Do not ignore pain in back, neck especially if it worsens at night Kathmandu Spinal cancers are not uncommon in our setting. Timely diagnosis and treatment usually results in a good outcome. The most common symptom of spinal cancer is pain. Back or neck pain during limited activities or during night time is considered significant, though regular pain any time may demand proper investigations. Symptoms depend upon size, location, age and degree of compression of the spinal cord or nerve roots. Compression of nerve roots results in arm or leg pain along with weakness and loss of sensation in affected limbs. Patient may have difficulty in urination or defecation. Compression of the spinal cord by a tumour may result in gait abnormalities or varying degrees of paralysis. Others include deformities of the back due to collapse of the affected vertebrae. Unexplained loss of weight and appetite, changes in bowel/bladder habits along with back/ neck pain should always be thoroughly investigated. Spinal cancer may affect any age group. Consultation with spine surgeons will help in accurate diagnosis. After a thorough history taking and clinical examination, the surgeon may ask for X-rays, MRI, CT scans and some blood investigations. However, what investigation modality to be chosen is to be decided only after thorough clinical examination depending upon which part of the body is to be visualised. Primary and Secondary There are basically two types of the spinal cancers. Primary cancers are the ones which arise in the native bone itself. The secondary are the ones which are seeded on the spine via blood or lymph from the tumours distant from the spinal column. The secondary cancers are also known as metastatic tumours. Primary cancers are more common in the younger age group. Any children below the age of 20 years complaining of the above mentioned signs and symptoms should get a consultation with spine experts. Common primary tumours are Primitive Neuroectodermal tumour (PNET), Lymphoma, Osteosarcoma, Giant Cell tumour et cetera. Tumours like Multiple Myeloma, Chondrosarcoma, Chordoma are usually considered to be seen in middle-age groups though these types of tumours have also been diagnosed in younger patients. Secondary or metastatic tumours are observed commonly in people above 50 years of age. The most common primary sites for metastasis are lungs, breasts, prostrate, thyroid, kidneys and intestine. It is recommended to screen anyone above 50 years of age with the above mentioned symptoms to rule out spinal cancers. Causes Causes of spinal cancers are largely unknown. However, there are risk factors — anyone having previous history of cancers in other parts, genetic inheritance (as in Neurofibromatosis Type II), and person with exposures to radiation or industrial chemicals are likely to develop spinal cancers. Treatment of spinal cancer is individualised. The appropriate and best treatment suitable for a patient is decided based upon grading, size, site, age, recurrence and its effect on daily activities of the affected. Various diagnostic tests will be required to confirm and grade the cancer. Obtaining results of the tests usually takes about three to five days. Comprehensive treatment is aimed at eradicating the disease and preventing its recurrence. Multispecialty holistic approach is targeted to improve quality of life and make one strong in body, mind and spirit. There are many causes of back/neck pain and more than 95 per cent of the causes are not serious and usually associated with bad postures, body weight, level of activities and age. These are called mechanical back pain and usually get better with regular exercises and taking care of postures and body weight. But one needs to be aware if s/he has the following symptoms — persistent and progressive pain, pain at rest and not related to activity, pain worsens at night, previous history of cancer, development of new type of pain, progressive muscle weakness and abnormality in walking, changes in bowel and bladder habits. (The author is Director, Spine Services at Grande International Hospital Limited, Dhapasi, Kathmandu)