Metastases involving spinal cord, roots, and plexus

Neurogenic pain is common in patients with widespread metastatic cancer. Pain of this type is often severe and typically results from neoplastic invasion of the peripheral nerves, spinal roots, or spinal cord. Tumors may invade the cervical, brachial, or lumbosacral plexuses either by direct extension from contiguous structures or in association with metastases to regional soft tissues and lymph nodes. Most of these patients experience progressive pain, motor loss, and sensory dysfunction. Metastases directly to the peripheral nerves are rare in patients with solid tumors but are more frequently encountered in patients with hematologic malignancies. Metastases to the spinal roots and the spinal cord usually occur in patients who also have demonstrable evidence of leptomeningeal or intraparenchymal brain metastases. These conditions may overlap and must be distinguished from other causes of plexus, nerve, or spinal cord disorders in the patient with cancer. Early identification and appropriate treatment allow these patients to remain functional and interactive with family and friends.