Malignancy

• Back pain in association with malignancy is commonly dur to metastasis to the spine (rarely from a primary bone cancer). Cancers more likely to metastasise to the spine:

  • Breast
  • Lung
  • Prostate
  • Kidney
  • Thyroid
  • Myeloma
• As cancer that has spread to the spine continues to grow it can damage surrounding structures leading to spinal instability - can lead to spinal cord compression or cauda equina syndrome
• Suspect spinal metastases but not MSCC:

  • Severe unremitting back pain
  • Progressive back pain
  • Mechanical pain - aggravated standing, sitting or moving
  • Back pain aggravated by straining - coughing, sneezing, opening bowels
  • Night-time back pain disturbing sleep
  • Localised tenderness
  • OFFER MRI WITHIN 1 WEEK
• Suspect MSCC:

  • Bladder or bowel dysfunction
  • Gait disturbance
  • Limb weakness
  • Neurological signs of spinal cord or cauda equina compression
  • Numbness, paraesthesia or sensory loss
  • Radicular pain
  • OFFER MRI WITHIN 24 HOURS