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8 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Intramedullary ependymoma or haemangioblastoma | Gross total resection with intraoperative neurophysiological monitoring; complete removal is usually curative and needs no adjuvant treatment. | not mapped |
| Incompletely resected, high grade or recurrent | Focal radiotherapy with intensity-modulated or proton techniques; temozolomide for high-grade astrocytoma by extrapolation. | not mapped |
| Von Hippel-Lindau haemangioblastoma not needing immediate surgery | Belzutifan, the HIF-2 alpha inhibitor approved for VHL-associated central nervous system haemangioblastomas, with surveillance imaging. | not mapped |
| Intradural extramedullary meningioma or schwannoma | Resection when symptomatic or growing; radiosurgery for residual or recurrent tumour where the cord dose allows; observation for small asymptomatic lesions. | not mapped |