EN
TR
RU
DE
SACRAL TUMOR
Sacral Tumor (Tailbone Tumor): Diagnosis and Treatment Process
The "sacrum" (tailbone bone) is the triangular bone located at the base of the spine, wedged between the hip bones. Masses developing in this region are referred to as Sacral Tumors.
These tumors are rare, but their diagnosis and treatment processes are highly complex. Sacral tumors are categorized into two main groups:
- Primary Sacral Tumors: Tumors originating directly from the sacral bone, nerves, or cartilage (e.g., Chordoma, Giant Cell Tumor, Osteoblastoma).
- Secondary (Metastatic) Tumors: Tumors resulting from cancer spreading to the bone from another part of the body (such as breast, prostate, or lung cancer).
What Are the Symptoms?
Sacral tumors often progress insidiously. For a long time, symptoms can be mistaken for a herniated disc or mechanical back pain. The most common symptoms include:
- Night Pain: Pain in the lower back and tailbone that does not improve with rest and typically worsens at night (a "red flag" symptom).
- Difficulty Sitting: Severe pain felt in the tailbone area when sitting down.
- Neurological Findings: Numbness or loss of strength/weakness in the legs.
- Sphincter Dysfunction: Issues such as incontinence (bladder/bowel loss of control), constipation, or sexual dysfunction due to the tumor compressing the sacral nerves.
Diagnosis and Biopsy Process
The most critical step determining the fate of the treatment plan is identifying the tumor type. While MRI and CT scans show the location, a Biopsy is essential to understand the cellular pathology.
- Needle Biopsy: Usually, a closed biopsy guided by CT is preferred.
- Surgical Biopsy: Rarely, an open surgical biopsy may be required.
Important: The biopsy must be planned by the surgical team experienced in tumor surgery. The biopsy track (the path of the needle) must be placed in a way that it can be removed during the definitive surgery to prevent tumor seeding.
Treatment of Sacral Tumors
The treatment is determined by a multidisciplinary tumor board consisting of a Spine Surgeon, Oncologist, and Radiation Oncologist, based on whether the tumor is benign or malignant, its size, and its spread.
1. Surgical Treatment (Sacrectomy)
For primary bone tumors (such as Chordoma), the "Gold Standard" treatment is the removal of the tumor with clear margins (leaving no tumor cells behind), often referred to as En Bloc Resection.
- Sacrectomy: This is the surgical removal of part or all of the sacrum. It is a major and complex procedure.
- Reconstruction: When the sacrum is removed, the connection between the spine and the pelvis may be disrupted. In such cases, the spine is reconstructed using screw and rod systems (instrumentation).
- A Difficult Decision: In some aggressive tumors, to save the patient's life (survival), it may be necessary to sacrifice the nerves invaded by the tumor. This can lead to risks of permanent loss of bowel/bladder control or sexual function (neuro-deficit). These risks are discussed in detail with the patient prior to surgery.
2. Radiotherapy (Radiation Therapy)
- Used pre-operatively to shrink the tumor,
- Used post-operatively to eliminate remaining microscopic cells,
- Or used as a primary treatment for patients who are not candidates for surgery. Advanced technologies like Proton Beam Therapy or Carbon Ion Therapy are frequently preferred for this region.
3. Chemotherapy and Targeted Therapy
For chemotherapy-sensitive tumors like Osteosarcoma or Ewing Sarcoma, or in cases of metastasis, medical treatment is administered by the oncology department.
FREQUENTLY ASKED QUESTIONS
Not every tailbone pain is a tumor; most are due to trauma (coccydynia) or poor sitting posture. However, deep pain that worsens at night, does not go away with rest, and is accompanied by unexplained weight loss requires further investigation (MRI).
Chordoma is the most common primary malignant bone tumor found in the sacrum. It grows slowly but has a high risk of recurrence. The treatment involves the surgical removal of the tumor in one piece (en bloc excision).
It depends on how much the tumor involves the nerve roots. If the tumor encases the nerves, they may need to be cut to remove the cancer completely. This can lead to partial weakness in the legs or loss of bowel/bladder function.
Depending on the size of the tumor and the required reconstruction, these are lengthy surgeries often involving plastic surgery and general surgery teams, lasting anywhere from 6 to 12 hours.