Malignant spinal cord compression: NICE guidance, improvements and challenges

Abstract

Enhanced patients pathways with ease of access, rapid assessment and prompt treatment can improve outcomes. Despite these pathways many patients still present with gross motor impairment and over 20% have no previous diagnosis of cancer. Ongoing work to maintain awareness for patients and primary care of the diagnosis and emergency pathways is essential to optimize outcomes.

Metastatic spinal cord compression: diagnosis and management

“…A recent UK hospital evaluation of current practice guidelines noted that 30% of their MSCC referrals were from cancer groups outside those most commonly associated with this complication. 7 In practice, we do not know the true incidence of MSCC as most countries do not have a systematic way of recording it. However, evidence from a Scottish audit carried out in the late 1990s and from a Canadian population based study suggests that the incidence may be up to 80 cases per million people per year.…”

Emergencies in Hematology and Oncology

“…135,136 Twenty percent of patients do not have a known cancer diagnosis at the time the MSCC is diagnosed. 133,134,137 Back pain in patients with cancer, especially pain of recent onset and worsening pain, should be taken very seriously and considered to be secondary to MSCC until proven otherwise. A careful history and a thorough physical examination including a neurologic examination are critical when evaluating back pain in patients with cancer.…”

Neuro-Oncologic Emergencies

“…18 It most often occurs as a manifestation of advanced metastatic cancer, especially in the setting of bone metastases, but a substantial proportion (21%) occurs as an initial manifestation of cancer. 19 Prostate, lung, breast, and kidney are the most common underlying malignancies. New-onset back pain is the most common first symptom, followed by weakness, autonomic dysfunction, and sensory loss.…”