Identifying patients with suspected MSCC

Clinicians who have a patient they are worried about should contact the MSCC co-ordinating service urgently, which is based at The Christie.

You can access the MSCC clinical guidance for metastatic spinal cord compression Greater Manchester Pathway [PDF, 1.37MB] for more information.

For more information on the management of spinal metastases with impending metastatic spinal cord compression (impending MSCC), please see our management guidance [PDF, 233KB].

Management and treatment of MSCC

Once a diagnosis of MSCC has been made, follow the pathway guidance on the management of MSCC patients as above.

To come to a treatment decision, the patient’s condition and likely prognosis will be taken into account when deciding the appropriate management; this may be:

Surgery

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, following discussion with the MSCC team.

Radiotherapy

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 supportive care team for pain and supportive care.

See the supportive care team webpage for more information.

Rehabilitation

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 advise 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.

Network flowcharts and pathways

Many hospitals in the Manchester Cancer area have created their own internal local pathways to help their staff navigate some of the differences between departments in each hospital.

Having these local pathways helps staff in these hospitals to efficiently manage their patients in line with local hospital procedures. Attached below are the internal pathway documents for The Christie NHS Foundation Trust:

MSCC guidelines for professionals

Education 

If you and your team require support with MSCC teaching, please Get in touch.

Resources

In collaboration with the MSCC team, GM Cancer Academy have created 3 e-learning modules covering the complete MSCC pathway. This is free at the point of access and can be found on the GM Cancer Academy website.

The video linked below was developed to help individuals with back pain to look out for signs and symptoms that may suggest the presence of something more serious. The majority of back pain is not serious but it’s important to know what to look for, so that anything more serious is not overlooked. 

Education for health professionals - 'No logo' information leaflets for organisations

We also offer MSCC patient information leaflets with no logos on for organisations to use with their own logo on. Please note: you can only use these documents on the condition that The Christie NHS Foundation Trust is acknowledged as the creator.

‘Red Flag’ alert cards

The MSCC Coordinator service and the local Acute Oncology teams in each hospital offer training sessions to staff, we also distribute ‘Red Flag’ alert cards which highlight the warning signs of MSCC.

If you and your team require support with MSCC teaching, please Get in touch.