Metastatic spinal cord compression in palliative care
Please be aware - this information is for healthcare professionals.
You can use our My Learning form to reflect on how this page has helped with your continuing professional development.
Metastatic spinal cord compression (MSCC) is an emergency and needs urgent medical attention. Help patients to get an early diagnosis by knowing who is at risk and the symptoms.
On this page:
What is metastatic spinal cord compression?
Metastatic spinal cord compression (MSCC) happens when a cancerous tumour damages or presses on the nerves in the spinal cord.
These nerves send messages between the brain and the rest of the body. Any damage can interrupt these messages. Without treatment, this can lead to weakness and paralysis in the legs, loss of sensation, urinary and faecal incontinence and loss of sexual function.
MSCC is also called malignant spinal cord compression.
Patients most at risk of metastatic spinal cord compression
Between five and 10% of people with cancer get MSCC. It is most common in patients with multiple myeloma, breast, lung or prostate cancer. But it can affect people with other types of cancer.
It usually happens when cancer spreads to the bones in the spine (spinal metastases). About 10% of patients with spinal metastases will get MSCC. This may be the first sign that someone has cancer.
Signs and symptoms of metastatic spinal cord compression
Signs and symptoms of MSCC include:
- back pain, which may be constant or get worse over time
- a narrow band of pain around the chest or abdomen
- back pain that spreads down the legs
- back pain that gets worse at night or when the patient lies down, coughs, strains or sneezes
- spine tenderness
- leg weakness with difficulty standing or walking
- numbness and tingling in the legs
- urinary incontinence or retention
- faecal incontinence or constipation.
Pain is usually the first symptom to develop. Tell the patient's GP, hospital acute oncology team or palliative care team straight away if they have any new back pain or if existing back pain gets worse or changes. This is especially important if they have a history of spinal metastases.
Pain is a very common symptom of MSCC. But if someone is taking painkillers, they may not be aware of it. Be aware of possible symptoms. If you suspect the patient has MSCC, tell their GP, hospital acute oncology team or palliative care team straight away.
The earlier MSCC is diagnosed and treated, the better the outcome is likely to be.
Read more about managing pain in palliative care.
If you suspect metastatic spinal cord compression
Contact the patient's GP, hospital acute oncology team or palliative care team immediately. Call 999 if you're not able to get through straight away, the patient has any new pain or they suddenly lose sensation in part of their body.
Patients need urgent diagnosis and treatment to prevent ongoing leg weakness, permanent paralysis and urinary and faecal incontinence.
Make sure the patient lies flat in bed. Do not move them until the medical team examine them. This can help to prevent further damage to the spinal cord. If the healthcare team need to move the patient, they will use the 'log roll' method. You should not attempt the 'log roll' method if you have not been shown how to do it safely.
The medical team will assess the patient's symptoms. They may arrange further tests, such as an MRI scan, or ongoing monitoring.
If the healthcare team diagnose MSCC, they'll offer the patient pain relief and other treatment as soon as possible. Treatment aims to improve their symptoms or stop them getting worse. Treatment options will depend on the patient's condition and wishes but may include surgery, radiotherapy and steroids. Patients may also need support from social services, psychological services, physiotherapy and occupational therapy to help them in their recovery.
Useful resources
NICE Quality Standard 56: Metastatic spinal cord compression in adults
Scottish Palliative Care Guidelines: Spinal Cord Compression
Key points
- Metastatic spinal cord compression is a palliative care emergency that can affect people with cancer.
- New back pain in someone who has cancer, especially if they have bone metastases, should make you think of metastatic spinal cord compression.
- If you suspect metastatic spinal cord compression, get help immediately. Know who to call in your area.
- If it’s not treated early, metastatic spinal cord compression can cause weakness and paralysis.
- Stay calm and explain what’s happening to the patient and those important to them.
Let us know what you think
Email your feedback to knowledgezone@mariecurie.org.uk
Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
Did you find this page useful?
Help us be there for anyone with an illness they're likely to die from by telling us what you think.
If you are completing this survey using a desktop computer, hold down the Ctrl button to select multiple options.
