Information
Malignant Spinal Cord Compression (MSCC) can affect any patient with cancer. Early diagnosis whilst the patient is still ambulant is crucial. Rapid referral and treatment lead to better outcomes.
Most common symptoms are vertebral pain (especially radicular thoracic), new spinal nerve root pain (burning, numb, shooting), any new difficulty walking, reduced power/altered sensation in limbs and or bowel/bladder disturbance.
M.A, K.E & J.W. 12-2-26
Who to refer:
Patients with: a cancer diagnosis (strongly suspected) or are under follow up from a previous cancer with:
- severe intractable vertebral pain (especially thoracic)
- new spinal nerve root pain (burning, numb, shooting)
- new difficulty walking, reduced power/altered sensation in limbs
- bladder or bowel disturbance
Lung, Prostate, Breast Cancer and myeloma are high risk for metastatic disease.
Who not to refer:
If in doubt please do not hesitate to call the Acute Oncology team. You may be advised to refer via medical team if patient does not have confirmed cancer pathology or does not meet clinical pathway for investigation via oncology.
How to refer:
Contact the Acute Oncology team at the Edinburgh Cancer Centre on 07798774842 or 0131 537 1000 and ask to speak to Acute Oncology team for oncology.
You may be advised that assessment will be arranged for the following day in a dedicated MRI slot with primary care prescribing dexamethasone 8 or 16mg with PPI cover as first line treatment. The Acute Oncology team may speak to the patient to relay advice and where to attend etc however if not appropriate will provide you with the details to relay to the patient.
All patients on or within six weeks of treatment should be encouraged to monitor symptoms and call The Cancer Treatment Helpline (CTH; 08009177711) with any treatment-related concerns. Please note, the CTH is a call operator service provided by NHS 24, who then refer on to an acute care specialist. They cannot give specialist advice.
If the patient has been assessed by a healthcare practitioner in Primary Care, and Oncology advice/input is felt to be required, the Primary Care clinician should call the Acute Oncology team at the Edinburgh Cancer Centre (based in the WGH) and discuss directly. The Acute Oncology team can be contacted during working hours (Mon-Fri 9-5) on 07798774842; If out of hours, please discuss with the Oncology Registrar On-Call via NHS Lothian Switchboard (0131 537 1000).
If the primary care clinician requires any further guidance on the suitability of referral to Acute Oncology, they can consult Pg 10 of the The UKONS Oncology/Haematology 24 Hour Triage Toolkit.
Note if a patient has presented to primary care for assessment, the patient should NOT be advised to call the CTH themselves to pass on this information or seek further advice.
Malignant spinal cord compression | Right Decisions
Link to Acute Oncology Initial Management Guidelines: UKONS | Acute Oncology Initial Management Guidelines (sundownsolutions.co.uk)
