Or you may prefer to get help from a healthcare professional or counsellor.
You might want to keep your feelings to yourself. There is no right or wrong way to cope, but but help is there if you need it. Our cancer support specialists can tell you about counselling in your area.
Our Online Community is a place to connect with people who understand what you are going through. You can visit our emotional support or spinal cord tumour forums to talk with others.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our metastatic spinal cord compression information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
NICE. Spinal metastases and metastatic spinal cord compression. NICE. www.nice.org.uk. 2023. Available from: www.nice.org.uk/guidance/ng234 (accessed January 2024)
Casey KF, Ruppert LM. Malignant spinal cord compression. BMJ Best Practice.. Available from: bestpractice-bmj-com.knowledge.idm.oclc.org/topics/en-gb/3000286 (accessed January 2024)
National Comprehensive Cancer Network (NCCN). Central Nervous System Cancers. 2023. Available from www.nccn.org/professionals/physician_gls/pdf/cns.pdf (accessed January 2024)
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