Once a diagnosis of MSCC has been made, follow the pathway guidance on the management of MSCC patients; ensure:
- Dexamethasone (unless contraindicated) and gastric protection (PPI)
- Patient is nursed flat and log-rolled to ensure spinal stability
- Contact is made with the MSCC coordinator to make a new referral
The patient’s condition and likely prognosis will be taken into account when deciding the appropriate management; this may be:
Patients with favourable prognosis of greater than 6 months, with good performance status will be discussed with the spinal team at Salford Royal Foundation Trust. Surgery should be considered if there is spinal instability, if the patient has no previous known cancer diagnosis or if the patient has had previous radiotherapy to the level of compression.
This is the most frequent treatment delivered to patients with MSCC, it can reduce pressure on the cord through tumour shrinkage, and can achieve local tumour control at the site of treatment. This may lead to some or complete resolution of neurological symptoms and signs, or at least prevent further deterioration. It can also help to relieve spinal and radicular pain.
Systemic Anti-cancer therapy (SACT)
A small group of patients whose tumour is especially sensitive to drug therapies will receive SACT as their first definitive treatment. The decision to deliver SACT will be taken in coordination with the specialist oncology team.
- Best supportive care – patients who are not surgical candidates and / or who are not well enough to tolerate radiotherapy should be managed symptomatically and referred to the Palliative Care Team for pain and supportive care.
All patients should be referred to Physiotherapy (within 24 hours) and Occupational Therapy (within 48 hours).
The physiotherapist will assess the patient on admission and advice in conjunction with the medical team and radiologist on spinal stability and early mobilisation. Once mobilisation commences, the aim of rehabilitation is to improve quality of life, maintain or increase functional independence and facilitate discharge from hospital.