What is metastatic spinal cord compression (MSCC)?

MSCC happens when cancer cells grow in or near to the spine and press on the spinal cord.

The spinal cord is a long thin bundle of nerves and other cells. It runs from your brain down through your spine. The nerves carry messages between your brain and all parts of the body. These messages allow you to move and to feel things like heat, cold, touch or pain. They also help control body temperature and how your internal organs work.

Cancer cells pressing on the spinal cord can cause problems with how these messages are carried. This can cause a range of symptoms which can get worse if left untreated. For example you may be less able to walk and move around.

At its worst, MSCC can cause paralysis which could mean you can’t walk or can’t use your limbs normally. Remember, there are treatments available and getting treatment straight away can lower the risk of this happening, or of it being permanent.

 Diagram showing cancer growing close to the spinal cord

What is my risk of developing MSCC?

MSCC is not common, but you need to be aware of it if you have prostate cancer which has spread to your bones or has a high chance of spreading to your bones. Your risk of MSCC is highest if your prostate cancer has already spread to your spine.

Speak to your doctor or nurse for more information about your risk of MSCC.

What symptoms do I need to watch out for?

MSCC can cause any of the following symptoms.

  • Pain or soreness in your lower, middle or upper back or neck which is severe or different from usual pain. The pain might get worse when you cough, sneeze, lift or strain, or go to the toilet. It might get worse when you are lying down. It may wake you at night or stop you from sleeping.
  • A narrow band of pain around your tummy or chest which can move towards your lower back, buttocks or legs.
  • Pain that moves down your arms or legs.
  • Weakness in your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.
  • Numbness or pins and needles in your legs, arms, fingers, toes, buttocks, stomach area or chest, that don’t go away.
  • Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.

These symptoms can also be caused by other conditions, but it is still important to get medical advice in case you do have MSCC.

What should I do if I get symptoms?

If you get any of the symptoms listed above, you should get medical advice straight away. Don’t wait to see if your symptoms get better and don’t worry if it’s an inconvenient time, such as the evening or weekend.

Ask your doctor or nurse to tell you who you should contact during the day, at night, and at the weekend.

If you don’t have details of who to contact, or you can't reach them, go to your nearest accident and emergency (A&E) department. You should tell the A&E staff that you have prostate cancer and symptoms of spinal cord compression. Not everyone will be familiar with MSCC, so it might be a good idea to show them this web page, take our fact sheet Metastatic spinal cord compression with you, or take other information about MSCC with you.

If your doctor suspects that you may have MSCC, you will need to have a magnetic resonance imaging (MRI) scan to look at your spine. You may also have a computerised tomography (CT) scan. Read more about scans.

How is MSCC treated and managed?

While you are waiting for a diagnosis, there are a number of things that can be done to make you more comfortable and to help protect your spinal cord from further harm.

  • Bed rest. You might be asked to lie flat on your back. This helps keep your spine still and reduce the risk of further damage to your spinal cord. Your doctor or nurse will monitor your condition and let you know when it’s safe for you to gradually sit up.
  • Pain relief. There are a number of pain-relieving drugs which can treat the pain caused by MSCC and by the cancer in other parts of your body. You can read more about these in our fact sheet, Managing pain in advanced prostate cancer.
  • A steroid called dexamethasone. This works quickly to reduce swelling and relieve pressure on the spinal cord. You’ll be given a daily dose as a tablet or a drip through a vein in your arm. The dose will be gradually reduced and stopped if your symptoms have improved, and after you’ve started other treatment. You might also be given tablets to help prevent the steroids irritating your stomach.

If you are diagnosed with MSCC, you will start treatment within 24hours. Your doctor will explain the different treatment options to help you decide what’s right for you. They will take your preferences into account as far as possible. They will also support you and your family after treatment to help you recover from MSCC.

There are several treatments available - you may be offered a combination of these.

  • Radiotherapy. The aim of this treatment is to shrink the cancer cells that are pressing on your spinal cord. It can also help to relieve the pain. Radiation is directed at the affected area from outside the body (known as external beam radiotherapy). The number of times you need treatment varies, but is likely to be every day for up to a week. Read more about radiotherapy for advanced prostate cancer.
  • Surgery. Surgery is sometimes used. Your doctor will discuss this with you if it’s suitable for you. It usually involves reducing the pressure on your spinal cord and stabilising your spine. Surgery is sometimes done at a specialist spinal unit. You might be given radiotherapy once you’ve recovered from surgery, to shrink any areas of cancer which might be left in the spine.
  • A support brace .This fits around your back or neck and helps keep your spine still. It can also help with pain. This is only used if other treatments are not suitable for you, or if your spine still needs support after other treatments.

What happens after treatment?

MSCC can affect men in different ways. Getting treatment early can reduce the risk of long-term problems, but for some men it can take weeks or months to recover. Sometimes the effects can last longer or are permanent. Your doctor or nurse at the hospital will make sure you get the support you need.

If MSCC means that you’re less able to walk and move around, a physiotherapist can show you exercises which can help. An occupational therapist (OT) can make sure you have the right equipment in your house so that you’re comfortable and can move about more easily. Your doctor will also look at the treatments you are having for your prostate cancer.

Read about treatments that can help control the growth of prostate cancer.

Read more about symptoms of advanced prostate cancer and treatments for them.

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References

Updated: February 2015 | Due for review: February 2018

  • List of references  

    • George R, Ramkumar G, Chacko AG, Leng M, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev. 2008;
    • Heidenreich A, Aus G, Abbou CC, Bolla M, Joniau S, Matveev V, et al. Guidelines on Prostate Cancer. European Association of Urology. 2013;
    • Loblaw DA, Mitera G, Ford M, Laperriere NJ. A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression. Int J Radiat Oncol. 2012;84(2):312–7
    • National Institute for Health and Care Excellence. Metastatic spinal cord compression: Diagnosis and management of adults at risk of and with metastatic spinal cord compression. NICE clinical guideline 75 [Internet]. 2008. Available from: https://www.nice.org.uk/guidance/cg75
    • NICE. guidance-metastatic-spinal-cord-compression QS NICE -pdf.pdf
    • Samphao S, Eremin JM, Eremin O. Oncological emergencies: clinical importance and principles of management. Eur J Cancer Care (Engl). 2010;19(6):707–13.