Scottish referral guidelines for suspected cancer: quick reference guide

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, round chest, down front or back of thighs)
• limb weakness or difficulty in walking
• sensory loss (including perineal or saddle paraesthesia)
• bladder or bowel dysfunction

All Scottish cancer networks have developed locally agreed MSCC pathways. More information is available via the Scottish Palliative Care Guidelines website:
https://www.palliativecareguidelines.scot.nhs.uk/guidelines/palliative-emergencies/malignant-spinal-cord-compression.aspx

Malignant Spinal Cord Compression

Good Practice

• 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