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Tumours inside or around the spinal cord are rare and usually slow growing, but they press on the cord and threaten walking and bladder control. Most are removed by a surgeon watching nerve signals during the operation; radiotherapy is used when a tumour cannot be fully removed or is high grade, and there are few drugs.
Spinal cord tumours are grouped by compartment. Intramedullary tumours, inside the cord, are mostly ependymomas in adults (WHO 2021 recognises spinal ependymoma, a MYCN-amplified aggressive subtype, and myxopapillary ependymoma of the filum terminale, now grade 2) and astrocytomas in children, with haemangioblastoma (a third of which are part of von Hippel-Lindau disease) and rare gangliogliomas; diffuse midline gliomas with H3 K27 alteration also occur in the cord and carry that diagnosis. Intradural extramedullary tumours are meningiomas and nerve sheath tumours (schwannoma, neurofibroma), often multiple in NF2-related schwannomatosis and neurofibromatosis type 1. Metastases to the vertebrae and cord compression from them are a separate, far commoner problem handled on the metastatic cancer page.
Surgery with intraoperative neurophysiological monitoring is the mainstay: ependymomas and haemangioblastomas have a plane and can usually be removed completely, which is curative for most; astrocytomas infiltrate and are debulked or biopsied. Radiotherapy follows incomplete resection of ependymoma, any high-grade tumour, and recurrence, with intensity-modulated or proton techniques to spare the cord and adjacent organs. Chemotherapy has a small role, largely temozolomide for high-grade astrocytoma by extrapolation from brain gliomas; belzutifan is approved for von Hippel-Lindau-associated haemangioblastomas that do not need immediate surgery and can shrink cord lesions.
Outcome depends more on neurological state at diagnosis than on any treatment, so early recognition of back pain with progressive weakness or sensory change matters. Long-term follow-up with MRI is standard because recurrence can be late. Molecular classification, including methylation profiling and MYCN status for ependymoma, is beginning to refine prognosis, and NF2-related tumours are the subject of the same targeted trials as vestibular schwannoma.
A small fraction of central nervous system tumours, mostly benign or low grade; ependymoma is the commonest intramedullary tumour in adults and astrocytoma in children, and meningioma and schwannoma dominate the intradural extramedullary space.
Gliomas infiltrate along white matter and can cross the corpus callosum, medulloblastoma sits in the cerebellum, and CNS lymphoma favours deep periventricular tissue; none spread through lymph nodes.
No conventional lymphatics: gliomas spread along white matter tracts and, rarely, through cerebrospinal fluid; medulloblastoma can seed the spine.
Same organ: Lactotroph pituitary neuroendocrine tumour (prolactinoma), Somatotroph pituitary neuroendocrine tumour (acromegaly), Corticotroph pituitary neuroendocrine tumour (Cushing disease and silent corticotroph tumour), Gonadotroph pituitary neuroendocrine tumour (non-functioning adenoma), Thyrotroph pituitary neuroendocrine tumour (TSH-secreting), Pineocytoma and pineal parenchymal tumour of intermediate differentiation, Pineoblastoma, Papillary tumour of the pineal region, Choroid plexus carcinoma, Glioma & glioblastoma, Primary CNS lymphoma, Medulloblastoma, Paediatric low-grade glioma, Diffuse midline glioma, H3 K27-altered (including DIPG), Atypical teratoid/rhabdoid tumour (ATRT), Ependymoma, Craniopharyngioma, Pituitary tumours (pituitary neuroendocrine tumours) and pituitary carcinoma, Brain and spinal cord tumours (all types), Astrocytoma, IDH-mutant (grades 2 to 4), Oligodendroglioma, IDH-mutant and 1p/19q-codeleted, Paediatric high-grade glioma (excluding diffuse midline glioma), Meningioma, Brain metastases (secondary brain tumours), Vestibular schwannoma (acoustic neuroma), Central nervous system germ cell tumours (germinoma and non-germinomatous), WNT-activated medulloblastoma, SHH-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH)
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Gross total resection with intraoperative neurophysiological monitoring; complete removal is usually curative and needs no adjuvant treatment.
Focal radiotherapy with intensity-modulated or proton techniques; temozolomide for high-grade astrocytoma by extrapolation.
Belzutifan, the HIF-2 alpha inhibitor approved for VHL-associated central nervous system haemangioblastomas, with surveillance imaging.
Resection when symptomatic or growing; radiosurgery for residual or recurrent tumour where the cord dose allows; observation for small asymptomatic lesions.
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Belzutifan is the first systemic therapy for von Hippel-Lindau disease, approved for renal, central nervous system and pancreatic tumours not needing immediate surgery, changing a lifetime of surveillance and surgery for many patients.
Every brain tumour page on this site uses these names and grades; a tumour called glioblastoma before 2021 may now be an IDH-mutant astrocytoma with a different outlook and treatment.
Query for this cancer: (TITLE:"Spinal cord tumours" OR ABSTRACT:"Spinal cord tumours" OR TITLE:"intramedullary and intradural" OR ABSTRACT:"intramedullary and intradural" OR TITLE:"Intramedullary spinal cord tumour" OR ABSTRACT:"Intramedullary spinal cord tumour" OR TITLE:"Spinal ependymoma" OR ABSTRACT:"Spinal ependymoma" OR TITLE:"Spinal astrocytoma" OR ABSTRACT:"Spinal astrocytoma" OR TITLE:"Intradural extramedullary tumour" OR ABSTRACT:"Intradural extramedullary tumour") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Spinal cord tumours (intramedullary and intradural), not a curated reading list.
The first successful operation for an intradural spinal tumour.
Haemangioblastoma of the cord and cerebellum recognised as a hallmark of the syndrome.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Take on an empty stomach or at bedtime to reduce nausea; PJP prophylaxis during concurrent chemoradiation.
See all on the product pages:Temozolomide·Printable cards in the navigator
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