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Last updated June 26, 1999
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Childhood leukemia
Tumors in the area
of the spinal cord
Acute Lymphocytic Leukemia, or "ALL" is the most common childhood leukemia, usually diagnosed between the ages of 3 and 7 (but it happens outside those ages, though with a worse prognosis). ALL has a fairly good survival rate for a leukemia (60% still alive longer than 5 years after diagnosis) and many people have a complete remission with today's treatment. Symptoms of ALL include fatigue, weakness, pallor (looking pale), and weight loss. Easy bruising and bleeding and infections such as pneumonia, urinary tract infection, etc. can occur.
The reason for all of these problems is that leukemia is a disease where the bone marrow is invaded by a "evil" clone of white blood cells which are usually defective. The bone marrow is taken over and begins producing only the bad white blood cells and not your regular red blood cells and regular white blood cells and platelets. You get anemic (fatigue, pallor, weakness) because you stop making enough red blood cells, easy bruising and bleeding from not enough platelets, and infections (pneumonia, etc.) from not enough good white blood cells. The weight loss is due to the fact that cancerous cells are dividing and growing so rapidly that they eat up all your energy, so you lose weight.
Treatment of ALL is initially a chemotherapy regimen including drugs such as vincristine, prednisone, and anthracycline. If someone achieves remission on this, they undergo another 2 to 3 years of intensive therapy with more chemotherapy at lower doses. If chemo doesn't work or if the patient has a relapse, the last resort is bone marrow transplantation from a donor who is an HLA match. This is most commonly a (genetic) sibling of the patient. The chances that a particular sibling will be a full HLA match to the patient are 1 in 4 (25%). They have national bone marrow registries now days, but the chances of finding someone who isn't related to you and matches your bone marrow are extremely slim (I'm not sure what the odds are off the top of my head). Lucky patients who get bone marrow transplants can be cured, but even that procedure has a high risk. Patients have to undergo intensive chemotherapy and radiation to kill off their bad bone marrow before getting a transplant, and if the transplant doesn't succeed, they will die.
This question brings up a good opportunity to make a plug for the National Marrow Donor Program Registry, an organization which maintains a listing of people who are willing to be bone marrow donors and matches them with patients who need bone marrow transplants. Over 4,000 bone marrow transplants have resulted from this program. All you have to do to join is go to a place (usually your local blood bank) which is a part of this program and give a couple tubes of blood to get your HLA genetic code determined. If you happen to match someone who needs a bone marrow transplant, you have a chance to save a life! I encourage you to visit their website above or call 1-800-MARROW-2 for more information.
Tumors in the area of the spinal cord
One of the most common benign spinal cord tumors is called an "intraspinal schwannoma" (a.k.a. neurilemmoma) and is a slowly growing tumor of Schwann cells, the cells that make the myelin covering for nerves. Since these tumors usually begin in the sensory spinal roots, the most common presentation is pain radiating down the nerves coming out of that part of the spinal cord. Someone with a tumor at the level of the lower lumbar spine or upper sacral spine would probably have low back pain. Intraspinal schwannomas are usually solitary (only one of them), well-demarcated (good for removing by surgery), and sometimes grow into a "dumb-bell" shape. When these tumors get big enough, they eventually compress the spinal cord and give you symptoms of pain (shooting down the back of the leg to the foot), numbness or tingling in the same area, weakness (foot drop occurs with a tumor in the lower back), and urinary and/or bowel incontinence (also with a tumor in the lower back). It is important to remember that the pain and sensory loss come first with the weakness and incontinence coming last. The weakness and incontinence indicate an emergency, meaning the tumor is really bad and must be removed immediately to try to relieve the compression and avoid permanent damage (which there could be anyway).
A patient presenting with these symptoms would be given a thorough neurological examination (look under the neurology section) with special emphasis on determining the extent of sensory loss (using pin prick and vibration), weakness (leg and foot muscles must be tested on both sides for comparison), and reflexes, particularly the ankle reflex (tapping on the achilles tendon) which would be absent in spinal cord compression. The patient would be asked specifically about where the pain and numbness was located, what activities had become difficult (i.e. walking) and whether or not he had experienced any urinary or bowel incontinence. At that point the patient would get x-rays of the lower back as well as an MRI scan of the lumbar and sacral spine. MRI is the best scan for the spine, better than CT, but it takes longer (around an hour or so). The MRI machine is the one that looks like a long tube that they slide the patient into. A neurosurgeon would be consulted in the meantime. Once the scan is completed, the tumor should show up and the neurosurgeon would be able to determine how quickly surgery should be done (probably right away).
A spinal tap (lumbar puncture) wouldn't necessarily be part of the diagnosis and the results would not be helpful.
I've never seen an actual spinal tumor resection (surgery), but it's probably similar to other lower back surgeries in that the patient is put under general anesthesia and portions of the backbone (vertebrae) are cut away to expose the spinal cord and tumor so it can be fully removed, with care to preserve as many nerves as possible. The schwannoma tumor is located within the dura layer of the meninges (the layer covering the spinal cord) but outside the cord itself, making the removal a little easier and rehab better. Thus, the spinal cord itself would hopefully not need to be cut if the tumor was fully removed and the compression relieved. The surgery would be a lengthy one (hours).
I can't give you a lot of information on the rehab phase after surgery because I'm not a physical therapist (they would be the main people involved). Obviously the whole process would take months, and the patient would probably remain in the hospital for in-patient rehab for several weeks. The patient would probably remain flat on his back for several days due to pain and would need ample pain medicine. Sitting and then walking would be taken in slow steps. The prognosis for walking again should be good if the tumor was completely removed and the spinal cord hadn't been compressed for too long, and none of the spinal cord needed to be removed during the surgery.