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Surgery helps patients with metastatic cancer in the spine

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​​​​Image of Douglas Norris
Douglas Norris has been living with cancer since 1978. Surgery to treat a cancerous tumour growing dangerously close to his spine allowed him to continue enjoying one of his favourite activities, bike riding. (Photo: Douglas Norris)​

"Surgery was my last hope."

This is what Douglas Norris recalls thinking the moment he was told decompression surgery on his spinal cord could spare him impending damage from a growing tumour.

Douglas, 66, was diagnosed with metastatic melanoma – a type of skin cancer – in 1978. In 1984, it metastasized. Although in most cases the disease can't be cured, several surgeries and regular radiation treatments helped keep the cancer that had spread to numerous parts of Douglas' body at bay.

Radiation proved enough to combat the cancer until 2008, when it was discovered that a tumour was pressing against his spinal cord.

Douglas was referred to Dr. Michael Fehlings, a spine neurosurgeon at the Krembil Neuroscience Centre (KNC), to surgically remove the tumour.

"Dr. Fehlings' procedure relieved the pressure I was feeling on my spine. The surgery was followed by radiation to attack as many cancer cells as possible," says Douglas, a retired high school teacher. "That treatment combination allowed me to be active for another seven years, relatively pain free under the circumstances."

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But in 2015, Douglas had a recurrence – his physicians found another tumour threatening to press up against his spine. Although he had yet to feel any symptoms, if left untreated, the tumour would likely cause debilitating pain as it grew up against the spinal cord. It would also have serious consequences for Douglas' ability to get around and his quality of life.

"Radiation wouldn't have much effect on the tumour and because of its location, the amount of radiation needed in the area, and my genetics, drug therapy was not an option," Douglas says. "It was very difficult to have to consider there might be nothing they could do."

Douglas met again with Dr. Fehlings who had recently completed a research trial across North America to support surgery as a treatment option for patients whose cancer has metastasized to the spine and is compressing the spinal cord.

This condition is known as Metastatic Epidural Spinal Cord Compression (MESCC) and if left untreated, it can progress to cause debilitating pain, paralysis, gait instability, sensory loss, as well as bladder, bowel and sexual dysfunction.

The results of that study​ were published in the Journal of Clinical Oncology on November 23, 2015.

"This is a fragile patient population that is really suffering from extreme pain caused by the spread of cancer cells to the spine," said Dr. Fehlings, who is also director of the Spine Program at KNC and the principal investigator of the study. "Our findings support spinal decompression surgery as a treatment option, along with radiation and chemotherapy, since it offers these patients rapid, substantial and sustained pain relief that improves their overall quality of life."

Despite the long recovery and possible complications that could arise from invasive surgery, Douglas opted to undergo the operation.

On March 11, 2015, Dr. Fehlings performed an anterior procedure to Douglas' lumbar region, accessing the spinal column from the front of the torso, to remove the section of the vertebrae affected by the cancer. The section was then replaced with a piece of bone and a titanium cage, and secured to a titanium rod from the previous surgery.  A round of radiation treatment followed over the summer to treat any lingering cancer cells in the area.

Since the operation, Douglas' recovery has been slow but steady. He deals with some residual pain from surgery and more significant pain from the radiotherapy, but is able to manage it without medication and he hopes it will eventually go away.

He sleeps well at night but needs some time to get up and begin moving in the morning. Still, he has been able to get back to bike riding and taking long walks with his wife. Douglas says he has resumed a relatively normal life.

"Having the surgery was totally worth it," he says. "To hear that there was a solution to prevent that tumour from doing irreversible damage gave me immediate relief and hope. I am so grateful to have had that option."

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