Malignant Spinal Cord Compression

Urgent suspicion of cancer referral for patients with known cancer (particularly prostate, breast, lung or multiple myeloma)

People with a history of cancer and any of the following symptoms:

significant localised back pain, especially thoracic
severe, progressive pain or poor response to medication
spinal pain aggravated by straining (for example, at stool, or coughing or sneezing)
nocturnal spinal pain, especially if preventing sleep
radicular pain (for example, around chest, down front or back of thighs)
limb weakness or difficulty in walking
sensory loss (including perineal or saddle paraesthesia)
bladder or bowel dysfunction

A normal neurological examination does not preclude epidural disease or
evolving MSCC
The definitive method of investigation is MRI of the whole spine
All patients with bone metastasis, or considered by their clinician to be at high risk of developing MSCC, should be given written guidance on early symptoms with advice to contact a health care professional promptly. This information should also be sent to the GP
Written information on early symptoms should also be given to patients
following treatment for MSCC

All Scottish cancer networks have developed locally agreed MSCC pathways.